Initiation of Antiretroviral Therapy (ART) for Inpatients

Criteria for ART initiation for inpatients at Groote Schuur Hospital 
Who should be referred to ID for inpatient initiation of ART?
If not for inpatient ART, refer patients to the ART clinic 
GSH Infectious Diseases Clinic
Counselling

Criteria for ART initiation for inpatients at Groote Schuur Hospital 

• CD4 count <350 cells/mm³
• WHO clinical stage 4 (irrespective of CD4 count)
• MDR/XDR TB (irrespective of CD4 count)

Who should be referred to ID for inpatient initiation of ART?

• Severe immunodeficiency (CD4<100 cells/mm³) in whom a protracted stay in hospital is anticipated (ie. >1-2 weeks)
• HIV-driven illnesses: e.g. TTP, ITP
• Patients with untreatable Ois such as cryptosporidiosis
• Patients with AIDS-defining or non-AIDS-related malignancies
• Pregnant women in 2^nd or 3^rd trimester with CD4 count <350 cells/mm³

If not for inpatient ART, refer patients to the ART clinic closest to their home

(see attached list).  In your referral, include:

• Details of admission (include contact person on admitting team for any queries)
• Pre-ART workup results: CD4 count, FBC & differential, creatinine, ALT, HepBsAg.
• GSH follow-up plans  (outpatient appointments or booked investigations)
• If TB diagnosed, complete TB referral forms (include details on method of dx, specimen numbers, DST, date Rx started)

GSH Infectious Diseases Clinic

• GSH ID Clinic is a tertiary level clinic and is not funded for routine primary care. Its function is to support management of sick, complex HIV-infected and non-HIV-infected patients, that cannot be managed at primary or secondary level clinics.
• All patients referred to the GSH ID Clinic must be discussed with a member of the ID team prior to referral. Those sent without first having been discussed with the ID Clinic, will not be seen.
• Once confirmed that the clinic referral is appropriate, contact the ID Clinic clerk, Ms Janine Vermeulen, at 5328 (Mon, Wed, Thur, Fri) or 5329 (Tues).
• Consider referral of pregnant women to the GSH Antenatal HIV Clinic at the Maternity Block on a Tuesday.
• On discharge, ensure patient has enough ART to last until their clinic appointment.
• Patients with TB must be referred to their closest TB clinic, even if they are to attend the GSH ID clinic.

Counselling

• Pre- and post-test counselling should be done by the ward social worker or doctor caring for the patient.
• Contact a member of the ID team if you require adherence counselling for your patient.