CURRICULUM
CURRICULUM
FELLOWSHIP PROGRAM
in HIV MEDICINE FOR
MEDICAL PROFESSIONALS
2012-2013
CONTENTS
1) INTRODUCTION…………………………………………………………………04
2) TITLE OF THE COURSE…………………………………………………………06
3) GOALS……………………………………………………………………………...06
4) OBJECTIVES………………………………………………………………………07
5) EDUCATIONAL APPROACH…………………..………………………………..08
6) RECOGNITION OF THE INSTITUTION FOR THE COURSE………….……..09
7) REGISTRATION COMMITTEE…………………………………...………….…..10
8) INTAKE OF STUDENTS…………………………………………………...….….10
9) ELIGIBILITY FOR ADMISSION…………………………………...………….......11
10) OBTAINING ELIGIBILITY CERTIFICATE BY THE UNIVERSITY……….….11
11) SELECTION/ ADMISSION PROCEDURE………………………….….…….….12
12) DURATION OF THE COURSE………………………………………………........12
13) ATTENDANCE, PROGRESS AND CONDUCT………………………….….……12
14) FEE……………………………………………………………………………..……13
15) MONITORING PROGRESS OF STUDIES……………………………….…...…....13
16) TEACHING HOURS ANDPOSTINGS…………………..……………….………...14
17) MEDIUM OF INSTRUCTION…………………………………………….………..15
18) SCHEME OF EXAMINATION………………………………………............……...15
19) CERTIFICATION…………………………………………………………………...18
20) STIPEND……………………………………………………………….…………....18
21) COURSE CURRICULUM……………………………………………….………..….20
22) TRAINING SKILLS……………………………………………….………..……..…31
23) SCHEME OF PRACTICAL LEARNING………………………….…………….......31
24) METHODS OF LEARNING…………………………………………….………....32
25) RESEARCH AND EPIDEMIOLOGY……………………………………………..32
26) MANAGEMENT……………………………………………………….…………..34
27) LEARNING RESOURCE MATERIAL…………………..………………………..35
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
INTRODUCTION:
Rajiv Gandhi University of Health Sciences, Karnataka was established in 1996 in Bangalore by the government of Karnataka, India for the regulation and promotion of higher education in health sciences throughout the state. It currently affiliates all training institutions for courses of medicine, nursing, dentistry, pharmacy and allied health fields in Karnataka. There are a total of 662 colleges affiliated to the University. RGUHS is active in the field of HIV for more than a decade now.
As a public health response to the growing epidemic of HIV and AIDS in the state, the University is keen on initiating a number of new activities. The various activities is guided by the following principles.
– HIV/AIDS is a Developmental Issue needing an Integrated and Inclusive approach.
– Develop Innovative Institutional model and programmatic approach to effectively address the growing HIV epidemic.
– Need to update the curricula and the course content of HIV/AIDS in Medical Nursing and other allied courses.
– Develop modules and implement training in HIV/AIDS for dental, nursing Physiotherapy, Pharmacy and other allied courses.
– Support research to understand opportunist infections relevant to our country, co-infection, reasons for treatment failure, barriers of treatment and compliance.
– Develop distance learning, virtual classroom and satellite communication scheme in HIV/AIDS to update faculty members and practicing physicians.
– Compliment and Catalyze Government initiatives and National programmes.
– Network and Build Linkages with Other credible organizations' working in HIV/AIDS sector for mutual sharing and learning.
The growing epidemic of HIV/AIDS has necessitated a change in our understanding of health issues in the community and approach of our Health care delivery. The increased number of people affected by the HIV epidemic has threatened the effectiveness of the health care delivery system. In addition, the stigma and discrimination associated with the disease have complicated matters often resulting in denial of even the basic health services to HIV patients that are otherwise available to the general public.
National AIDS Control Organisation has been continually increasing the number of Community Care Centres and Anti Retroviral Treatment Centres to meet the growing demand for HIV care, treatment and support services. Karnataka State is now on the verge of having nearly 40 Community Care Centres and 30 Antiretroviral Treatment Centres. The state has planned to cater to Anti Retroviral treatment needs of the people at primary Health Centre level in a phased manner.
The transformational changes seen in the National and State program has led to emergence of new challenges to be addressed. The increase in the number of care and treatment centres has resulted in a felt need for committed and competent physicians to manage the centers. However, for most practicing doctors today, HIV Medicine was not a part of the curriculum at the time of their training. Also, the steady progress in knowledge and practice in this field necessitates constant updating. Currently, there are limited opportunities for physicians to hone their knowledge and skills. The state of Karnataka is facing an shortage of qualified and trained human resources to manage these ART and community care centres. This shortage is particularly felt among doctors.
To address these deficiencies the University has taken the initiative to start a 12 month residential course in HIV Fellowship in at least two institutions in the state with a maximum of 10 participants from July 1st 2009 onwards.
I. TITLE OF THE COURSE: Fellow in HIV Medicine.
II. GOALS:
A) The programme envisaged is to provide opportunity for hands on training for acquiring high proficiency in integrated approach in HIV management for candidates who would be placed in institutions accredited for that purpose by the University.
B) To improve the quality of HIV care support and treatment, in Karnataka and India through focused building of capacities of medical professionals.
C) To promote integrated model of care for PLHIVs amongst these medical professionals there by reducing stigma and discrimination in health care settings.
D) To facilitate creation of a network of Institutions and Individuals of academic excellence to constantly upgrade of health and HIV care.
E) To make available a trained pool of doctors as leaders to be placed within Government & Non Governmental sector.
a) Who shall recognize the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy.
b) Who shall have mastered most of the competencies, pertaining to the speciality, that are required to be practiced at the primary, secondary and the tertiary levels of the health care delivery system.
c) Who shall aware of the contemporary advances and developments in the discipline concerned.
d) Who shall have acquired a spirit of scientific inquiry and is oriented to the principels of research methodology and epidemiology; and
e) Who shall have acquired the basic skills in teaching, leadership qualities and commitment to the service of PLHIV.
III. OBJECTIVES: After the completion of the training the student shall be able to
A) Recognise the importance of HIV/AIDS in the context of the health need of the community and the national priorities in the health sector and acquire the knowledge and the skills needed.
B) Practise the speciality, ethically and in step with the principles of primary health care and adopt integrated module of HIV care services. Diagnose and manage the conditions on the basis of clinical assessment; and appropriately select and conduct investigations.
C) Identify social, economic, environment, biological and emotional determinates of health in a HIV/AIDS patients, and take them into account while planning therapeutic, rehabilitative, preventive and promotive measures/strategies.
D) Plan and advise measures for the prevention and rehabilitation of patients suffering from disease and disability. Demonstrate sufficient understanding of the basic sciences and related diseases relevant to the speciality.
E) Demonstrate skill in documentation of individual case details as well as morbidity and mortality data relevant to the assigned situation. Function as an effective leader of a health team engaged in health care, research and training.
F) Demonstrate empathy and humane approach towards patients and their families and exhibit interpersonal behavior in accordance with societal norms and expectations.
G) Play the assigned role in the implementation of national health programmes, effectively and responsibly. Organize and supervise the health care services, demonstrating adequate managerial skills in the clinic/hospital or the field situation.
H) Develop skills as a self-directed learner, recognise continuing educational needs; select and use appropriate learning resources. Demonstrate competence in basic concepts of research methodology and epidemiology, and be able to critically analyse relevant published research literature.
IV. EDUCATIONAL APPROACH:
The HIV Fellowship program shall be a 12 month, full time, hands on, residential training program for doctors. The trainees will have the graded responsibilities in the management and treatment of patients entrusted to his/her care. The participation of the fellows in all facets of care is essential. Every fellow should take part in seminars, group discussions, rounds, case demonstration, clinics, journal meetings, CPC and Clinical meetings. Training includes involvement in laboratory and research studies. The participants shall learn the management of HIV patients in institutional settings and HIV issues in the community. They shall undergo training in ART/VCTC/PPTCT/RNTCP/STI centres. Accomplished National and International faculty residing in India and abroad would facilitate learning. The course focuses on equipping the ‘fellows’ to appreciate and adopt an integrated approach to health and HIV management. The highlights of the training includes
o Hands on clinical care experience under the guidance of experts in the HIV field.
o Structured problem based exercises to stimulate specific case examples.
o Sessions include management, Leadership, Epidemiology, Infection control, Public Health Systems, Psychosocial and behavior Issues.
o Audio visual material and/or printed handouts to supplement reading and classroom instruction.
o Exposure and experiential visits to various HIV program implementation sites of both Government and Non Government sectors at the primary and secondary levels of health care.
o Use of Internet/Medline and other teaching AIDS.
o Video conferencing with National and International faculty.
Course participants would be managing outpatients and inpatients in a HIV care facility having an integrated and inclusive model of care. The Fellowship program focuses on building knowledge, clinical skills, research and communication techniques and right attitude. The training programme prepares the physician to be a leader in HIV Care, support, training and management.
RECOGNITION OF THE INSTITUTION FOR THE COURSE:
• An institution desirous of starting the programme should have been in existence as a centre and engaged in implementation of AIDS control Program for at least 5 years.
• An institution starting the Fellow in HIV program should have in-house faculties listed below
|Particulars |Criteria |
|Teaching Staff |Minimum of 3 qualified teachers or Consultants, of which one teacher appointed shall be full time. Other 2|
| |may be part time visiting consultants and these two should not be faculty for the Fellowship Programme in |
| |any other institution |
| |Post Graduate degree in Clinical specialties or Para Clinical like Pathology/Microbiology/Community |
| |medicine or Public Health (Post MBBS) |
| |Professional experience of 5 years after post graduation or 3 years of teaching experience after Post |
| |graduation |
|Hospital |Should have 50 beds with 20 beds dedicated for HIV positive patients’ care |
| |The clinical load shall be not less than 50 inpatients per month and not less than 50 outpatients per |
| |month |
| |Should be providing at least the following 5 specialty services either full time or on visiting viz, |
| |Medicine, Obstetrics and Gynecology, Microbiology or Pathology, Pediatrics, Dermatology. Out of these at |
| |least 2 should be full time. |
| |Should have a functioning Integrated Counseling and Testing Centre |
| |Should be implementing Prevention of Parent to Child Transmission of HIV program including institutional |
| |delivery care |
| |Should have a functioning Anti retroviral Treatment (ART) Centre or Link ART centre |
| |Should be offering Services for Sexually Transmitted Infections |
| |Should be implementing Revised National Tuberculosis Program |
| |Should have laboratory facilities for diagnosing Opportunistic infections and monitoring treatment |
| |Should have functioning Blood Bank or Blood Storage Centre |
| |Should be undertaking community extension program in HIV sector |
| |Should be undertaking Research activities in HIV sector |
| |Should have established practices of waste management systems and standard precautions in the hospital for|
| |all patients irrespective of their HIV status |
The academic training programme should be held in the institution itself. Only institutions fulfilling all the requirements shall be allowed to conduct the programme and no relaxation in the requirements will be made.
The Rajiv Gandhi University will arrange for inspection of the institution/department by a duly constituted registration committee for validation of the facilities, staff etc and will accord recognition based on the recommendation.
The applications received only on or before 31st March each year will be processed.
REGISTRATION COMMITTEE:
The Registration Committee will have members as follows.
1. One Syndicate member of RGUHS nominated by the Vice Chancellor, Chairman of the Committee.
2. One or more subject specialist nominated by the Vice Chancellor.
V. INTAKE OF STUDENTS:
The ratio of the number of candidates per bed related to the Speciality shall be 1:5. The intake for each programme shall be not more than 10 in an accredited institution. The number of candidates shall be decided by the Registration Committee in consultation with the Head of the Department and Head of the Institution.
VI. ELIGIBILITY FOR ADMISSION:
• Candidates with MBBS, BDS degree or its equivalent recognized by the Medical Council of India/Dental Council of India and completed one year compulsory rotating internship in a teaching institution or other institution recognized by the Medical Council of India/Dental Council of India, and has obtained permanent registration of any State Medical/Dental Council shall be eligible for admission.
• Candidates sponsored by an institution or Government shall be given preference
VII. OBTAINING ELIGIBILITY CERTIFICATE BY THE UNIVERSITY BEFORE MAKING ADMISSION:
No candidate shall be admitted for the course unless the candidate has obtained and produced the eligibility certificate issued by the university. The candidate has to make an application to the university with the following documents along with the prescribed fee:
1) MBBS Pass / degree Certificate issued by the university.
2) Marks card of all the university examinations passed MBBS Course.
3) Attempt Certificate issued by the Principal.
4) Certificate regarding the recognition of the medical college by the Medical Council of India.
5) Completion of Internship certificate.
6) Incase internship was done in a non-teaching hospital, certificate from the medical council of India that the hospital has been recognised for internship.
7) Registration by any state medical council.
Candidates should obtain the Eligibility Certificate before the last date for admission as notified by the University.
A candidate who has been admitted to fellowship should register his/her name in the University within a month of admission.
VIII. SELECTION/ ADMISSION PROCEDURE
• The candidates will be selected on the basis of merit and aptitude
• A selection committee appointed by Rajiv Gandhi University of Health Sciences, Karnataka with members drawn from multiple stakeholders would finalize the list of selected candidates based on predetermined objective criteria.
• The Committee shall include Head of Institution conducting the programme, Head of the Department or Coordinator of the Programme, One subject specialist from another institution, a representative of the Rajiv Gandhi University of Health Sciences nominated by the Vice Chancellor, One representative of Karnataka State AIDS Prevention Society nominated by the Project Director. The Chairman and Convener of the Committee would be designated by the University while constituting the committee.
DURATION OF THE COURSE:
The course of study shall be for a period of 12 months.
IX. ATTENDANCE, PROGRESS AND CONDUCT:
a) A candidate persuing Fellowship should work in the institution for the full period as a full time student. No candidate is permitted to run a clinic / laboratory / nursing home during the course.
b) Every candidate is required to attend a minimum of 80% of the training during academic year of the Fellowship course. Each month shall be taken as a unit for the purpose of calculating attendance.
c) Every student shall attend symposia, seminars, conferences, journal review meetings, grand rounds, CPC, case presentation, clinics and lectures during each month as prescribed by the institution and not absent himself/herself from work without valid reasons.
d) Leave of absence with permission of the Head of the Department up to a maximum of 12 days in a year is permitted
e) Any student who fails to complete the course in the manner stated above shall not be permitted to appear for the University examination.
X. FEE:
A Registration fee per candidate of Rs.10,000 shall be paid by the candidate or the sponsoring institution to the University. No capitation fee or donation shall be taken by the institution
A tuition fee of Rs. 20,000/- shall be paid by selected candidate to the affiliated Institution where the candidate posted and notified to the university well in advance. It shall be fully utilized by the Institution for the management and upkeep of said Institution with all facilities and good infrastructure thus maintaining quality and excellence in higher education.
XI. MONITORING PROGRESS OF STUDIES:
a) Work diary/Log Book:- Every candidate shall maintain a work diary and record his/her participation in the training programmes conducted by the centre such as journal reviews, seminars etc. Special mentioned may be made by the presentations by the candidate as well as details of clinical or laboratory procedures, if any, conducted by the candidate. The work diary shall we scrutinized and certified by the Head of the course and Head of the Institution, and presented in the university practical/clinical examination.
b) Periodic tests:- Minimum of three tests to be held at the interval of three months before the final examination to be conducted at the end of 12 months. The test may include written papers, practicals / clinical and viva voce. Records and marks obtained in such tests will be maintained by the Head of the course and sent to the university, when called for.
c) Records:- Records and marks obtained in tests will be maintained by the Head of the course and will be made available to the university.
TEACHING HOURS and POSTINGS for academic duration of 12 Months
|Method |
|Theory |250 hours | |
|Clinicals |400 hours | |
|Journal Club/Seminars |128 hours including 24 presentations by each fellow | |
|Counseling |60 hours | |
|Research Work |60 hours | |
|Field Visit | 60 hours | |
The candidate has to be posted to the following departments/sectors in order to be eligible for appearing in the University Examination.
a. Community Care Centre for People living with HIV – 2 months
b. Antiretroviral Treatment Centre – 2months
c. Unit implementing Revised National Tuberculosis Control Programme – 7 days.
d. Outreach programme with focus on Diagnosis and Treatment of Reproductive Tract and Sexually Transmitted Infections – 15 days
e. Unit implementing programme on PMTCT of HIV – 7 days
f. Unit implementing programme on Targeted intruventions – 7 days
g. Laboratory and Blood Bank – 15 days
h. Counseling Department – 15 days
XII. MEDIUM OF INSTRUCTION:
The Medium of Instruction shall be English.
SCHEME OF EXAMINATION:
a) Internal assessment ( 100 marks)
• Monthly objective/Problem based Tests – aggregate of 2 best performances in tests each valued at 15 marks (total 30 marks)
• Monthly bedside Clinical Case discussions - aggregate of 2 best performances in case discussions each valued at 15 marks (total 30 marks)
• Log book of activities (10 marks)
• Fellow led Seminars and teaching sessions (30 marks)
A student should score at least 50% of the total marks fixed for internal assessment in order to be eligible for the University examination. Proper record of the work should be maintained which will be the basis of all candidates’ internal assessment and the same should be available for scrutiny by appropriate authorities. The internal assessment marks of the candidates shall be sent to the University at least one week prior to the commencement of the University examination.
b) University Examination
Eligibility For Examination
To be eligible to appear for University examination a candidate:
• Shall have undergone satisfactorily the approved course of study in the approved institutions for the prescribed duration
• Shall have attended at least 80% of the total number of classes in Theory, practical, Clinical, seminars and other curricular activities jointly
• Shall secure at least 50% of the total marks fixed for internal assessment in both Theory and Practicals
• Shall fulfill any other requirement that may be prescribed by the University from time to time
Examination components and distribution of marks
| |Particulars |Marks |
|A |THEORY | |
|1 |Theory – 2 papers |50x2=100 |
|2 |Internal Assessment (Theory) |30 |
|3 |Structured Viva Voce |25 |
|4 |PROJECT WORK – Presentation cum Viva Voce |25 |
| |Total Theory |180 |
|B |PRACTICAL/CLINICAL | |
|1 |Clinical Examination ( 1 long case for 40 marks, 2 short cases for 25 marks each and 10 marks for spotters) |100 |
|2 |Internal Assessment (Practical)– including Log book, Fellow led seminars, teaching sessions and Clinical Case |70 |
| |discussions | |
| |Total Practical/Clinical |170 |
| |GRAND TOTAL |350 |
Types, number of questions and distribution of marks for EACH of the written papers. All questions should preferably be problem based.
|Type of questions |Number of questions |Marks for each question |Total marks |
|Objective type |10 |1 |10 |
|Short answer |05 |2 |10 |
|Short Essay type |03 |5 |15 |
|Essay type |01 |15 |15 |
|TOTAL MARKS |50 |
• Each paper shall be for a duration of 2 hours and recent advances may be asked in or all of the papers
• Registrar(Evaluation) shall recommend the names of the paper setters to the Hon’ble Vice Chancellor from the panel suggested by the Head of the Institution in consultation with the Programme Coordinator.
• The Written assessment shall be conducted at the place and on the dates notified by the Registrar (Evaluation) RGUHS
• The papers shall be valued by the examiners appointed for practical assessment who also will be notified by the Registrar (Evaluation)
Examiners:
• There shall be one Internal Examiner generally the Programme Coordinator and an external examiner appointed by the RGUHS. The appointment of the external examiner is by invitation based on a panel of three names given by the Programme Coordinator. The external examiner shall be paid TA and DA by the University as per RGUHS rules.
CRITERIA FOR PASS
For declaration of ‘PASS’ in the Programme in the University examination, a candidate shall pass both in Theory and Practical/Clinical Examinations components separately as stipulated below
For a pass in the Theory, a candidate shall secure not less than 50% in aggregate i.e., marks obtained in University written examination, Structured Viva Voce, Project work presentation cum viva-voce and internal assessment (theory).
For a pass in Practical/Clinical examination, a candidate shall secure not less than 50% in aggregate, i.e., marks obtained in University Practical/Clinical Examination and internal assessment (practical) added together.
A candidate not securing 50% marks in aggregate in Theory or Practical/Clinical examination shall be declared to have ‘Failed’ and is required to appear for both Theory and Practical/Clinical examination again in the subsequent examination period.
DECLARATION Of CLASS
a. A candidate having appeared in the examination and passed the examination in first attempt and securing 75% of marks or more of grand total marks shall be declared to have passed the examination with Distinction
b. A candidate having appeared in the examination and passed the examination in first attempt and securing 65% of marks or more but less than 75% of grand total marks shall be declared to have passed the examination in First Class
c. A candidate having appeared in the examination and passed the examination in first attempt and securing 50% of marks or more but less than 65% of grand total marks shall be declared to have passed the examination in Second Class
d. A candidate passing the examination in more than one attempt shall be placed in Pass Class (Please note fraction of marks should not be rounded off for classes a, b, c)
NUMBER OF CHANCES:
Candidates who have satisfactorily completed the duration of the course and also have minimum of 50% of marks in Internal Assessment but have not appeared for the University Examination or have failed in the first attempt of the University examination are eligible to appear for the University examination as and when the University announces the examination for a maximum of FIVE attempts. There would be no scope for improvement of Internal Assessment marks.
PROJECT WORK:
Every candidate persuing fellowship course is required to carry out work on a selected research project under the guidance of institution teacher. The result of such work shall be submitted at the time of University clinical examination.
The research project is aimed to train fellow student in research methods and techniques. It includes identification of a problem, formulation of a hypothesis, search and review of literature, getting acquainted with recent advances, designing of a research study, collection of data, critical analysis, comparison of results and drawing conclusions.
SCHEDULE OF EXAMINATION:
At the end of the fellowship course, the final exam to be conducted with two external examiners nominated by the University and two internal examiners of the centre.
XIII. CERTIFICATION:
Based on the recommendations made by the Examiners successful candidates shall be awarded the ‘Fellow’ scroll by Rajiv Gandhi University of Health Sciences.
XIV. STIPEND:
The institution shall pay stipend equivalent to that of a resident.
XXI. FELLOWSHIP COURSE CURRICULUM
CONTENTS
1) HEALTH AND DISEASE……………………………………………….………20
2) EPIDEMIOLOGY AND BIOSTATISTICS……………………………….……..20
3) NATIONAL HEALTH PROGRAMS……………………………………...…….20
4) HEALTH AND MANAGEMENT…………………………………………….….20
5) CLINICAL COMPONENT INCLUDING INFECTION CONTROL…………..21
6) LABORATORY COMPONENTS……………………………………..…………..26
7) SAFE BLOOD BANKING…………………………………………….………….26
8) HIV & NUTRITION………………………………………………………...…….26
9) SELF CARE, HOME BASED CARE AND PALLIATIVE CARE……………….26
10) SOCIAL, LEGAL AND ETHICAL ISSUES RELATED TO HIV……………….27
11) LEADERSHIP IN HIV PROGRAMS………...…………………………………...27
12) HIV AND WOMEN…………………………...………………………….…….....27
13) HIV AND CHILDREN……………………..…………………………….……....27
14) HIV & SURGERY……………………………….……………………….………28
15) BEHAVIORAL AND SOCIAL SCIENCES CURRICULUM…………….……..28
16) PSYCHOLOGICAL AND BEHAVIORAL ISSUES RELATED TO HIV……...29
17) PUBLIC HEALTH CURRICULUM……………..…………………………..…..29
XV. FELLOWSHIP COURSE CURRICULUM:
Fellowship curriculum: total 300 days of 303 accounted (365-52 Sundays-10 holidays olh = 303 days)
I. Health and Disease:
(2 days.)
a) Definition of Health, Dimensions of Health, Determinants of Health, Health status measurement
b) Disease definition; Impact of Chronic Disease on Individual, Family, Community and Country
c) Chronic Care
d) Principles and Components of Chronic Care
e) Approaches –
Institutional – team approach, 5 A principles
Community – Understand dynamics, participation, conflict resolution, Resource mobilization
II. Epidemiology and Biostatistics
(2 days.)
a) Epidemiology – Definitions, Scope, Methods
b) Basic Statistics – Measures of Central Tendency, Measures of Dispersion
c) Research Methods
d) Sampling
e) Interpretation of data/Literature Review
III. National Health Programs
(2 days.)
a) Epidemiology of HIV – History, Global, National, State and Local scenario
b) Determinants of HIV
c) National HIV programs – NACP – III linkages and coordination
d) National TB program – RNTCP, HIV-TB
e) National Rural Health Mission – Health systems
IV. Health and Management
(2 days.)
a) Principles of Leadership and Management
b) Basics of Management – Managing Self, Managing Human Resources, Material resource Management, Financial Management and Time Management, Management Information System
c) Training and presentation skills
d) Leadership in HIV programs
V. Clinical component including infection control:
(96 days.)
1. Crash course on Opportunistic infections: (During the first month of the fellowship program)- 9 days, 12 sessions, each 1.5 to 2.0 hours (total 19 hours).
2. Add in one hour bedside sessions on examinations of the organ systems to correspond appropriately
a. Introduction to HIV: testing, CD4 count, staging and progression- 1.0 hours
b. Overview of management of the newly diagnosed HIV + patient including common OIs and their prevention, partner protection (1.5 hrs)
c. Introduction to ART (NACO guidelines, ART combinations, common side effects and adherence)- 2 hours and
d. Post exposure Prophylaxis (PEP) –1.0 hour
Clinical management of common medical problems. (e-j)
e. Approach to the HIV+ patient with fever 2 hrs
f. Approach to the HIV+ patient with cough/respiratory symptoms – 1.5 hours
g. Approach to the HIV+ patient with diarrhea -2 hours
h. Approach to the HIV+ patient with headache and fever- 1.5 hours
i. Approach to the HIV+ patient with skin rash or genital ulcer- 1.5 hours
j. Tuberculosis and HIV coinfection 1.5 hours
k. Managing emergencies in HIV patients - 2 hours
Tools for taking care of ward and clinic patients
l. Writing a SOAP note/medical record keeping in the wards (1.0 hour)
m. Using the information system for patient care (1.5 hour)
n. Bedside sessions on the history taking and the systemic exam (CNS, respiratory, cardiac, abdomen, skin, pelvic exam) to be conducted between 12-1 to supplement the corresponding afternoon sessions.
3. Management of the Newly Diagnosed Patient & Patient education: (5 days)
a. What do you tell the patient on the first visit (what is HIV? What does it do? How long do I have to live? What is a CD4 count? What baseline labs do you get and what preventative measures do you do? (one full session of 3 hours)
b. Staging Exercise (to break the Fellows into groups and assign them cases to stage with WHO staging. They can then go to the computer room and look up the CDC staging and WHO staging and then apply it to the cases. 3 hour, computer room & bedside with worksheet)
c. Baseline psychosocial evaluation;( 3 hour session: 1 hr classroom, 2 hr bedside)
• Quality of life assessments
• Screening for depression
d. Nutrition counseling, Safe water, safe food (one full session of 3 hours)
e. Hygiene , Partner counseling, Notification and Co-factors of transmission(one full session of 3 hours)
f. Transmission and prevention of HIV Infection.(one day)
4. Basic sciences and pathogenesis: (two days)
a. HIV virology (HIV Structure & Viral proteins and their Functions)- one hour
b. Viral replication (HIV life cycle; Virus and immune system interaction;
CD4 and CD8 cell dynamics)-1.5 hours
c. HIV Pathogenesis : latest theories and evidence: 1.5 hours
d. HIV Transmission 1 hour
5. Infection Control (2 Days)
6. Symptom and system evaluation: (10 sessions, each 1.5 hours duration, 5 days)
a. Respiratory symptoms
b. Cardiovascular symptoms
c. Gastro intestinal symptoms
d. Neurological symptoms
e. The red eye
f. Renal disorders
g. Fever
h. Joint pain
j. Dermatological disorders
i. Mental health cases
7. Acute HIV infection; Manifestations, Diagnosis, and treatment ( one day, one full session, 3 hours )
8. Opportunistic infections: (7 days)
a. Bacterial infections presentations; diagnosis, treatment, and prophylaxis (community acquired pneumonia and other bacterial infections)- (one session of 3 hours duration).
b. Mycobacterial infections; Tuberculosis and MAC infection. (Two session, 2 hours and one hour duration)
c. Viral infections; HSV & VZV- presentation, diagnosis, prophylaxis and management. (one session of 3 hours)
d. Viral infections; CMV retinitis (2 hours) - presentation, diagnosis, prophylaxis and management & CMV non-retinitis (1 hour)
e. Protozoan/parasitic infections; cryptosporidium and microsporidia, isospora infection (one session of 3 hours)
f. Protozoan/parasitic infections; Toxoplasmosis and leishmaniasis infection (two sessions of 2 hours and 1 hour duration)
g. Fungal infections; PCP & Cryptococcus , (two sessions of 2 hours and 1 hour duration)
h. Penicillim marneffi, and Histoplasmosis (1.5 hour duration)
9. Sexually transmitted diseases. 3 days
(Three days, sessions on different STI’s, including Syndromic managements)
10. Anti retro-viral therapy: (35 days)
a. HIV in the HAART era: overview of historical data and impact of HAART on mortality/OIs, effect of HAART on CD4 count and viral load)- 1.5 hours
b. ART agents; Mechanism of anti retro virals, Pharmacology, ART formulations, drug interactions, investigational ARVs, (3 days, each session for 1-2 hours duration)
c. What you need to know about CD4 count/VL & goals of ART
d. NACO indications for Initiating ART therapy, Delaying initiation in treatment naïve patients, initiation strategies.( one full session of 3 hours)
e. Problem based review/discussions of patients on ART: selecting a regimen, managing the patient who was on sub-optimal therapy in the past, what to do with patients who are not tolerating therapy or failing therapy? (one full session of 3 hours- Fellows to present cases from clinic)
f. Clinical and laboratory monitoring including maintaining a proper clinic flow sheet (one full session of 3 hours)
g. ADHERENCE ISSUES: principles and measurement of adherence, (one full session of 3 hours)
h. ARV side effects; (4 days, each session 3 hours, including bed side case discussions)
I. Overview, epidemiology and common side effects: NRTI, NNRTI and PI’s (3 hours)
II. Diagnosing and managing metabolic complications: hyperlipidemia, insulin resistance, lipodytrophy/atrophy (1.5 hours lecture; then bedside for 2 days)
III. Diagnosing and managing Lactic Acidosis (1.5 hour lecture/bedside cases on ARV toxicity)
i. Immune reconstitution inflammatory syndrome; (one full session of 3 hours)
j. Substitution of ARVs;Intolerability and others (one full session of 3 hours)
k. Treatment failure; definitions, regimen failure etc. (one full session of 3 hours)
l. ARV resistance and cross resistance (one full session of 3 hours), case study discussion for 2 more days.
m. Therapeutic drug monitoring (1 hours)
n. Structured treatment interruptions and treatment cessation (one full session of 3 hours)
o. Pediatric guideline discussion; ARV guideline, Initiation of ARV in children,Regimen selection,(2 days, full session of 3 hours, case discussion at bed side for two more days)
p. Barriers in pediatric ARV therapy (one full session of 3 hours)
q. Paediatric ART counseling (one full session of 3 hours)
r. Treatment failure in children (one full session of 3 hours, including case discussion at the bed side for one full day)
s. ART adherence; experience at GHTM (one full session of 3 hours)
t. Case discussions on the above topics- 4-5 days.
u. Giving HAART to the pregnant patient: ART GUIDELINES (one full session of 3 hours)
11. Pregnancy and HIV
a. Reproductive health and family planning for HIV+ patients
b. What do you tell the couple/HIV+ patient who wants to have a baby? (one full session 3 hours including review of data on risks of transmission, risks of getting HIV with unprotected sex, and safer ways to get pregnant)
c. PPTCT: an evidenced based review of effective regimens and risk of future resistance (one full session of 3 hours)
d. Educating the pregnant patient: including breast feeding, delivery methods (Caesarean section) and the immediate post-partum period (one full session of 3 hours)
e. Early management of the HIV exposed infant (preventive regimens (ART and PCP), testing and follow-up)
12. Current HIV vaccine research (one full session of 3 hours)
13. Care and support.(3 days)
a. Palliative care and pain support (one full session, 3 hours each)
b. Peri operative care (one full session, 3 hours each)
c. Transplantation in HIV (one full session, 3 hours each)
14. Clinical manifestations;Complications of OI’s. (26 days): Unless otherwise indicated, each Fellow will be assigned to prepare and given one of these sessions
a. Oral complications: presentation, diagnosis and treatment (one full session of 3 hours
b. Dermatological complications; presentation, diagnosis and referral & treatment (one full session of 3 hours)
c. Neurological complications; 2 parts; global cerebral syndrome and focal neurological deficits (two 3 hour sessions including case discussions on one day.)
d. Neurological complications: AIDS Dementia and PML (one full session of 3 hours)
e. Psychiatric complications- diagnosing and managing depression (one full session, 3 hours)- Faculty
f. Neurological complications; Distal symmetric polyneuropathy, AIDP/CIDP , myelopathy and mononeuritis (one full session, 3 hours)
g. Respiratory complications- case discussions on Nocardiosis, aspergillosis, PCP and other respiratory cases. (one full session, 3 hours each)
h. Gastro-intestinal Diarrhoeal diseases, esophageal diseases, (one full session of 3 hours duration)
i. Hepatobiliary complications(three days, full sessions of 3 hour duration, including case discussions)
I. Hepatitis A, B (3 hours: case based session)- Faculty
II. Hepatitis C (3 hours: case based session)-Faculty
III. Biliary and pancreatic disease (3 hours: case based session)
j. Endocrine diseases; Screening, diagnosis and treatment, Hypogonadism, thyroid disease and osteoporosis/osteopenia (one full session, 3 hours)
k. Common hematologic complications of HIV
I. Anemia, leucopenia, cytopenias ( one full session, 3 hours)
II. ITP coagulation disorders, (one full session, 3 hours)
l. Musculo skeletal complications; Rheumatological disorders, Polymyositis and Myopathy, (one full session, 3 hours)
m. Malignancies in HIV for the Internist
I. Lymphomas (case based: epidemiology, risk factors, common presentations, role of HAART, and overall prognosis)-1.5 hours
II. Kaposi sarcoma (case based: epidemiology, risk factors, common presentations, role of HAART, and overall prognosis)-1.0 hour
III. Cervical dysplasia and cervical cancer: How common? What are the risk factors? How can we screen for it? How do we manage ASCUS, CIN, etc… (1.5 hours)
IV. Anal dysplasias and anal carcinoma: How common? What are the risk factors? Should we be doing anal PAP smears? (1.0 hour)
n. Gynaecological complications
I. Common gynaecologic infections (non STI)-1.0 hours
II. Menstrual disorders, (1.5 hours)
o. HIV+ associated disorders of the kidneys
I. HIVAN: What are the risk factors? How do you screen for it? How do you prevent? How does it present? How do your treat? What is the role of HAART? (3 hours)
II. Other common disorders of the kidney (Non-HIVAN) (1.5 hours and and bedside cases for 1 hour)
15. Herbal remedies and other systems of medicine. (1 day, two full sessions, 3 hours each)
16. Infection control: (4 days) : Weave these lectures in to the regular schedule
a. Hand hygiene (early on in year)- 0.5 hours
b. Aseptic and septic techniques (early on in year): 1.0 hours
c. Infection control overview-HIV and other blood borne pathogens (early on in year)- 1.0 hours
d. Infection control overview- TB, instrument process-overview (0.5 hours)
e. Effective infection control practices- one hour
f. Indwelling catheters – one hour
g. Managing medical waste- one hour
h. Post exposure prophylaxis: HCW exposure scenarios to review algorithms, discuss setting up a system of reporting, tracking, and follow-up. ( 3 hour session)
i. Monitoring and evaluation of infection control practices 2 hours
VI. Laboratory components(10 days)- Weave in with appropriate clinical sessions
1. Diagnosis and detection of HIV
a. Testing methods (tri dots, ELISA based tests for anti body based tests, antigen based tests, False positive and false negative results CD4 tests, Viral load tests
b. Test sensitivities and specificities
c. Diagnosis of acute primary HIV infection
1. Diagnosis of opportunistic infections (cultures, CNS infections, respiratory specimens, stool pathogens)
2. Diagnosis of STIs
VI. Safe Blood Banking
(2 days.)
a. Blood banking policy – Blood banks, Blood storage Centres, Testing protocols, linkages
b. Blood Transfusion, Blood Component Transfusion Transmissible Infection; Transfusion Reaction and Complications;
VIII. HIV & Nutrition
(3 days.)
a. Introduction to basics of Nutrition and Health
b. Relationship between HIV & Nutrition
c. Management of Nutrition – General, Specific situations
IX. Self Care, Home Based Care and Palliative Care
(5 days.)
a. Understanding Burn out – Why it happens? How common is it? Coping skills
b. Home based care – Why? How? When? Cost effectiveness. Overview of different HBC models currently in practice- related to chronic care: eg. For malignancy, dementia, HIV, etc; Role of family, network members, and community; How to develop a HBC program
c. Trajectory of Palliative Care in HIV – Need in different stages of HIV – Pre diagnosis, pre-ART and when on ART, etc
d. Components of palliative graphs – Physical, social, emotional, and spiritual component. Disease management with symptom control with psychosocial support for complete care, Concept of total suffering
e. Symptom management – Wounds and Nursing, Pain: Total pain, Symptoms related to Respiratory, Nervous, Gastrointestinal and Urinary systems
f. End of Life Care – Impact on the family and the patient, Understanding the dying process, Differentiating between essential intervention and otherwise (eg IV antibiotics in the terminal phase or costly parenteral nutrition in the dying patient). Differentiating between withholding and withdrawing treatment. Advance directive, leaving will. Children and property rights
X. Social, Legal and Ethical Issues related to HIV
(3 days.)
a. Stigma and Discrimination,
b. Rights in Health Care; Medical Negligence, Handling of a dead body Rights of PLHIV; HIV/AIDS Bill 2005
c. Ethical Issues: Patients choices, choosing options in resource limited settings, withdrawal/withholding treatment, comfort care, euthanasia, writing a death Certificate/Fellowship, disclosure of information to insurance firms and other agencies,
XI. Leadership in HIV programs
(2 days.)
a. Leadership issues and challenges in HIV program
b. Role models
c. Team building, Task shifting, leveraging opportunities and efforts
XII. HIV and Women
(5 days.)
a. Gender and HIV
b. HIV and Pregnancy - Mode of transmission, Variables in transmission, Interventions for prevention of transmission, PPTCT program - NACO & WHO guidelines; Infant feeding options, Special issues of ART in Pregnancy & Lactation, Special issues of OIs in Pregnancy & Lactation
c. Contraception in Women with HIV
d. HIV and fertility
e. Gynecological evaluation of patients with HIV – Common gynecological infections and their relevance in patients with HIV, Gynecological neoplasias tumors
f. Gynaecological complications
i. Common gynaecologic infections (non STI)-1.0 hours
ii. Menstrual disorders, (1.5 hours)
XIII. HIV and Children (up to 18years of age)
(5 days.)
a. Orphans and Vulnerable Children ; Early identification of HIV infected or exposed child; Management of the HIV-exposed infant
b. Infant diagnosis; Clinical assessment of HIV infected child
c. Disclosure issues in Children
d. Growth & Development of a HIV infected child; Immunization, Nutritional support & counseling of children with HIV infection
e. Identification and management of common illnesses and Opportunistic Infections in children
f. Antiretroviral therapy (ART); Management of children on ART- Adherence; ; follow up
XIV. HIV & Surgery
(2 days.)
a. Stigma and discrimination in Surgical care - Preoperative Counseling and testing issues
b. Standard precautions and waste disposal
c. Post operative management
XV. Behavioral and Social Sciences
1.Socioeconomic Determinants of Health
• The health hierarchy and human illness
• Transdisciplinary perspectives in health
• Individual, Structural, Community, and Policy Interventions
• Understanding Impact on Health by Gender, Caste, Race, Sexual Identity
• Provision of Quality Clinical Services to Vulnerable Populations
1. Behaviour Change Theory and Practice
• Integration of behaviour and health
• Basic theories of Behaviour Change and its applications
• IEC vs. BCC
• Social marketing and effective models
2. Basics of Counselling
• Counselling and guidance-principle and theories
• Behavioural theories- Classical and operant conditioning
• Counselling in different situations- Grief counselling, crisis counseling, counseling children
3. Follow-up Counselling for Positive Prevention
• Telling your partner- issues and concerns, methods of telling your partner
• Disclosure to significant others- its relevance, issues and concerns
• Safer Sex Practices-its importance, issues and concerns
• Mental Health-problems of depression, alcohol, violence- working with clients
• Stigma and Discrimination- types of stigma, its impact on health and health care seeking, coping with stigma and discrimination
• Ethical issues in HIV counselling
4. Social Science Research
Qualitative Research
What is qualitative research, its uses, contrasting qualitative/
• quantitative research
• Sampling in qualitative research, maintaining rigour in qualitative research
• Doing in-depth interviews and focus group discussions
• Analysis of qualitative data
Questionnaire Design
• What are questionnaires, types of questionnaires, methods of administration
• Item generation, developing a response scale
• Issues in translation and biases in responding
• Assessing the reliability and validity of a questionnaire
5. Legal Issues
• Notifiable disease registries
• PLHA and rights
XVI. Psychological and Behavioral issues related to HIV
a) Behavioral Issues – risk factors, risk assessment
b) How to deal with sexual minorities- MSM and Transgender; anal ulcers, hormonal use by transgender
c) Addiction/ Drug Abuse – Risk factors, etiology, precursor personality traits and how it interacts with HIV management – Interaction of Methadone with ART drugs
d) Adherence to Antiretroviral treatment and Follow up – Prevalence, reasons for no adherence, barriers, etc, Adherence in Children
e) Positive Living – Importance and impact on HIV outcomes: Example: exercise, nutrition, yoga; Positive Prevention
XVII. Public Health curriculum:
I. Quarter 1:
a) Overview of Public Health Curriculum, Exposure Visits, Assignments
b) Core concepts of public health,Public Health vs. Clinical Medicine: Integration and Role of Clinician as PH Practitioner - I
c) Core concepts of public health,Public Health vs. Clinical Medicine: Integration and Role of Clinician as PH Practitioner - II
d) Overview of HIV - I
e) Overview of HIV in India - II
f) Biostatistics: basic concepts-Assignment - I
g) Epidemiology of HIV-Assignment II
h) HIV in India – focus on: prevention/subpopulations/vulnerable groups / prevention strategies
i) Intro to Public Health Practitioner Skills
j) Field exposure
II. Quarter 2
a) Behavioural Sciences concepts - I
b) Behavioural Sciences concepts - II
c) Communication / Advocacy
d) Assignment - III
e) Research methods - quantitative
f) Cross sectional studies
g) Case control studies
h) Clinical Trials (TRC)
i) Qualitative research methods
j) Public Health Practitioner Skills/Exercises (survey development/FGD guide development and how to conduct a FGD)
k) Public Health Practitioner Skills: qualitative/applied epi skills (conduct a needs assessment, how to develop in-depth interviews, basic qualitative data analysis
l) Public Health Practitioner Skills: ( how to develop a research protocol)
m) Health management
III. Quarter 3:
a) TB HIV
b) Introduction to Health Systems
c) National programs - NACP
d) NACP (contd)
e) RNTCP
f) Environmental Health and HIV in India
g) Long Exposure Visit Presentations
h) Exposure Visits
i) Environmental Health and HIV in India
j) Public Health Practitioner Skills: ( journal review, proposal writing, poster / paper presentations )
IV. Quarter 4:
a) Monitoring and Evaluation
b) Monitoring and Evaluation
c) Advocacy
d) Health planning
e) Health management
f) Health economics - related to HIV
g) Public Health Practitioner Skills: ( visit to positive network )
XVI. TRAINING SKILLS:
1) Adult Learning Principles - 3 hrs
2) How to Develop Power Point Presentations-3 hrs
3) Training Methodologies -3hrs
4) Facilitation Skills- 1&1/2 hrs
5) How to Develop an Effective Training Programme -3hrs
6) How to Evaluate a Training Programme - 1&1/2hrs
7) How to write a Grant application- 3hrs
8) How to write a Good Abstract-3hrs
9) How to develop a Poster Presentation- 3hrs
10) How to develop a Case study-3hrs
SCHEME OF PRACTICAL LEARNING DURING HIV FELLOWSHIP PROGRAM:
|Skills |Able to perform |Able to perform |Assist |Observe |
| |independently |under guidance | | |
|Counseling – Adult, Pediatric including Pre-Test, Post-Test, Adherence and |+ | | | |
|Nutritional | | | | |
|Laboratory Investigations like Fluid analysis, ZN staining, gram’s staining, India |+ | | | |
|Ink Preparation, , KOH Preparation, | | | | |
|Drug challenging Test and Cotrim Desensitization |+ | | | |
|Diagnosis and management of opportunistic Infections |+ | | | |
|Clinical staging and management of HIV patients |+ | | | |
|Procedures like Pleural, Peritoneal Tapping, Lumbar Puncture, FNAC of Lymph Node |+ | | | |
|and Bone Marrow Aspiration | | | | |
METHODS OF LEARNING:
- Clinical management of patients
- Read and study assigned and/or recommended readings.
- Participate in class discussion.
- Participate in group interaction and ask questions of lectures.
- Seminars by fellows
- Complete required assignments.
- Practical – hands on laboratory work
- Clinical Case presentations
- Project work as Thesis – preferably a project which includes both institutional and community phases of intervention
XVII. RESEARCH AND EPIDEMIOLOGY :
1) Introduction to Epidemiology and Research Component
2) ID a problem to developing a question/thesis & conducting a lit search
3) Advice on how to identify a problem and to construct a research question around it (this is follow-up to the previous session).
4) Literature search methodologies and strategies
5) Conceptualizing a Research Project: Study Question & Objective development
6) Overview of research protocol outline/lifecycle of designing and conducting research project. Special focus on identifying a study question and objective(s).
7) Presentation of research topics
8) Intro to Epi Analytic Methods 1- Frequency measures: Basic Epidemiology terminology: frequencies, rates, ratios, proportions, incidence, prevalence.
9) Intro to Epi Analytic methods 2- Measures of central tendency. Sampling Distribution
10) Normal Distribution, Probability, and Sampling Basic Epidemiology: measures of central tendency and dispersion (mean, median, mode, variance, standard deviation)
11) What is qualitative research and how is it of use to a researcher?
12) Study Types and Objectives: Brief review of study types and rationale (descriptive: surveillance, cohort, case-control prospective/retrospective; interventional: clinical trial, randomized trial)
13) Review Study objectives concepts
14) Intro to Epi/Analytic methods 3 (part 1 of 2): Measures of association
15) relative risk, odds ratios, attributable risk, sensitivity and specificity)
16) In depth interviews and focus group discussions
17) Intro to Epi/Analytic methods 3 (part 2 of 2): Confidence Intervals Confidence Intervals and continued measures of association
18) Survey Design and Qualitative Research methods:
19) Overview of qualitative research methodologies, strengths, weaknesses.
20) Overview of the value of qualitative research and data.
21) Epi Info: Developing a data analysis and collection plan & Designing a data collection instrument.
22) Practical application of study design, questionnaire, data collection, cleaning, entry, and analysis using CDC case study and Epi-Info.
23) Sampling and Sample Size calculation. What is this and why is it important? • TO provide the GHTM Clinical fellows with the basic concepts of sampling and sample size (including methods to calculate the sample size based on study design).
24) This should be in the context of applied epidemiology. i.e. field project work rather than academic in nature.
25) Appropriate analysis and tests of significance. What do you need to know to analyze and interpret your data?
26) To provide basic guidance on developing an analysis plan that is appropriate to achieving the project objectives.
27) Helping to define specific parameters to capture and measure.
28) How to create appropriate data shells.
29) Provide and overview of ‘tests of significance’ (keep to the very basics).
30) Organizing and documenting qualitative data
31) Challenges to study validity: Common biases and misreported information. Selection, Information, & Confounding
32) How to Write a Scientific Abstract?:
33) Lessons and strategies for writing a scientific abstract.
34) Effective presentation of scientific data
35) Ethics
36) Using MS-Excel as a data management and analysis tool
37) Journal Club
38) Presentation of research project work
XVIII. MANAGEMENT:
Key Modules:
01: Management Principles 3 hours:
➢ Principles of Management: Planning Organizing, Leading and Controlling
➢ The competitive Edge: An analysis of top priorities in the profit sector and how these principles can be adapted to non profits
➢ Non-profit Sector Management: Who is the customer? Management by Objectives
➢ Fundraising for Non Profits
02: Institutional Management 3 hours:
➢ Strategic Planning: Institutional audit; Vision and Mission building
➢ Total Quality Management and other quality movements in the world
➢ Customer Relations, Press Relations and Public Relations
04: Human Resources Management 3 hours:
➢ Personnel Audit; Recruitment Process; Attrition; Mentoring and retaining staff
➢ Creating excellent workplaces
➢ Creating a learning organization; Training strategy
03: Project Management 6 hours:
➢ Problem Definitions; Developing work objectives; Intervention pathway
➢ Logical Framework and analysis
➢ Applying for proposals; Writing Proposals
➢ Using project management tools: Gantt Chart, PERT Chart
➢ Monitoring and Evaluation
➢
05: Self Development and soft skills 6 hours:
➢ Leadership: Team building
➢ Social Intelligence; Conflict Resolution skills; Negotiation skills
➢ Interpersonal Relationships Presentation Skills
XXVII. LEARNING RESOURCE MATERIALS
CONTENTS PAGE
1.TEXTBOOKS ……………………………………………………………………………36
2.NATIONAL AND INTERNATIONAL GUIDELINES…………………..………………38
3.MEDICAL JOURNALS……………………………………………………….…………...41
4.INTERNET RESOURCES………………………………………………………………...44
ICWISE REFERENCES
A.HIV:BASIC SCIENCES AND LABORATORY TESTING 46
B.HIV AND RESPIRATORY SYSTEM 51
C.HIV AND CENTRAL NERVOUS SYST 53
D.HIV AND WOMEN 54
E.STIs,RTIs AND HIV 55
F.HIV AND CHILDREN 56
G.INFECTION CONTROL AND EXPOSURE PREVENTION 57
H.ANTIRETOVIRAL THERAPY 59
I.SAFE BLOOD BANKING 61
J.HIV AND GASTROINTESTINAL TRACT 62
K.PSYCOLOGICAL CARE IN HIV 62
L.HIV AND TB 64
M.HIV AND FEVER 69
1. TEXTBOOKS:
Park’s Text Book of Preventive Social Medicine K. Park Publisher: Banarsidas Bhanot Publishers, 19th Ed., 2007
WHO: IMAI modules for acute care, chronic care and palliative care telemedicine.itg.be/telemedicine/site/Default.asp?WPID=79&MIID=97&L=E&FID=0 - 24k
Principle of Medicine by Harrison, Charles M. Wiener, Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo Publisher: McGraw-Hill, 17th Edition,
National Health Program of India: National policies and legislation related to health Kishore: Publisher: Century Publications, New Delhi. 7th Edition ( 2007)
Crofton and Douglas's Respiratory Diseases, Anthony Seaton, A Gordon Leitch & Douglas Seaton Publisher- Blackwell publishing, 2 volume set, Fifth Edition
Textbook of AIDS Medicine by Thomas C. Merigan, John G. Bartlett, Dani Bolognesi Publisher: Lippincott Williams & Wilkins; 2nd edition (January 15, 1999)
The AIDS Knowledge Base: Textbook on HIV Disease from the University of California, San Francisco, and the San Fransciso General Hospital P.T. Cohen, Merle A. Sande, Paul A. Volberding Publisher: Lippincott Williams and Wilkins 3rd edition (February 1999).
AIDS Therapy, (Hardcover) 2nd edition - Raphael Dolin, Henry Masur, Michael S. Saag, ISBN 0443065942 Publisher:Churchill Livingstone · Published November 2002
Management of the HIV-Infected Patient (Hardcover)
by Suzanne Crowe, Jennifer Hoy, John Mills , Publisher: London: Martin Dunitz, Taylor & Francis Group; 2nd edition (April 15, 2001)
Medical Management of HIV infection 2005-2006 Edition. Bartlett JG, Gallant J. Baltimore, MD: Johns Hopkins University; 2003.
The pocket guide to Adult HIV/AIDS Treatment: January 2005. Bartlett JG. John Hopkins University; 2005 ( available as pdf free)
A Clinical Guide to Supportive & Palliative Care for HIV/AIDS CD-ROM Inventory Code: HAB00312 Year: 2003 Language: English U. S. Department of Health and Human Resources
American College of Physicians Home Care Guide for HIV and AIDS: For Family and Friends Giving Care at Home Peter S. Houts (July 1997) Publisher: American College of Physicians
HIV and AIDS Prevention Prince Efere (November 4, 2004) Publisher: Trafford Publishing
Textbook of Pediatric HIV Care Steven L. Zeichner, Jennifer S. Read (April 28, 2005) Publisher: Cambridge University Press
Sexually Transmitted Diseases King K. Holmes (June 30, 2005) Publisher: Mcgraw-Hill (Tx)
ABC of AIDS Michael W. Adler (September 30, 2001) Publisher: BMJ Books
Current Medical Diagnosis & Treatment, 2005 (Paperback)by Lawrence M. Tierney, Stephen J. McPhee, Maxine A. Papadakis, Publisher: McGraw-Hill Medical; 44 edition (October 19, 2004)
HIV Medicine Self-Directed Study Guide 2005: - American Academy of HIV Medicine
Fitzpatrick’s Dermatology in General Medicine Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy Paller, and David J. Leffell, Publisher: McGraw-Hill Professional New York, New York 7th ed, 1197 pp, with illustrations, 2007.
Text Book of dermatology Rooks Publisher: Wiley InterScience 7th edition-
Clinical Management" and "Epidemiology & Prevention" AAHIV , 2007 edition
Epidemic Rothman / Park / Betty Kirkhood
2. NATIONAL & INTERNATIONAL GUIDELINES:
World Health Organisation (WHO)
who.int/HIV/pub/guidelines/en/
6 August 2008, Priority interventions: HIV/AIDS prevention, treatment and care in the health sector
1 July 2008, Essential prevention and care interventions for adults and adolescents living with HIV in resource-limited settings
19 March 2008, Post-Exposure Prophylaxis to prevent HIV infection: Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection
1 November 2007, Guidance on global scale-up of the prevention of mother-to-child transmission of HIV: Towards universal access for women, infants and young children and eliminating HIV and AIDS among children
1 June 2007, Guidance on provider-initiated HIV testing and counselling in health facilities: New recommendations aim for wider knowledge of HIV status and greatly increased access to HIV treatment and prevention
26 April 2007, TB Care with TB-HIV Co-Management
7 August 2006, WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children
7 August 2006, WHO recommendations for clinical mentoring to support scale-up of HIV care, antiretroviral therapy and prevention in resource-constrained settings
7 August 2006, Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access: Recommendations for a public health approach
7 August 2006, Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults: Recommendations for a public health approach
7 August 2006, Antiretroviral therapy for HIV infection in adults and adolescents
Recommendations for a public health approach
7 August 2006, Antiretroviral therapy of HIV infection in infants and children: towards universal access: Recommendations for a public health approach
19 June 2006, Patient Monitoring Guidelines for HIV Care and ART
15 June 2006, Sexual and reproductive health of women living with HIV/AIDS
Guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings
16 June 2005, Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance
9 June 2005, Joint ILO/WHO guidelines on health services and HIV/AIDS
14 March 2005, Policy and Programming Guide for HIV/AIDS Prevention and Care among Injecting Drug Users
30 November 2004, Guidance on Ethics and Equitable Access to HIV Treatment and Care
23 September 2004, Rapid Assessment and Response: Adaptation guide for work with especially vulnerable young people
23 September 2004, Rapid Assessment and Response: Adaptation guide on HIV and men who have sex with men
21 September 2004, Nutrition Counselling, Care and Support for HIV-infected Women: Guidelines on HIV-related care, treatment and support for HIV-infected women and their children in resource-constrained settings
16 September 2004, A Guide to Monitoring and Evaluation for Collaborative TB/HIV Activities: Field Test Version
6 July 2004, Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Guidelines on Care, Treatment and Support for Women Living with HIV/AIDS and their Children in Resource-Constrained Settings
9 June 2004, Advocacy Guide: HIV/AIDS Prevention among Injecting Drug Users
25 May 2004, National Guide to Monitoring and Evaluating Programmes for the Prevention of HIV in Infants and Young Children
16 March 2004, Training Guide for HIV Prevention Outreach to Injecting Drug Users Workshop Manual
3 March 2004, National AIDS Programmes: A Guide to Monitoring and Evaluating HIV/AIDS Care and Support
1 February 2004, Guidelines for the Management of Sexually Transmitted Infections; Syndormic Case Management
12 January 2004, Guidelines for conducting HIV sentinel serosurveys among pregnant women and other groups: UNAIDS/WHO working group on global HIV/AIDS and STI surveillance
30 November 2003: Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach
10 June 2003: Guidelines for Implementing Collaborative TB and HIV Programme Activities: Stop TB Partnership: Working Group on TB/HIV
Toman's Tuberculosis Case Detection, Treatment And Monitoring :- 2nd Edition, Who
NATIONAL AIDS CONTROL ORGANISATION (NACO) GUIDELINES: Quick_Links/Publications
Guidelines on HIV testing
Guidelines for Prevention and Management of Common Opportunistic Infections
Operational Guidelines for ART Centers
Guidelines for HIV Care and Treatment in Infants and Children
Antiretroviral Therapy Guidelines for HIV infected Adults and Adolescents including Post-exposure
National Guidelines on Prevention, Management & Control of Reproductive Tract Infection including Sexually Transmitted Infections
Guidelines for Community Care Centre
Guidelines for Setting up Blood Storage Centers
Post Exposure Prophylaxis (PEP)
Policy Guidelines - Mainstreaming Gender in HIV Programmes
Operational Guidelines for STI/ RTI Services
National Guidelines for the Enumeration of CD4 T-Lymphocytes
Practice Guidelines for Substitution Therapy with Buprenorphine for Opioid Injecting Drug Users
National Guidelines on Prevention, Management & Control of Reproductive Tract Infection including Sexually Transmitted Infections
CDC REFERENCES:
hiv/resources/guidelines
CDC guidelines for prevention and treatment of opportunistic infections in HIV infected adults and adolescents-June 2008
CDC guidelines for use of Anti Retroviral Agents in HIV-1 infected adults and adolescents – Jan 2008
CDC guidelines for prevention and treatment of opportunistic infections and use of Anti Retroviral Agents in Pediatric HIV
NRHM MISSION DOCUMENT:
mohfw.nic.in/NRHM/DocumentsNRHM/%20Mission%20Document.pdf
Others
Management training module for Medical Officers. – Regional Resource and Training Centre – Level-1 & 2
The. EPEC. TM. -India. Project. Module 12. Final Days /. Last Hours of. Living. Education in Palliative and End-of-life Care - India.
Education on Palliative and End of Life Care - India
Infection prevention and Stigma reduction in Health Care Settings - Engender Health
3. MEDICAL JOURNALS:
New England Journal of Medicine :
Journal of the American Medical Association: jama.ama-
The Lancet:
Clinical Infectious Diseases – University of Chicago Press: journals.uchicago.edu/CID/index.htm
Journal of Infectious Diseases: journals.uchicago.edu/JID/home.htm
AIDS. Official journal of the International AIDS Society:
Journal of Acquired Immunodeficiency Syndrome:
AIDS and Behaviour Publisher: Springer Science+Business Media B.V., Formerly Kluwer Academic Publishers B.V. app/home/journal
AIDS Care. Psychological and Socio-medical aspects of AIDS/HIV tandf.co.uk/journals/titles/09540121.asp
AIDS Patient Care and STDs. Publishers: Mary Ann Liebert Inc. publications
AIDS Research and Human Retroviruses. Publishers: Mary Ann Liebert Inc. publications
British Medical Journal
Archives of Internal Medicine :
Annals of Internal Medicine:
American Journal of Public Health:
Journal of Association of Physicians of India
4. INTERNET RESOURCES:
HIV & AIDS Treatment in Practice: A regular electronic newsletter for health care workers and community-based organizations on HIV treatment in resource-limited settings. It is supported by and produced in collaboration with St Stephen's AIDS Trust and the International HIV/AIDS Alliance.
AIDSinfo – HIV/AIDS information: HIV/AIDS treatment, prevention, medical research, clinical trials, drugs, treatment guidelines, and vaccines for patients, health care providers, Available at:
UNAIDS: The Joint United Nations Program on HIV/AIDS: Joint United Nations program on AIDS/HIV. A global source of information on the AIDS epidemic, includes comprehensive information on UN policies, news, ...
CME Website
AIDS Education Global Information System (AEGiS) - Enhanced Site AEGIS is one of the largest HIV/AIDS databases in the world, includes the HIV Daily Briefing, updated hourly.
HIV InSite Gateway to HIV and AIDS Knowledge Gateway to HIV/AIDS knowledge from the University of California, San Francisco. Comprehensive medical and societal news. hivinsite.ucsf.edu/InSite
amfAR The American Foundation for AIDS Research, a leading organization dedicated to the support of HIV/AIDS research. -
AVERT - A UK HIV and AIDS Charity Information about HIV infection, testing, prevention and treatment; plus pages about AIDS in specific countries, statistics, and personal stories.
CDC-NCHSTP-Divisions of HIV/AIDS Prevention (DHAP) Home Page CDC's HIV mission is to prevent HIV infection and reduce the incidence of HIV-related illness and death, in collaboration with community, state, national, ...
hiv/dhap.htm
Elizabeth Glaser Pediatric AIDS Foundation A leading organization dedicated to identifying, funding and conducting basic pediatric HIV/AIDS research.
International AIDS Vaccine Initiative | IAVI - International AIDS ... aids vaccines is the website of the International AIDS Vaccine Initiative. The International AIDS Vaccine Initiative is a global organization -
HIV/AIDS Fact Sheets - CDC/NCHSTP/Divisions of HIV/AIDS Prevention ... CDC Global AIDS Program Link Leaves the DHAP Internet Site ... Preventing the Sexual Transmission of HIV, the Virus that Causes AIDS: What You Should Know ...hiv/pubs/facts.htm - More results from
International AIDS Society The International AIDS Society (IAS) is the world's leading independent association ... By convening the world’s largest meetings on HIV/AIDS, ias.se/
The John Hopkins HIV Guide
8. TOPICWISE REFERENCES:
A. HIV: BASIC SCIENCES AND LABORATORY TESTING
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2. Grez M, Dietrich U, Balfe P, et al. (1994) Genetic analysis of human immunodeficiency virus type 1 and 2 (HIV-1 and HIV-2) mixed infections in India reveals a recent spread of HIV-1 and HIV-2 from a single ancestor for each of these viruses. J Virol 68: 2161-2168.
3.Kannangai R, Ramalingam S, Castillo R.C, et al. (1999) HIV-2 status in southern India. Trans Roy Soci of Trop Med and Hyg 93:30-31.
4.Mellors JW, Kingsley LA, Rinaldo CR, Jr., Todd JA, Hoo BS, Kokka RP, et al. (1995) Quantitation of HIV-1 RNA in plasma predicts outcome after seroconversion. Ann Intern Med 122(8):573-9.
5.Mellors JW, Rinaldo CR, Jr., Gupta P, White RM, Todd JA, Kingsley LA. (1996) Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science 272(5265):1167-70.
6.Ghate MV, Mehendale SM, Mahajan BA, Yadav R, Brahme RG, Divekar AD, et al. (2000) Relationship between clinical conditions and CD4 counts in HIV-infected persons in Pune, Maharashtra, India. Natl Med J India 13(4):183-7.
7.Ramalingam S, Kannangai R, Zachariah A, Mathai D, Abraham OC. (2001) CD4 counts of normal and HIV-infected south Indian adults: Do we need a new staging system? Natl Med J India 14: 335 - 9.
8.Kannangai, R., K.J. Prakash, S. Ramalingam, O.C. Abraham, K.P. Mathews, M.V. Jesudason and G. Sridharan. (2000) Peripheral CD4+ / CD8+ T-lymphocyte counts estimated by an immunocapture method in the normal healthy south Indian adults and HIV seropositive individuals. J Clin Virol. 17:101-108.
9.Hughes MD, Stein DS, Gundacker HM, Valentine FT, Phair JP, Volberding PA. (1994) Within-subject variation in CD4 lymphocyte count in asymptomatic human immunodeficiency virus infection: implications for patient monitoring. J Infect Dis 169(1):28-36
10.Kannangai R, Ramalingam S, Pradeepkumar S, Damodharan K, Sridharan G (2000) Hospital-based evaluation of two rapid human immunodeficiency virus antibody screening tests J .Cli Microbiol. 38: 3445-7.
11.Kannangai R, Ramalingam S, Jesudason MV, Vijayakumar TS, Abraham OC, Zechariah A, Sridharan G. (2001) Correlation of CD4 (+) T-Cell counts estimated by an immunocapture technique (Capcellia) with viral loads in human immunodeficiency virus-seropositive individuals. Clin Diagn Lab Immunol. 8: 1286-8.
12.Lodha R, Upadhyay A, Kapoor V, Kabra SK. Clinical profile and natural history of children with HIV infection. Indian J Pediatr. 2006 Mar;73(3):201-4.
13.Hira SK, Shroff HJ, Lanjewar DN, Dholkia YN, Bhatia VP, Dupont HL. The natural history of human immunodeficiency virus infection among adults in Mumbai. Natl Med J India. 2003 May-Jun;16(3):126-31.
14.Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of human immunodeficiency virus disease in southern India. Clin Infect Dis. 2003 Jan 1;36(1):79-85. Epub 2002 Dec 9.
15.Mehendale SM, Bollinger RC, Kulkarni SS, Stallings RY, Brookmeyer RS, Kulkarni SV, Divekar AD, Gangakhedkar RR, Joshi SN, Risbud AR, Thakar MA, Mahajan BA, Kale VA, Ghate MV, Gadkari DA, Quinn TC, Paranjape RS. Rapid disease progression in human immunodeficiency virus type 1-infected seroconverters in India.AIDS Res Hum Retroviruses. 2002 Nov 1;18(16):1175-9.
16.Ghate MV, Mehendale SM, Mahajan BA, Yadav R, Brahme RG, Divekar AD, Paranjape RS. Relationship between clinical conditions and CD4 counts in HIV-infected persons in Pune, Maharashtra, India. Natl Med J India. 2000 Jul-Aug;13(4):183-7.
17.Bollinger RC, Tripathy SP, Quinn TC. The human immunodeficiency virus epidemic in India. Current magnitude and future projections. Medicine (Baltimore). 1995 Mar;74(2):97 -106.
18.Carriere, D., Vendrell, J. P., Fontaine, C., Jansen, A., Reynes, J., Pages, I., Holzmann, C., Laprade, M. & Pau, B. (1999). Whole blood capcellia CD4/CD8 immunoassay for enumeration of CD4+ and CD8+ peripheral T lymphocytes. Clin Chem 45(1), 92-7.
19.Cox, S. W., Aperia, K., Albert, J. & Wahren, B. (1994). Comparison of the sensitivities of primary isolates of HIV type 2 and HIV type 1 to antiviral drugs and drug combinations. AIDS Res Hum Retroviruses 10(12), 1725-9.
20.Vacca, J. P. (1994). Design of tight-binding human immunodeficiency virus type 1 protease inhibitors. Methods Enzymol 241, 311-34.
21.Tomasselli, A. G., Hui, J. O., Sawyer, T. K., Staples, D. J., Bannow, C., Reardon, I. M., Howe, W. J., DeCamp, D. L., Craik, C. S. & Heinrikson, R. L. (1990). Specificity and inhibition of proteases from human immunodeficiency viruses 1 and 2. J Biol Chem 265(24), 14675-83.
22.Tantillo, C., Ding, J., Jacobo-Molina, A., Nanni, R. G., Boyer, P. L., Hughes, S. H., Pauwels, R., Andries, K., Janssen, P. A. & Arnold, E. (1994). Locations of anti-AIDS drug binding sites and resistance mutations in the three-dimensional structure of HIV-1 reverse transcriptase. Implications for mechanisms of drug inhibition and resistance. J Mol Biol 243(3), 369-87.
23.Descamps, D., Collin, G., Letourneur, F., Apetrei, C., Damond, F., Loussert-Ajaka, I., Simon, F., Saragosti, S. & Brun-Vezinet, F. (1997). Susceptibility of human immunodeficiency virus type 1 group O isolates to antiretroviral agents: in vitro phenotypic and genotypic analyses. J Virol 71(11), 8893-8.
24.Rodes, B., Holguin, A., Soriano, V., Dourana, M., Mansinho, K., Antunes, F. & Gonzalez-Lahoz, J. (2000). Emergence of drug resistance mutations in human immunodeficiency virus type 2-infected subjects undergoing antiretroviral therapy. J Clin Microbiol 38(4), 1370-4.
25.van der Ende, M. E., Guillon, C., Boers, P. H., Ly, T. D., Gruters, R. A., Osterhaus, A. D. & Schutten, M. (2000b). Antiviral resistance of biologic HIV-2 clones obtained from individuals on nucleoside reverse transcriptase inhibitor therapy. J Acquir Immune Defic Syndr 25(1), 11-8.
26.Miyoshi, I., Fujishita, M., Taguchi, H., Matsubayashi, K., Miwa, N. & Tanioka, Y. (1983). Natural infection in non-human primates with adult T-cell leukemia virus or a closely related agent. Int J Cancer 32(3), 333-6.
27.Miyoshi, I., Ohtsuki, Y., Fujishita, M., Yoshimoto, S., Kubonishi, I. & Minezawa, M. (1982a). Detection of type C virus particles in Japanese monkeys seropositive to adult T-cell leukemia-associated antigens. Gann 73(6), 848-9.
28.Miyoshi, I., Yoshimoto, S., Fujishita, M., Taguchi, H., Kubonishi, I., Niiya, K. & Minezawa, M. (1982b). Natural adult T-cell leukemia virus infection in Japanese monkeys. Lancet 2(8299), 658.
29.Watanabe, T., Seiki, M., Tsujimoto, H., Miyoshi, I., Hayami, M., & Yoshida, M.(1985) Sequence homology of the simian retrovirus genome with human T-cell leukemia virus type I. Virology. 144 (1):59-65.
30.Sharp, P. M., Bailes, E., Chaudhuri, R. R., Rodenburg, C. M., Santiago, M. O. & Hahn, B. H. (2001). The origins of acquired immune deficiency syndrome viruses: where and when? Philos Trans R Soc Lond B Biol Sci 356(1410), 867-76.
31.Sharp, P. M., Bailes, E., Gao, F., Beer, B. E., Hirsch, V. M. & Hahn, B. H. (2000). Origins and evolution of AIDS viruses: estimating the time-scale. Biochem Soc Trans (2), 275-82.
32.Hahn, B. H., Shaw, G. M., De Cock, K. M. & Sharp, P. M. (2000). AIDS as a zoonosis: scientific and public health implications. Science 287(5453), 607-14.
33.Gao, F., Bailes, E., Robertson, D. L., Chen, Y., Rodenburg, C. M., Michael, S. F., Cummins, L. B., Arthur, L. O., Peeters, M., Shaw, G. M., Sharp, P. M. & Hahn, B. H. (1999). Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature 397(6718), 436-41.
34.Gao, F., Yue, L., Robertson, D. L., Hill, S. C., Hui, H., Biggar, R. J., Neequaye, A. E., Whelan, T. M., Ho, D. D., Shaw, G. M. & et al. (1994). Genetic diversity of human immunodeficiency virus type 2: evidence for distinct sequence subtypes with differences in virus biology. J Virol 68(11), 7433-47.
35.Gao, F., Yue, L., White, A. T., Pappas, P. G., Barchue, J., Hanson, A. P., Greene, B. M., Sharp, P. M., Shaw, G. M. & Hahn, B. H. (1992). Human infection by genetically diverse SIVSM-related HIV-2 in West Africa. Nature 358(6386), 495-9.
36.Nyambi, P. N., Willems, B., Janssens, W., Fransen, K., Nkengasong, J., Peeters, M., Vereecken, K., Heyndrickx, L., Piot, P. & van der Groen, G. (1997). The neutralization relationship of HIV type 1, HIV type 2, and SIVcpz is reflected in the genetic diversity that distinguishes them. AIDS Res Hum Retroviruses 13(1), 7-17.
37.Chen, Z., Luckay, A., Sodora, D. L., Telfer, P., Reed, P., Gettie, A., Kanu, J. M., Sadek, R. F., Yee, J., Ho, D. D., Zhang, L. & Marx, P. A. (1997a). Human immunodeficiency virus type 2 (HIV-2) seroprevalence and characterization of a distinct HIV-2 genetic subtype from the natural range of simian immunodeficiency virus-infected sooty mangabeys. J Virol 71(5), 3953-60.
38. Chen, Z., Telfier, P., Gettie, A., Reed, P., Zhang, L., Ho, D. D. & Marx, P. A. (1996). Genetic characterization of new West African simian immunodeficiency virus SIVsm: geographic clustering of household-derived SIV strains with human immunodeficiency virus type 2 subtypes and genetically diverse viruses from a single feral sooty mangabey troop. J Virol 70(6), 3617-27.
39. Kandathil AJ, Ramalingam S, Kannangai R, David S, Sridharan G. Molecular epidemiology of HIV.Indian J Med Res. 2005 Apr;121(4):333-44.
40. Lal RB, Chakrabarti S, Yang C. Impact of genetic diversity of HIV-1 on diagnosis,
antiretroviral therapy & vaccine development. Indian J Med Res. 2005 Apr;121(4):287-314
Further Reading
AIDS: Biology, Diagnosis, Treatment and Prevention. In: V.T. Devita JR, S.Hellman and S.A.Rosenberg editors. Lippincott-Raven Publishers Philadelphia, 1997;
Textbook of AIDS Medicine. In: Thomas C Merigan Jr., John G.Bartlett and Dani Bolognesi editors. Williams and Wilkins publishers. 1999.
B.HIV AND THE RESPIRATORY SYSTEM
Crowe S, Hoy J, Mills J (eds) (2002) Management of HIV infected patient. Martin Dunitz.
Buckley RM, Gluckman SJ (eds) (2002) HIV infection in primary care. WB Saunders.
Dolin R, Masur H, Saag Ms (eds) (2003) AIDS therapy. Churchill Livingston.
Kumari S (ed) (2001) Guidelines on standard operating procedures for lab diagnosis of HIV-opportunistic infections. WHO.
Department of Clinical Microbiology (2001) Myers and Koshi’s manual of diagnostic medical microbiology and immunology/serology. Christian Medical College.
FURTHER READING
Scott JA, Hall AJ, Muyodi C et al (2000). Aetiology, outcome and risk factors for mortality among adults with acute pneumonia in Kenya. Lancet 355; 1225-30.
Jones N, Huebner R, Khoosal M et al (1998) The impact of HIV on Streptococcus pneumoniae bacteraemia in a South African population. AIDS 12: 2177-84.
Malin AS, Gwanzura LK, Klein S et al. (1995) Pneumocystis Jiroveci pneumonia in Zimbabwe. Lancet 346: 1258-61.
French N, Nakiyingi J, Carpenter LM et al. (2000) 23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double-blind, randomised and placebo controlled trial. Lancet. 355:2106-11.
Klugman KP, Madhi SA, Huebner RE, Mbelle N, Pierce N (2003) A trial of a 9-valent pneumococcal condjugate vaccine in children with and without HIV infection. N Eng. J Med. 341, 1341-1348.
Mayaud C, Parrot A, Cadranel J. Pyogenic bacterial lower respiratory infection in human immunodeficiency virus infected patients. Eur Respir J 2002; 20: Suppl. 36, 28s-39s.
Gilks C, Ojoo S, Ojoo J et al. Invasive pneumococcal disease in a cohort of predominantly HIV-1 infected female sex workers in Nairobi. Lancet 1996; 347: 718-723.
Furrer H, Egger M, Oprail M, Bernasconi E, Hirschel B, Battegay M, Telenti A et al. Discontinuation of primary prophylaxis against Pneumocystis Jiroveci pneumonia in HIV-1 infected adults treated with combination anti-retroviral therapy. N Eng J Med 1999; 340:1301-6.
Bartlett JG, Breiman RF, Mandell LA, File TM Community acquired pneumonia in adults: guidelines for management. Clini Infect Dis 1998; 26: 811-38.
Samuel A. Shelburne, Martin Montes and Richard J. Hamill. Immune reconstitution inflammatory syndrome: more answers, more questions. Journal of Antimicrobial Chemotherapy, Oxford journals. 2006;57(2):167-170
Patricia Price, Nadine Mathiot, Rom Krueger, Shelley Stone, Niamh M. Keane, Martyn A. French. Immune dysfunction and immune restoration disease in HIV patients given highly active anti retroviral therapy. Journal of Clinical Virology. 2001; 22(3):279-278
Kumarasamy N, Chaguturu S, Mayer KH, Solomon S, Yepthomi HT, Balakrishnan P, Flanigan TP. Incidence of immune reconstitution in HIV/tuberculosis coinfected patients after initiation of generic antiretroviral therapy in India. Journal of Acquired Immunodeficiency syndrome. 2004;37(5):1574-6.
Stephen D Lawn, Linda-Gail Bekker, Robert F Miller. Immune reconstitution disease associated with mycobacterial infections in HIV infected individuals receiving antiretrovirals. Lancet Infectious Disease 2005; 5:361-73.
Treating opportunistic infections in HIV infected adults and adolescents. Recommendations from CDC, National Institutes of health, and HIV medicine association/ Infectious Diseases Society of North America MMWR 2004; 53: 1-120.
15. National Guidelines for implementation of Anti Retroviral Therapy drat
version August, 2004.
Anti Retroviral Therapy for HIV infection in adults and adolescents in resource limited settings: Towards universal access Recommendations for a public health approach
C.HIV AND CENTRAL NERVOUS SYSTEM
CRYPTOCOCCAL MENINGITIS
van der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, Johnson PC, Tuazon CU, Kerkering T, Moskovitz BL, Powderly WG, Dismukes WE. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. N Engl J Med. 1997 Jul 3;337(1):15-21.
Graybill JR, Sobel J, Saag M, van Der Horst C, Powderly W, Cloud G, Riser L, Hamill R, Dismukes W. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. Clin Infect Dis. 2000 Jan;30(1):47-54.
Tuberculous Meningitis
Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, White NJ, Parry CM, Farrar JJ. Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet. 2002 Oct 26;360(9342):1287-92.
Thwaites GE, Nguyen DB, Nguyen HD, Hoang TQ, Do TT, Nguyen TC, Nguyen QH, Nguyen TT, Nguyen NH, Nguyen TN, Nguyen NL, Nguyen HD, Vu NT, Cao HH, Tran TH, Pham PM, Nguyen TD, Stepniewska K, White NJ, Tran TH, Farrar JJ. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004 Oct 21;351(17):1741-51.
Pai M. The accuracy and reliability of nucleic acid amplification tests in the diagnosis of tuberculosis. Natl Med J India. 2004 Sep-Oct;17(5):233-6.
Thwaites GE, Duc Bang N, Huy Dung N, Thi Quy H et al. The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with Tuberculous meningitis. J Infect Dis 2005 Dec 15;192(12):2134-41.
TOXOPLASMA ENCEPHALITIS
Skiest DJ. Neurologic Disease in Patients with Acquired Immunodeficiency Syndrome. Clin Infect Dis 2002;34:103-115.
APPROACH TO PARAPLEGIA IN AN HIV-INFECTED PATIENT
Griffiths P. Cytomegalovirus infection of the central nervous system. Herpes. 2004 Jun;11 Suppl 2:95A-104A. Available at:
(95A)sup295A.pdf
McArthur JC, Brew BJ, Nath A. Neurological complications of HIV infection. Lancet Neurol. 2005 Sep;4(9):543-55
AIDS DEMENTIA COMPLEX (ADC)
Price R, Brew B. The AIDS Dementia Complex. J Infect Dis. 1988; 158: 1079 -1083
Price R, Sidtis J. Early HIV infection and the AIDS Dementia Complex. Neurology 1990; 40: 323 – 326.
Merigan Jr. Thomas C, Bartlett John G, Dani Bolognesi. Textbook of Aids Medicine (Second edition)
Neurosyphilis
(Romanowski B, Sutherland R, Fick GH, Mooney D, Love EJ. Serologic response to treatment of infectious syphilis. Ann Intern Med 1991; 114:1005-9.)
D.HIV AND WOMEN
PACTG 076, NEJM 19994, 331 (18): 1173 – 1180
A trial of shortened zidovudine regimen to prevent MTCT of HIV type 1, NEJM Vol 343 (14), 5th October 2000, pp 982 -991 (Thai study )
HIV NET 012 randomised trial, Lancet, 1999, 354 (9181) : 795 -802
PPTCT pdf file, NACO
HIV Screening in Pregnancy
Centers for Disease Control and Prevention. HIV testing among pregnant women- United States and Canada, 1998-2001. MMWR 2002 Nov.15;51(45):1013-1016
PPTCT of HIV/AIDS Foundation Training Programme Manual, p 36
HIV Testing Strategies
1. NACO HIV Testing Manual, pp 58 to 68
2. PPTCT of HIV/AIDS Foundation Training Programme Manual, pp 38 to 42
Counselling in the Antenatal Clinic
Women, Children and HIV Resource for prevention and treatment
E. STIs, RTIs AND HIV
(APAC) Prevention and Control Quality STD Care Module for private practitioners. AIDS Prevention and Control Project, Voluntary Health Services 1998.
(CDC) Sexually Transmitted Diseases Treatment Guidelines 2002 MMWR 2002; 51: 1-80.
(WHO) Guidelines for Management of Sexually Transmitted Infection.
WHO/HIV_AIDS/2001.01WHO/RHR/01.10.
(NACO) Practical considerations in diagnosis and treatment of STDs.
( NACO) Flow charts on the syndromic Management of Sexually Transmitted Infections. ( available as PDF documents on the web)
(NACO) Sexually Transmitted Infections – Treatment Guidelines
( available as PDF documents on the web)
(Grosskurth H, Rangaiyan G) The management and control of sexually transmitted infection, and their implications for AIDS control in South-east Asia (to be published in Journal of Health Management).
further reading
Hawkes S, Santhya K.G. Diverse realities: sexually transmitted infections and HIV in India. Sex. Transm. Infect. 2002; 78 (Suppl I): 131-39.
Rodrigues J.J, Mehendale S.M et al. Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India. BMJ 1995; 311:283-286.
Pedhambkar R.B, Pedhambkar B.S, Kura M.M. Study of risk factors associated with HIV seropositivity in STIs patients at Mumbai, India. Sexually Transmitted Infections 2001; 77:388-389.
Thomas K, Thyagarajan S.P et al. Community based prevalence of sexually transmitted diseases and human immunodeficiency virus infection in Tamil Nadu: a probability proportional to size cluster survey. National Medical Journal of India 2002; 15: 135-40.
Grosskurth H, Gray R et al. Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials. Lancet 2000; 355: 1981-7.
Allopathic private practitioner training module, APAC VHS 2003
F.HIV AND CHILDREN
1.WHO/UNAIDS/UNICEF infant feeding guidelines. Available at
2. Joint WHO/UNAIDS/UNICEF statement on use of cotrimoxazole as prophylaxis in HIV exposed and HIV infected children. Accessible at
3. Moss WJ, Clements CJ, Halsey NA. Immunization of children at risk of infection with human immunodeficiency virus. Bull World Health Organ 2003; 81: 61-70.
4. Mofenson LM, Oleske J, Serchuck L, Van Dyke R, Wilfert C. Treating opportunistic infections among HIV-exposed and infected children: recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. Clin Infect Dis 40: S1-84; 2005.
5. Guidelines for Preventing Opportunistic Infections Among HIV-Infected Persons — 2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. MMWR 51(No. RR-8): 1-52, 2002.
6. Antiretroviral treatment of HIV infection in infants and children in resource-limited settings, towards universal access: Recommendations for a public health approach (2006 revision), Final Draft February 2006, World Health Organization.
Available at
7. Pediatric Antiretroviral Drug Dosing Guide, National AIDS Control Organisation (NACO), 2006.
Further reading
1. HIV/AIDS in infants, children and adolescents. Pediatric Clinics of North America February 2000; 47 (1). WB Saunders Company, Philadelphia.
2. Yogev R, Connor E (eds) Management of HIV infection in infants and children. (1992), Mosby-Year Book Inc., St.Louis.
3. Pizzo P.A., Wilfert CM (eds) Pediatric AIDS (1998). Williams and Wilkins, Baltimore.
4. Verghese VP, Cherian T, Cherian A.J., Babu P.G., John TJ, Kirubakaran C, Raghupathy P (2002). Clinical manifestations of HIV-1 infection. Ind Pediatr 39: 57-63.
G.INFECTION CONTROL AND EXPOSURE PREVENTION
1. hiv/resources/factsheets/hcwprev.htm
2. who.int/mediacentre/factsheets/fs231/en/
3. American Journal of Infection Control, Feb 2005, Vol 33, No1, Kermode M et al
4. Annals of Internal Medicine 1996; 125:917-28
5. J. Hosp Infect 2005 Aug; 60 (4): 368-78, Mehta A et al
6. Indian Journal of Occupational & Environmental Medicine 2006, Vol 10, Issue 1, Pg 35 -40; Tetali S et al
7. Universal precautions for prevention of transmission of HIV and other blood borne infections.
8. CDC (2001) Updated U.S Public Health Service Guidelines for the management of occupational exposures to HBV, HCV and HIV and recommendations for post-exposure prophylaxis. MMWR 50/No. RR-11: 1-54.
a. pg. 24
b. pg 25
c. pg. 47
d. pg. 13
e. pg. 46
9. CDC (September 2005) Updated U.S. Public Health Service Guidelines for the management of occupational exposures to HIV and recommendations for post exposure prophylaxis. MMWR54 (RR09); 1-17
Other reference sources:
Hospital Infection Control Committee, Christian Medical College and Hospital (2001) Guidelines and policies in HIV care
International Health Care Safety Centre (1998). Annual Number of Occupational Percutaneous Injuries and Mucocutaneous Exposures to Blood or Potentially Infective Biological Substances.
Immunisation Action Coalition. Hepatitis B and the health care worker
CDC (1987) Recommendations for prevention of HIV transmission in health-care settings. MMWR 36(suppl no. 2S).
CDC (1988) Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other blood borne pathogens in health-care settings. MMWR 37:377-388.
CDC (1989) Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR 38(S-6):1-36.
Lin EY, Burnicardi FC (1994) HIV Infections and Surgeons. World J Surg; 18(5): 753-8.
Smoot EC (1998) Practical Precautions for Avoiding Sharp Injuries and Blood Exposure. Plastic Recons Surg. 101(2): 528-34.
Schiff SJ (1990) A surgeon's risk of AIDS. J Neurosurg 73 (5):651-60.
Crombleholme WR (1990) HIV Infection. Managing exposure risks for the Obstetrician / Gynecologist. Obstet Gynecol Clin. North Am. 17 (3): 627-36.
Stotter AT, Vipond MN, Guillou PJ (1993) The response of general surgeons to HIV in England and Wales. Ann R Coll Surg Engl. 75(5): 330-2.
Gerberding JL, Littell C, Tarkington A, Brown A, Schecter WP (1990) Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 322:1788-93.
Zuger A, Miles SH. Physicians, AIDS, and occupational risk: Historic traditions and ethical obligation. JAMA 1987; 258:1924-8.
Selecting, evaluating and using sharp disposal containers.
Post graduate Medical Journal 2003; 79: 324-328
MMWR Dec23, 2005/54 (RR16) :1-23
H.ANTIRETROVIRAL THERAPY
The US Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents - October 10, 2006 (Available at: )
The British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy 2005 (Available at: )
WHO Guidelines: Antiretroviral therapy for HIV infection in adults and adolescents in resource-limited settings: towards universal access. Recommendations for a public health approach (Available at: )
NACO ART Guidelines (Available at: )
Highly Active Antiretroviral Therapy
Palella FJ Jr et. al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853-60.
Sterne JA et al. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study.
Lancet. 2005;366(9483):378-84.
Walensky RP et al. The survival benefits of AIDS treatment in the United States. J Infect Dis. 2006;194(1):11-9.
Freedberg KA et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med. 2001;344(11):824-31.
Badri M et al. Cost-effectiveness of highly active antiretroviral therapy in South Africa. PLoS Med. 2006;3(1):e4.
Evolution of ART
Concorde: MRC/ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection. Concorde Coordinating Committee. Lancet 1994;343: 871-881
Delta: a randomised double-blind controlled trial comparing combinations of zidovudine plus didanosine or zalcitabine with zidovudine alone in HIV-infected individuals. Delta Coordinating Committee.
Lancet. 1996;348(9023):283-91.
Hammer, S.M. et al . A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med 1997;337: 725-733
Gulick RM, Mellors JW, Havlir D, Eron JJ, Gonzalez C, McMahon D, et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med 1997;337: 734-9
Staszewski S et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N Engl J Med. 1999;341(25):1865-73.
van Leth F et al. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study. Lancet. 2004;363(9417):1253-63
Walmsley S., Bernstein B. et al Lopinavir-Ritonavir versus Nelfinavir for the Initial Treatment of HIV Infection. N Engl J Med 2002; 346:2039-2046.
Gallant JE et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA. 2004;292(2):191-201
.
Gallant JE et al. Tenofovir DF, emtricitabine, and efavirenz vs. zidovudine, lamivudine, and efavirenz for HIV. N Engl J Med. 2006;354(3):251-60.
I.SAFE BLOOD BANKING
1. Sudarsanam A. (1998) Increasing prevalence of HIV antibody among blood donors monitored over 9 years in one blood bank. Ind. Jl. Med. Research 1998
2.Harris VK, SC Nair, PK Das, U Sitaram, YN Bose, A Sudarsanam, E Mathai (1999). Prevalence of syphilis and parasitic infections among blood donors in a tertiary care centre in Southern India. Annals of Tropical Medicine and Parasitology 93: 163-65.
3.Das PK, Harris VK, Shoma B, Bose YN, Annie S. (1999) Trend of hepatitis B virus infection in southern Indian blood donors. Indian J Gastoenterol. 18: 182
4. Hazra SC, Chatterjee S, Das Gupta S, Chaudhuri U, Jana CK, Neogi DK (2002). Changing scenario of transfusion-related viral infections. J Assoc Physicians India, 50:879-81.
5. Kapur S, Mittal A. Incidence of HIV infection & its predictors in blood donors in Delhi. Indian J Med Res, 108:45-50.
J. HIV AND GASTROINTESTINAL TRACT
Dieterich D.T, Poles M.A, Cappell M.S, Lew E.A. (1999) Gastrointestinal manifestations of HIV disease including peritoneum and mesentery. In Merigan T.C, Bartlett J.G, Bolognesi D (eds) Textbook of AIDS Medicine. Williams and Wilkins.
Main J, McNair A, Goldin R, Thomas H.C. (1999). Liver Disease and AIDS In Merigan T.C, Bartlett J.G, Bolognesi D (eds) Textbook of AIDS Medicine. Williams and Wilkins.
Wilcox C.M, Friedman S.L. (1998) Gastrointestinal Manifestations of Acquired Immunodeficiency Syndrome. In Feldman M, Scharschmidt B.F, Sleisenger M.H (eds) Gastrointestinal and Liver Disease. Saunders.
Smith P.D, Wilcox C.M. (1999) Sastrintestinal Complications of the Acquired Immunodeficiency Syndrome. In Yamada T, Alpers D.H, Laine L, Owyang C, Powell D.W. (eds) Testbook of Gastroenterology.Lippincott Williams and Wilkins.
FURTHER READING
1. Mukhopadhya A, Ramakrishna BS, Kang G, Pulimood AB, Mathan MM, Zachariah A, Mathai DC. (1999) Enteric pathogens in southern Indian HIV-infected patients with & without diarrhoea. Indian J Med Res 109:85-9.
2. Kelly P, Lungu F, Keane E, Baggaley R, Kazembe F, Pobee J, Farthing M. (1996) Albendazole chemotherapy for treatment of diarrhoea in patients with AIDS in Zambia: a randomised double blind controlled trial. BMJ 312(7040):1187-91
K. PSYCHOLOGICAL CARE IN HIV
Arroll B and contributors. (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal 327:1144-1146.
National Institute on Alcohol Abuse and Alcoholism (2002). Alcohol and HIV/AIDS Alcohol Alert No. 57: available at:
(). Accessed June 10, 2007
3. Catalan J and contributors. (1999) Mental health and HIV infection. Psychological and Psychiatric aspects. London: UCL press.
4.Work group on HIV/AIDS. (2000) Practice guidelines for the treatment of patients with HIV/AIDS. American Journal of Psychiatry 157: supplement.1-62.
5. Green J & McCreaner. (1989) Counselling in HIV infection and AIDS. Oxford:
Blackwell.
6.World Health Organisation. (1990) Guidelines for counselling about HIV infection and Disease. WHO AIDS series 8. WHO: Geneva.
7. Green J & McCreaner A. (1989) Counselling in HIV Infection and AIDS. Blackwell Scientific Publications: Oxford .
8. Olantunge B O and contributors. (2006). A review of treatment studies of depression in HIV. Topics in HIV Medicine 14:112-124.
9. Royal College of Psychiatrists. Guidelines for the prescribing of medication for mental health disorders in people with HIV infection. London (UK): Royal College of Psychiatrists; 2004 Apr. 23 p. (Council report; no. CR127).
10. Tharyan P, Ramalingam S, Kannangai R, Sridharan G, Muliyil J, Tharyan A. (2003) Prevalence of HIV infection in psychiatric patients attending a general hospital in Tamil Nadu, South India. AIDS Care 15:197-205.
FUTHER READING
1. Ciesla JA, Roberts JE. (2001) Meta-Analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry 158: 725-730.
2. Goodkin K, Wikie FL, Concha M, Asthana D, Shapshank P, Douyon R, Fujimura, RK, LoPiccolo C. (1997) Subtle neuropsychological impairment and minor cognitive motor disorder in HIV-1 infection: neuroradiological, neurophysiological and virological correlates. Neuroimaging Clinics of North America 7: 561-579.
3. Lesserman J, Petitto JM, Gaynes BN, Barroso J, Golden RN, Perkins DO, Folds JD, Evans DL. (2002) Progression to aids, a clinical AIDS condition and mortality: psychological and physiological predictors. Psychological Medicine 32: 1059-1073.
4. Maslach C, Jackson SE. (1986). The Maslach Burnout Inventory. Manual (2nd edn). Palo Alto, CA: Consulting Psychologists Press
5. Miller D. (2000) Dying to care? Work, stress and burnout in HIV/AIDS. Social aspects of AIDS series. Taylor and Francis: Guildford
L. HIV AND TB
1. Jamison DT, Mosley WH. Disease control priorities in developing countries: health policy responses to epidemiological change. Am J Public Health 1991;81(1):15-22.
2. Hopewell PC PM, Maher D, Uplekar M, Raviglione MC. International Standards for Tuberculosis Care. Lancet Infectious Diseases 2006;6:710-25.
3. World Health Report 2004: Changing History; 2004.
4. WHO Report 2006. Global Tuberculosis Control. Surveillance, Planning, Financing; 2006.
5. TB India 2006. RNTCP Status Report.; 2006.
6. Corbett EL, Watt CJ, Walker N, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 2003;163(9):1009-21.
7. Disease Control Priorities Project. HIV and TB.; 2006.
8. HIV/AIDS epidemiological Surveillance & Estimation report for the year 2005; 2005.
9. Narain JP, Lo YR. Epidemiology of HIV-TB in Asia. Indian J Med Res 2004;120(4):277-89.
10. Narayanan S DS, Garg R, Hari L, Bhaskara V, Frieden T, Narayanan P. Molecular Epidemiology of Tuberculosis in a Rural Area of High Prevalence in South India: Implications for Disease Control and Prevention. Journal of Clinical Microbiology 2002;40(12):4785-8.
11. Swaminathan S, Ramachandran R, Baskaran G, et al. Risk of development of tuberculosis in HIV-infected patients. Int J Tuberc Lung Dis 2000;4(9):839-44.
12.Sharma SK MA, Kadhiravan T. HIV-TB co-infection: Epidemiology, diagnosis & management. Indian J Med Res 2005;121(April):550-67.
13. Small PM, Shafer RW, Hopewell PC, et al. Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med 1993;328(16):1137-44.
14. Whalen C, Horsburgh CR, Hom D, Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Care Med 1995;151(1):129-35.
15. Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1999;340(5):367-73.
16. TB/HIV. A Clinical Manual; 2004.
17.Behr MA, Warren SA, Salamon H, et al. Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli. Lancet 1999;353(9151):444-9.
18. Canadian TB Standards. . 5 ed; 2000.
19.Gedde-Dahl T. Tuberculous infection in the light of tuberculin matriculation. Am J Hyg 1952;56(2):139-214.
20. Steingart KR, Henry M, Ng V, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis 2006;6(9):570-81.
21. Steingart KR, Ng V, Henry M, et al. Sputum processing methods to improve the sensitivity of smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis 2006;6(10):664-74.
22. Managing the Revised National Tuberculosis Program in Your Area. ATraining Course; 2005.
23. Pai M, Riley LW, Colford JM, Jr. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4(12):761-76.
24. Dheda K, Lalvani A, Miller RF, et al. Performance of a T-cell-based diagnostic test for tuberculosis infection in HIV-infected individuals is independent of CD4 cell count. Aids 2005;19(17):2038-41.
25.Enarson D RH, Arnadottir T, Trebucq A. Management of Tuberculosis - A guide for Low Income Countries; 2000.
26. Tuberculosis Control in India. New Delhi: Directorate General of Health Services. Ministry of Health and Family Welfare; 2005.
27. Treatment of Tuberculosis - Guidelines for National Programs. Geneva; 2003.
28.Alpert PL ea. A prospective study of tuberculosis and human immunodeficiency virus infection: clinical manifestations and factors associated with survival. . Clinical Infectious Diseases 1997;24:661-8.
29. Alwood K ea. Effectiveness of supervised, intermittent therapy for tuberculosis in HIV infected patients. AIDS 1994;8:1103-8.
30.Onyebujoh P, Zumla A, Ribeiro I, et al. Treatment of tuberculosis: present status and future prospects. Bull World Health Organ 2005;83(11):857-65.
31. Toman’s Tuberculosis. Case Detection, Treatment and Monitoring - Questions and Answers. 2nd ed. Geneva: WHO 2004.
32. Kwara A, Roahen-Harrison S, Prystowsky E, et al. Manifestations and outcome of extra-pulmonary tuberculosis: impact of human immunodeficiency virus co-infection. Int J Tuberc Lung Dis 2005;9(5):485-93.
33.Jindani A, Nunn AJ, Enarson DA. Two 8-month regimens of chemotherapy for treatment of newly diagnosed pulmonary tuberculosis: international multicentre randomised trial. Lancet 2004;364(9441):1244-51.
34. Matchaba PT, Volmink J. Steroids for treating tuberculous pleurisy. Cochrane Database Syst Rev 2000(2):CD001876.
35.Prasad K, Volmink J, Menon GR. Steroids for treating tuberculous meningitis. Cochrane Database Syst Rev 2000(3):CD002244.
36. Mayosi BM, Ntsekhe M, Volmink JA, Commerford PJ. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev 2002(4):CD000526.
37.Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A. Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart 2000;84(2):183-8.
38. Hargreaves NJ, Kadzakumanja O, Whitty CJ, Salaniponi FM, Harries AD, Squire SB. 'Smear-negative' pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence. Int J Tuberc Lung Dis 2001;5(9):847-54.
39.Perriens JH, St Louis ME, Mukadi YB, et al. Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months. N Engl J Med 1995;332(12):779-84.
40. Elliott AM ea. The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia. . Transactions of the Royal Society of Tropical Medicine and Hygiene 1995;89:78-82.
41. Treatment of Tuberculosis; 2003 June 20.
42. Badri M, Wilson D, Wood R. Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study. Lancet 2002;359(9323):2059-64.
43. Dheda K, Lampe FC, Johnson MA, Lipman MC. Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy. J Infect Dis 2004;190(9):1670-6.
44. Antiretroviral Therapy for HIV Infected Adults and Adolescents in Resource-limited Setting: Toward Universal Access - Recommendations
for a public health approach; 2006.
45. The HIV-TB Coinfection. Program Coordination Guidelines for Clinincians and Standard Operating Procedures; 2004.
46.Wilkinson D, Squire SB, Garner P. Effect of preventive treatment for tuberculosis in adults infected with HIV: systematic review of randomised placebo controlled trials. Bmj 1998;317(7159):625-9.
47. Grant AD, Charalambous S, Fielding KL, et al. Effect of routine isoniazid preventive therapy on tuberculosis incidence among HIV-infected men in South Africa: a novel randomized incremental recruitment study. Jama 2005;293(22):2719-25.
48. Colditz GA, Brewer TF, Berkey CS, et al. Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. Jama 1994;271(9):698-702.
49.Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet 2006;367(9517):1173-80.
50. Kumarasamy N, Chaguturu S, Mayer KH, et al. Incidence of immune reconstitution syndrome in HIV/tuberculosis-coinfected patients after initiation of generic antiretroviral therapy in India. J Acquir Immune Defic Syndr 2004;37(5):1574-6.
51. Kwara A, Flanigan TP, Carter EJ. Highly active antiretroviral therapy (HAART) in adults with tuberculosis: current status. Int J Tuberc Lung Dis 2005;9(3):248-57.
52. Lipman M, Breen R. Immune reconstitution inflammatory syndrome in HIV. Curr Opin Infect Dis 2006;19(1):20-5.
53.Stoll M SR. Adverse events of desirable gain in immunocompetence: the Immune Restoration Inflammatory Syndromes. Autoimmunity Reviews 2004;3:243-9.
54. Swaminathan S, Paramasivan CN, Ponnuraja C, Iliayas S, Rajasekaran S, Narayanan PR. Anti-tuberculosis drug resistance in patients with HIV and tuberculosis in South India. Int J Tuberc Lung Dis 2005;9(8):896-900.
55. DOTS-Plus Guidelines; 2006.
56.Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis; 2006.
57. Nathanson E ea. Multidrug-resistant Tuberculosis Management in Resource-limited Settings. Emerging Infectious Diseases 2006;12(9):1389-97.
58. Charlotte R. Hawkey TY, Janis Pereira, David A. J. Moore, Robert N. Davidson, Geoffrey Pasvol, Onn Min Kon, Robert A. Wall, Robert J. Wilkinson. Characterization and Management of Paradoxical Upgrading Reactions in HIV-Uninfected Patients with Lymph Node Tuberculosis
Clinical Infectious Diseases 2005;40(May 1):1368.
59. Dube MP, Holtom PD, Larsen RA. Tuberculous meningitis in patients with and without human immunodeficiency virus infection. Am J Med 1992;93(5):520-4.
60. Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM, Jr. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2003;3(10):633-43.
61. Dittrich S, Yordi LM, de Mattos AA. The value of serum-ascites albumin gradient for the determination of portal hypertension in the diagnosis of ascites. Hepatogastroenterology 2001;48(37):166-8.
62. Miguez-Burbano MJ, Shor-Posner G, Hadrigan S. Non-tuberculous mycobacteria in HIV-infected patients: geographic, behavioural, and immunological factors. Lancet Infect Dis 2005;5(7):394-5; author reply 6.
63. Karakousis PC, Moore RD, Chaisson RE. Mycobacterium avium complex in patients with HIV infection in the era of highly active antiretroviral therapy. Lancet Infect Dis 2004;4(9):557-65.
64. Jones D, Havlir DV. Nontuberculous mycobacteria in the HIV infected patient. Clin Chest Med 2002;23(3):665-74.
65. Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America; 2004.
66. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med 1997;156(2 Pt 2):S1-25.
67. Guidelines for the Prevention of Opportunistic Infections Among HIV-Infected Persons. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America; 2002.
M. HIV AND FEVER
1.USPHS/IDSA (2002) Guidelines for the prevention of opportunistic infections in persons infected with Human Immunodeficiency Virus- 2002.
2.Rupali P, Abraham OC, Zachariah A, Subramanian S, Mathai D. Aetiology of prolonged fever in antiretroviral naïve human immunodeficiency virus infected adults. Natl Med J India 2003 Jul-Aug 16(4): 193-9.
3.Sullivan M, Feinberg J. Bartlett JG (1996) Fever in patients with HIV infection. Infec Dis Clin North Am ; 10 : 149-165.
4.World Health Organization (1990) Acquired immune deficiency syndrome (AIDS): interim proposal for a WHO staging system for HIV-1 infection and disease. Wkly Epidemiol Rec 65: 221-228.
Subhash HS, Christopher DJ, Roy A, Cherian AM. Pulmonary nocardiosis
in HIV infection: a tuberculosis mimic. Journal of postgraduate medicine:
2001; 47 ( 1): 30-2.
Treating Opportunistic Infections Among HIV-Infected Adults and
Adolescents. Recommendations from CDC, the National Institutes of
Health, and the HIV Medicine Association/Infectious Diseases Society of
America December 17, 2004 / 53(RR15);1-112;
mmwr/preview/mmwrhtml/rr5315a1.htm
HIV and transmission of leishmania, Ann. Trop Med Parasitol, 2003 Oct;
97 Suppl 1:24 – 45
Regis A.V, Chris J.F, Jeffrey L.J. et al. Clinical epidemiology of Hodgkin’s
Lymphoma in HIV- infected patients in the HAART era. Medicine
Baltimore).2003 Mar;82(2): 77 -81.
Nicolas M., Michele S., Jean G. et al. AIDS-related non-Hodgkin’s lymphoma: final analysis of 485 patients with risk-adapted intensive chemotherapy. Blood, May 2006;107(10):3832-3840.
Naresh S.R., Ayan D., Veena B., et al. Leishmania-HIV coinfection: An emerging problem in India. AIDS May 2006. 20(8):1213-1215.
Israel C., Javier M., Carmen C. et al. Leishmania/ HIV co-infections in the second decade. Indian J. Med. Res. March 2006; 123:357-388.
Purva M., J.C. Samantaray, Madhu V. et al. Visceral leishmaniasis/ human immunodeficiency virus co-infection in India: the focus of two epidemics. Journal of Medical Microbiology 2006; 55:919-922.
Eline L.K., Brian G.W., Sake J. de Vlas et al. Malaria attributable to the HIV-1 Epidemic, Sub-Saharan Africa. Emerging Infectious Diseases. eid.vol. 11(9), Sept 2005.
D. Wilson, J.Nachaga, R.Chaisson. G.Maartens. Diagnosing smear-negative tuberculosis using case definitions and treatment response in HIV-infected adults. International Journal of Tuberculosis and Lung Disease 2006;10 (1):31-38.
Suggested reading
1. Khasnis AA, Karnad DR. Human Immunodeficiency Virus Type 1 Infection in Patients with Severe Falciparum Malaria in Urban India. J Postgrad Med 2003;49:114-117.
2. Moses R.K., Anne F.G., Adoke Y. et al. Effect of HIV-1 Infection on Anti-malarial Treatment Outcomes in Uganda: A Population-Based Study. The Jornal of Infectious Diseases 2006;193:9-15.
3. R.Russo, F. Laguna, R. Lopez-Velez, et al. Visceral leishmaniasis in those infected with HIV: clinical aspects and other opportunistic infections.Annals of Tropical Medicine & Parasitology 2002,vol.97, suppl no.1, S99-S105.
4.Text book of AIDS Medicine , 2nd Edition 1999 Thomas C. Merigan, Jr; John G. Barlett & Dani Bolognesi; Willimas and Wilkins, USA.
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