HIV - Full Management Guide for Refugee Patients

Overview

HIV infection is screened as part of the routine initial refugee assessment (with patient consent). A positive HIV serology requires confirmation with a supplementary test, which is performed automatically by the laboratory. Once confirmed, the following steps should be completed promptly.

HIV can carry significant stigma in many cultures. All steps below should be handled with exceptional sensitivity and confidentiality.

Step 1 - Post-Diagnosis Counselling

Announce the diagnosis only with the patient alone in the room. Use a professional interpreter if needed. Never use family members to interpret for an HIV diagnosis.

*     Explain the diagnosis clearly in understandable terms

*     Emphasize confidentiality. Reassure the patient that this information will not affect their refugee claim.

*     Explain modes of transmission (sexual contact, blood-to-blood, mother-to-child)

*     Explain that effective antiretroviral treatments are available in Canada and that HIV is now a manageable chronic condition

*     Assess for immediate psychological distress. Offer support and follow-up.

Step 2 - Assess for Opportunistic Infections

If the patient has any of the following symptoms, refer to the Emergency Department immediately.

*     Fever

*     Cough or shortness of breath (rule out PCP pneumonia)

*     Severe or profuse diarrhea

*     Dysphagia or odynophagia (rule out esophageal candidiasis)

*     Headache with neck stiffness or photophobia (rule out cryptococcal meningitis)

*     Focal neurological symptoms or seizures

*     Significant weight loss or wasting

Step 3 - Report the Infection

HIV is a notifiable disease in Alberta. Contact the AHS Communicable Disease Unit:

*     Phone: 403-955-6750

*     Fax: 403-955-6755

Reporting is mandatory regardless of whether the patient is referred to a specialist.

Step 4 - Referral to the Southern Alberta HIV Program

All patients with HIV in southern Alberta should be referred to the Southern Alberta Clinic (SAC) at Sheldon M. Chumir Health Centre.

*     SAC Referral Fax: 403-955-6355

The SAC will order all baseline investigations, initiate antiretroviral therapy, provide vaccinations, and coordinate all HIV-specific care. The family physician does not need to initiate investigations or treatment before the SAC appointment.

Step 5 - Counsel Partners and Contacts

Sexual partners and children (if the patient is a woman of reproductive age) should be offered HIV testing. The SAC team can assist with partner notification if needed.

Step 6 - Ongoing Role of the Family Physician

Once the patient is established with the SAC, the family physician continues to:

*     Provide general preventive care and manage non-HIV medical conditions

*     Monitor for antiretroviral side effects at routine visits (common: nausea, diarrhea, lipid changes, renal function changes depending on regimen)

*     Reinforce adherence to antiretroviral therapy

*     Screen for and manage comorbidities: cardiovascular disease, mental health, substance use

*     Co-ordinate with the SAC for any acute issues related to HIV

Key Resources

*     Southern Alberta Clinic (SAC): Sheldon M. Chumir Health Centre, Calgary

*     CATIE - Canadian HIV Treatment Guidelines: catie.ca