Introduction to HIV (Part 4)



1: Call out the patient’s identifier and invite them to the counselling room if there is one available, or a private area at the hatch. Introduce yourself to the patient and confirm the patient’s identity by checking their date of birth and name.

2: Check the patients allergy status and whether the patient is on any other

prescribed medication, medication bought over the counter, recreational drugs, herbal, homeopathic or vitamin/mineral supplements.

Specifically ask about inhalers, nasal sprays, eye drops, injections, (even if only given once) and creams.

If the patient is taking anything new, first check the HIV specialist drug interaction resources for any potential interactions and then consult with a specialist HIV pharmacist if you are unsure how to proceed.

3: Always show the patient the medication and quantity you are giving them. If there are any short-dated items, bring this to the attention of the patient. Advise them to use any short-dated medication first and use longer dated packs later to ensure that they will not expire before they can be used.

4: Ask the patient how they are managing with their medication and check for any missed doses e;g how many doses did you miss in the last week. If there is time and it is appropriate review their adherence.

5: Once the medication has been given out, direct them to make another appointment (if not already done so) or wait for another member of staff to call them if appropriate.

For patients starting ART (For switching can use an abbreviated form of this)

Have the following ready

-Patients notes and samples of the medication

-Patient information leaflets (PILs) for the ART (see

-Supporting information from NAM, i-base or locally produced information and details about opening hours and contact details.

Counselling checklist (see below two possible versions)

The counselling checklist can be kept close by, though a consultation flows better when you dont need to look at the sheet. Review the checklist before seeing the patient and when the appointment is over, document the consultation in the notes and tick everything that was discussed on the counselling checklist. Throughout the consultation remember to use simple language that the patient can understand and avoid using medical jargon and abbreviations. Ensure the patient has the chance to ask questions and have their concerns addressed during the consultation. Try to ascertain the patients understanding of what is explained as you go along and give the patient opportunity to ask questions.

  1. Introduction

  1. General information on ART – Check patients understanding of…

  1. Individual drugs: (see the full training module or the individual drug sheets or the SPC for specific details)

Efavirenz should be taken on an empty stomach to minimise side effects but in practice some patients find that taking it with food helps to reduce the side effects, hence advise the patient that they can do whichever works best for them.

Tenofovir SPC states for it to be taken with food but explain to the patient that this is not necessary for therapeutic levels and that in practice it is ok to be taken without food

Eviplera needs to be taken with a meal, but it can be a small meal such as breakfast, but not a protein shake. Supply the patient with the information sheet for Eviplera and if appropriate show them how to make up the food requirement.

Boosted Atazanavir, Boosted Darunavir, Etravirine, Stribild and Genvoya should be taken with food.

Raltegravir, Dolutegravir, Bictegravir, Doravirine, Abacavir, Lamivudine, Emtricitabine, Zidovudine, Nevirapine, Maraviroc and Kaletra can be taken with or without food.

  1. Medication and lifestyle

  1. Adherence

(i.e. *If patients are taking a once daily treatment, 95% adherence means missing no more than one dose a month. If patients are taking twice a day, 95% adherence means missing no more than three doses a month)

      1. Alarm on their mobile phone

      2. Dosette boxes: Some patients find it helpful to know they have taken the medication so a small version may be useful for this purpose. They are also beneficial for when patients are going away or for those with difficulties reading bottles or taking many additional medicines. Check who will fill them? (Generally, nurses are not authorized to fill dosettes; ‘Carers’ and patients filling it together is probably the safest arrangement)

      3. Small pill boxes: For nights out and for keeping an extra supply at work or partners/friend’s house

6) Interacting medication

-OTC products

-Drugs prescribed by their GP

-Inhalers, injections, creams, eye/ear/nose drops particularly looking for steroid preparations including one off injections.

-Herbal and homeopathic remedies and supplements

-Recreational drugs (Important as their use is widespread in our patient cohort)

7) Missed doses and vomiting

The SPCs for most ART have specific guidance for missed doses. But as a general rule, for once daily dosing medication if the patient forgets to take their usual dose and remembers within a 12 hour period, advise them to take their missed dose. However, if the patient remembers after 12 hours have lapsed, the patient should wait for their next dose. For twice daily dosing medication the above rule applies, however for a 6 hour period.

Explain that if the patient has prolonged or profuse diarrhea that it may interfere with the absorption of their medication and to contact the clinic for advice.

8: Additional information


This is an opportunity to review how the patient is managing with their ART and to check their adherence and any potential new drug interactions.

Click here for the Checklist for adherence




Click here for the Pharmacy counselling checklist


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