ABCDE Assessment of an Elevated Viral Load
ABCDE Assessment Mental Health Disorders Remember, an elevated VL in a pregnant or breastfeeding mother is a MEDICAL EMERGENCY! Every week she continues with an elevated VL increases her risk for vertical transmission! A thorough assessment is essential for any client with a viral load measuring ≥ 50 c/mL Adherence Is adherence to medication poor? Ask about factors that may in
Remember, an elevated VL in a pregnant or breastfeeding mother is a MEDICAL EMERGENCY! Every week she continues with an elevated VL increases her risk for vertical transmission!
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A thorough assessment is essential for any client with a viral load measuring ≥ 50 c/mL |
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 Adherence |
Is adherence to medication poor? Ask about factors that may influence adherence e.g. - Medication side-effects, - Mental health disorders (see mental health screen below), - Alcohol or substance abuse, - Poor social support or - Non-disclosure. Pregnant women may experience nausea, heartburn, and constipation. Assess the need for symptomatic treatment with an anti-emetic, anti-diarrhea agent, or fibre supplement. |
Tips Ask open ended questions e.g. “What makes it difficult for you to take your treatment?”, and “How many doses have you missed this week?” Be non-judgemental. Statements like “we all miss a dose now and then” can encourage a client to be more open. |
 Bugs (Infections) |
Check for symptoms and signs of infection. Do a TB and STI screen. |
Remember that immune compromised and pregnant clients may not exhibit overt symptoms of TB. If in doubt, do a TB GXP. |
 Correct Dose |
Is the client on the correct dose for her weight? This is especially applicable to young or malnourished girls who may have recently gained weight, or clients with previous renal impairment. | |
 Drug Interactions |
Are there any potential drug interactions? Consider: - Other prescribed treatment e.g. rifampicin, anti-epilepsy drugs - Over the counter treatment e.g. antacids - Supplements and herbal/traditional medications e.g. St John’s wort |
If in any doubt, call the HIV Hotline 0800 212 506 |
 RE-sistance |
Consider HIV drug resistance if other causes of virological failure have been excluded and the client is adherent to their medication. | Refer to the algorithm for “Management of confirmed virological failure” in the 2023 ART Clinical Guideline |
MENTAL HEALTH DISORDERS
Pregnancy, childbirth and the first year after birth are often stressful times for women. Mental health conditions affect a person’s feelings, thoughts, behaviours, and functioning. Women with mental disorders may struggle to use health and social services that are available and may struggle to bond with and parent their children.
Mental Health Screen
| When to screen | Screen at booking visit in antenatal care, once during each trimester, and once during the postnatal period (from 6 weeks to 3 months). Thereafter, screen at regular intervals for up to one year. |
| How to screen | Ask the following 3 screening questions, using a gentle and kind attitude: |
| In the last 2 weeks, have you felt unable to stop worrying or thinking too much? (Yes = 1 point; No = 0) | |
| In the last 2 weeks, have you felt down, depressed, or hopeless? (Yes = 1 point; No = 0) | |
| In the last 2 weeks, have you had thoughts and plans to harm yourself or commit suicide? (Yes = 1 point; No = 0) | |
| When to refer | If the Total score across the 3 questions = 2 or 3 points, refer If a patient answers ‘yes’ to the self-harm question, refer urgently for a mental health assessment with a medical officer or mental health professional |
| Additional Resources: | Maternity Care Guidelines; Primary Healthcare and Adult Hospital Standard Treatment Guidelines (STGs); Adult Primary Care (APC); FAMSA 0119757106/7; Lifeline 0861 322 322 |
South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023