Table 4. HIV knowledge domain covered in each workshop.
STIs, sexually transmitted infections; PLHIV, people living with HIV; ART, antiretroviral treatment; PWIDs, people who inject drugs; PPTCT, parent-to-child transmission; VMMC, voluntary medical male circumcision; IRIS, immunoreconstitution inflammatory syndrome
| Basic science | Clinical progression and pathogenesis |
| What are HIV and AIDS? Structure of the HIV virus. Modes of transmission. Natural history of HIV transmission | Seroconversion. Acute retroviral syndrome. Asymptomatic HIV infection. Symptomatic HIV infection (AIDS). Some common opportunistic infections in HIV/AIDS patients. HIV care continuum |
| HIV epidemiology | HIV counseling |
| Epidemiology of HIV/AIDS. Estimated PHIV, new HIV infections, and AIDS-related deaths, 1990-2021. Epidemiology of HIV/AIDS HIV prevalence among key populations, 2005-recent HIV prevalence among key populations, 2016-recent HIV/AIDS situation in Asia HIV/AIDS in Pakistan. UNAIDS fast-track strategy to end AIDS by 2030 | Definition of counseling. Difference between counseling and education. Characteristics of a counselor. Characteristics of counseling session. Key principles of counseling. The steps that the counselor should follow. Purpose of HIV counseling. Pre- and post-test counseling including positive and negative patients. How to disclose HIV status to partner (sexual partner). Counseling for the prevention of HIV transmission. Counseling for ART adherence. How to counsel patients for ensuring follow-up counseling for specific groups |
| Providing user-friendly, high-quality HIV/AIDS prevention, diagnosis, treatment, and care and support services to key populations | HIV/AIDS prevention evidence-based recommendations |
| Define terms, key populations, and vulnerable populations and understand the behaviors of key populations. Define stigma and discrimination and how stigma undermines the health of key populations. Challenges faced by key populations in accessing healthcare services. Provide user-friendly services to key populations according to WHO recommendations. Ensure the confidentiality and privacy of the client. Understand why it is necessary to provide services under one roof. Know community-based HIV prevention services for key populations. Coordinate with NGOs and CBOs working with key populations | Evidence-based recommended strategies for HIV/AIDS prevention. How to prevent sexual transmission of HIV. Role of HIV testing and counseling in the prevention of HIV transmission. ART as an HIV prevention tool. Role of harm reduction program in the prevention of HIV transmission among PWIDs. Role of prevention of PPTCT of HIV. Role of VMMC. Role of safe injection practices, screening of blood before transfusion, and infection control in the prevention of HIV transmission |
| Comprehensive history-taking and focused clinical examination of HIV/AIDS patient | Video on clinical examination |
| How to assess the risk of the client for HIV and current health status. How we may take comprehensive history ensuring privacy and confidentiality in a non-judgmental manner. Conduct physical, genital, and rectal examinations including documentation of vital signs, height, weight, and systemic examination. Perform vaginal examination of women with vaginal speculum and conduct pap test. Perform rectal examination of men and women with a proctoscope and collect specimens for diagnostic test | Signs and symptoms of STIs among men and women. In the session, a video was displayed on signs and STIs among male and female patients |
| Role play on history-taking skill | HIV testing and diagnosis |
| What are good history-taking skills? A role play was demonstrated in front of participants to show them what good history-taking skills are and what are the common mistakes we make during history taking of a vulnerable person. Trainees among the participants take part in the role play. | Characteristic of HIV tests used in Pakistan approved by WHO. Rationale for HIV screening, confirmatory and molecular (PCR) tests. Guiding principles of HIV testing include 5Cs: consent, confidentiality, counseling, correct test results, connection to the care, and support services. WHO recommended HIV diagnosis, and three test strategies on rapid testing kits. Screening and conformity tests, including sensitivity and specificity of WHO-recommended HIV testing kits. Voluntary HIV confidential counseling and testing, care provider-initiated HIV testing and counseling, community-based HIV testing and counseling, and self-testing. Merits and demerits of different approaches. NAT and Viral load PCR tests, for diagnosis and monitoring and CD4 count, direct test, indirect test, and reference ranges for monitoring. |
| Clinical presentation of HIV | Antiretroviral therapy |
| Define HIV and AIDS. Identify the clinical presentation of HIV, elite responders, and IRIS. Describe and identify the clinical spectrum of HIV and categorize the disease according to the WHO staging in children and adults. Enlist differential diagnoses in patients presenting with symptoms involving different systems. The session was followed by the question and answer session | Define important terms used in ART. Providing ART to patients presenting at the ART center according to consolidated guidelines and monitoring patients on ART following recomposed protocol. Describe antiretroviral drugs, classification, and mechanism of action and resistance, and adverse effects of ARVs. Prescribe ART in adults, adolescents, children, and pregnant and lactating females |
| Live demonstration of HIV/HBV/HCV/syphilis serological tests | HIV co-infections and opportunistic infections: screening/clinical presentation/diagnosis/management/prevention |
| Alere HIV Combo - Early Detect Alere HIV – ½ Determine Unigold SD Bioline ½ 3.0 (Abbott) HBV. Determine HCV. Determine Syphilis TP (Abbott) | Screening of PLHIVs for opportunistic and co-infections. Diagnosing and treatment of viral hepatitis including hepatitis B, hepatitis C, and hepatitis D. Diagnosing, prevention, and treatment of AIDS-defining illnesses. Screening, prevention, diagnosing, and treatment of co-infections and opportunistic infections in PLHIV and CLHIV. Prescribe important vaccination |
| Therapy adherence; clinical presentation of HIV | TB HIV co-infection |
| Define adherence and describe the importance of adherence and the consequences of non-adherence. Identification of potential barriers to starting ART. Barriers to adherence. Monitoring adherence. Discuss strategies to promote adherence success. Discuss strategies to track lost to follow-up and reengage them. Basic strategies to re-initiate ART in lost to follow-up patients. Explain the link between adherence and resilience | Why it is important to learn about TB-HIV co-infection. How TB spreads. Natural history of TB infection and TB disease. How to deal with TB in PLHIV the three “S.” Intensify case finding in PLHIV. Identification of TB presumptive in PLHIV. Diagnosis of TB in PLHIV adults and children. How to ensure high-quality anti-tuberculosis treatment in PLHIV. Management of drug-sensitive TB. Management of drug resistance TB. Principle of management of TB in PLHIV. Special consideration in giving anti-TB drugs with ART. Time to start ART with ATT drug interaction. Management of side effects of ATT. Isoniazid preventive therapy for PLHIV. IRIS association with ART and ATT co-treatment and its management |
| STIs in PLHIVs | Screening and care of non-communicable diseases in children and adults |
| Importance of sexually transmitted infections in PHIV. Terms VDs, STDs, STIs, RTIs. STIs and reproductive tract infections. Classification of STIs, on an etiological basis and syndromic basis. Common symptoms and signs of STIs and epidemiology. How to assess risk for STI in men and women. Understand the relationship between HIV and STI and STI in PHIV. Importance of screening for STIs in PHIV (individual STIs to be screened and methods of screening). How to diagnose and provide evidence-based treatment of common STIs in PHIV on a syndromic basis | Understand the risk of non-communicable diseases in PLHIV. Screening and management of common NCDs in PHIV. Implementation of WHO Package of Essential Noncommunicable Diseases Interventions. Implementation of different components of care for children with HIV as recommended in consolidated guidelines. Identification of the non-communicable diseases in children and adults and timely reference to the subject experts |
| Infection prevention and control: laboratory safety, waste management | Data management of patients registered at the ART center and inventory/stock management |
| Understand the chain of infections. Hand washing steps, cough etiquette, sharp safety, safe injection practices, sterilization, and disinfection of patient care items and devices. Environmental infections prevention and control. Prevent the spread of pathogens and infection by using current techniques for hand hygiene and universal precautions. Protect yourself and those you serve by recognizing the chain of infections. How to identify, label, and dispose of hazardous waste. How to clean the facility - Guide and supervise cleaning/disinfection of facility | Maintenance of data on patients registered at the ART center manually and through MIS. Analyzation and reporting of patient data. Management of inventory/stock data manually and through LMIS. Understanding of different components of inventory management including procurement, storage, and distribution. Calculation and forecasting of consumption of ARV drugs, diagnostics, and consumables. Development of indent request. How to prevent stock-outs. How to avoid any stock losses/expiry |