Introduction

“HIV/AIDS since the beginning of epidemic almost 78 million people have been infected with HIV virus and about 39 million people have died of HIV globally and 35.3 million [33.2 – 37.2 million] people were living with HIV at the end of 2013. An estimated 0.8% of adult aged 15-49 years worldwide are living with HIV, although the burden of the epidemic continue to vary considerably between countries and regions. Sub-Saharan African remains most severely affected with nearly 1 in every 20 adults living with HIV and accounting for 71% of the people living with HIV worldwide.” [1]

In Tanzania mainland experience a mature generalized HIV epidemic while in Zanzibar the epidemic remain largely concentrated, data has shown that in December 2013, 1,411,829 people were living with HIV and AIDS in the country.

The HIV epidemic in Tanzania is predominantly heterosexually transmitted with 80% of infections attributable to heterosexual transmission, mother to child transmission (MTCT) accounts for 18% while blood borne accounts for 1.8% of infections. Currently in Tanzania the prevalence has decreased significantly from an overall prevalence of 7.0% in 2003/2004 to 5.1% in 2011/2012 but is still high with women mostly affected especially of age group 23 to 24 also reports from TACAIDS show that about 2% of people from age of 15 to 24 are also affected [2].

In Kilimanjaro region the HIV and AIDS prevalence has decreased from 7.3% in 2005 to 1.9% in 2010 [3]. Machame Lutheran hospital is located at Hai district in Kilimanjaro region in 2003 Machame Lutheran hospital HIV/AIDS program was initiated, it initiated, it include care and treatment center (CTC), provider initiated testing and counseling (PITC), voluntary counseling and testing (VCT) prevention of mother to child transmission (PMTCT) and community counseling and testing outreaches are done at the open air places or at market. Under these categories some of the services offered include, registration of new clients and taking of base line investigations, staging of clients by using World Health Organization criteria, monitoring of clients health by taking body weight and CD4 counts, treatment and prevention of opportunistic infection, preparatory adherence counseling for clients eligible to start ARVs, supportive counseling, nutrition and infection prevention education, pre-test counseling, testing and post-test counseling [4].

The main goal of Machame CTC is to strengthening provision of quality ART services, to increase access to HIV counseling and testing to health care seeking, TB patients, pregnant women and spouses and for general population, to improve quality of life for people living with HIV by providing integrated and high quality services through trained health care workers and community volunteers. This is achieved through registration of new clients, taking of the base line investigations for the new clients, clinical staging by using World Health Organization criteria, monitoring of clients health by taking body weight and CD4 counts, treatment and prevention of opportunistic infections, preparatory adherence counseling for clients eligible to start ARVs, supportive counseling, nutrition and infection prevention education, pre-test counseling, testing and post-test counseling. Also Machame CTC is a referral clinic which receives different cases from other peripheral CTCs for further management including investigations, common cases frequently referred include complication opportunistic infections, severe side effects from ARVs and second line ARVs treatment failure.

Objectives: During field attachment, I spent one month at Machame CTC to achieve the following objectives:
To learn on how counseling (pre and post testing) and testing is performed.
To learn on preparatory adherence counseling for clients eligible to start ARVs.
To learn on common opportunistic infection in HIV/AIDS patients and how are they managed.
To identify common ARVs side effects patient present with and their management.
I spent the first two weeks in learning and practicing counseling and HIV testing, preparatory adherence counseling for HIV clients who meet WHO criteria for eligibility to start ARVs, and remaining two weeks I was involved in the management of HIV/AIDS clients.