Abstract:

Background: The health sector HIV and AIDS strategic plan (HSHSP) II 2008-2012 builds on the national HIV and AIDS care and treatment plan for PLHIV, which was developed in 2003, and calls for the provision of quality HIV and AIDS services at all health care facilities across the country, which itself requires the establishment and organization of effective CTCs. By the end of 2010, a total of 1100 health facilities had begun providing care and treatment services. Of those 220 are hospitals and the remaining 880 are primary health facilities (1).

Care and treatment clinic [CTC] is the care and treatment program for outpatients who have HIV/AIDS.

In order to meet the goals of the HIV and AIDS care and treatment plan, an expanded effort involving all sectors of development through CBOs, NGOs, the private sector and government structures, is required to identify clients in need of HIV care and treatment. Within the health sector, health services exist within communities for identification of people in need of care and treatment these services are: HIV testing and counselling (HTC), Home based care (HBC), PMTCT, outpatient department (OPD), In patient department (IPD), and TB clinic, HTC components include voluntary counselling and testing (VCT) at facilities, as stand-alone sites, or as part of one-time campaigns using any place of gathering, provider initiated testing and counselling (PITC) in health facilities, and home based testing and counselling (HBTC). Using all effective communication channels, including interpersonal and peer-led group education, media-led, mobile and electronic communication technologies, people in both urban and rural area need to be encouraged to come forward for testing and counselling so that those in need of care and treatment can be identified and linked to relevant as part of the continuum of care [1].

Scope of care and treatment clinic: The core elements of HIV prevention, treatment and support that need to be available within CTC services at any level include basic education about the mode of HIV transmission, about disease progression, about management of the disease, and about all elements of positive health, dignity and prevention (PHDP).

This includes the following:
1. Education about behavioral risks and condom use for infected people.
2. Orientation on care and treatment services available in hospital and district.
3. Education and regular counseling on lifelong disease management and in particular on treatment adherence
4. Education and counseling on actions that may delay progression of disease and reduce co-morbidities; for example, addressing nutrition, food safety, clean water and use of insecticide treated bed-nets.
5. Early identification and management of co-morbidities such as TB.
6. Prophylaxis for OIs and cancers including contrimoxazole, TB preventive therapy and cervical screening
7. Accessing eligibility for ART (clinical staging, social eligibility and CD4 counts).
8. Effective referrals to essential hospital services such as antenatal clinics for MTCT, family planning advice before and while on ART, STI or other specialized clinics.
9. Recording and reporting according to the established electronic and paper based system.
10. Registration and appointment systems for effective treatment continuation and preventing missed appointments.
11. Referral to community services such as HBC, social welfare and legal support.
12. In order to provide effective and quality HIV and AIDS care and treatment, service delivery needs to be organized in a manner to ensure efficiency, user friendliness, and regular, standardized follow up. Quality improvement (QI) initiatives are a helpful tool in this regard.

Objectives of CTC field attachment at Misungwi hospital: The objectives of this field attachment at ‘Care and treatment clinic’ was to learn and participate fully on HIV/AIDS outpatients management as the best foundation on my career as a future doctor. This field attachment was also a part of academic completion of semester 8 as a student of doctor of medicine and this field attachment report will be used by the CUHAS-Bugando as among the criteria to certify me as a medical doctor.

Upon completion of my field attachment, I had to gain more knowledge and understanding:
HIV counseling and testing
• Pretest counseling
• HIV testing
• Posttest counseling

HIV/AIDS management
• HIV/AIDS staging
• Opportunistic infections and management of each infection
• ARTs related side effects
• Factors cause ARTs non-adherence

Pharmacy
• Dispensing ART drugs
• Condition necessary for ARTs storage.