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CURRICULUM
FELLOWSHIP PROGRAM
in HIV MEDICINE FOR
MEDICAL PROFESSIONALS
2012-2013
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
Page 1
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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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
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FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL
PROFESSIONALS
I.
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.
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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.
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II.
TITLE OF THE COURSE: Fellow in HIV Medicine.
III.
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.
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IV.
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.
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V.
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.
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RECOGNITION OF THE INSTITUTION FOR THE COURSE:
VI.
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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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 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.
VII.
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.
VIII.
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.
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IX.
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
X.
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.
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SELECTION/ ADMISSION PROCEDURE
XI.
 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:
XII.
The course of study shall be for a period of 12 months.
XIII.
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.
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XIV.
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.
XV.
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.
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XVI.
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
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h. Counseling Department – 15 days
XVII. MEDIUM OF INSTRUCTION:
The Medium of Instruction shall be English.
XVIII. 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
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Examination components and distribution of marks
A
1
2
3
4
B
1
2
Particulars
THEORY
Marks
Theory – 2 papers
Internal Assessment (Theory)
Structured Viva Voce
PROJECT WORK – Presentation cum Viva Voce
Total Theory
PRACTICAL/CLINICAL
Clinical Examination ( 1 long case for 40 marks, 2 short cases for 25 marks each and
10 marks for spotters)
Internal Assessment (Practical)– including Log book, Fellow led seminars, teaching
sessions and Clinical Case discussions
Total Practical/Clinical
GRAND TOTAL
50x2=100
30
25
25
180
100
70
170
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
Objective type
Short answer
Short Essay type
Essay type
TOTAL MARKS
Number of questions
10
05
03
01
Marks for each question
1
2
5
15
Total marks
10
10
15
15
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

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
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
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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.
XIX.
CERTIFICATION:
Based on the recommendations made by the Examiners successful candidates shall be awarded
the ‘Fellow’ scroll by Rajiv Gandhi University of Health Sciences.
XX.
STIPEND:
The institution shall pay stipend equivalent to that of a resident.
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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
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XXI.
FELLOWSHIP COURSE CURRICULUM:
Fellowship curriculum: total 300 days of 303 accounted (365-52 Sundays-10 holidays = 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
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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.
b.
c.
d.
e.
f.
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)
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)
Baseline psychosocial evaluation;( 3 hour session: 1 hr classroom, 2 hr bedside)
 Quality of life assessments
 Screening for depression
Nutrition counseling, Safe water, safe food (one full session of 3 hours)
Hygiene , Partner counseling, Notification and Co-factors of transmission(one full session of 3
hours)
Transmission and prevention of HIV Infection.(one day)
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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.
b.
c.
d.
e.
f.
g.
h.
j.
i.
Respiratory symptoms
Cardiovascular symptoms
Gastro intestinal symptoms
Neurological symptoms
The red eye
Renal disorders
Fever
Joint pain
Dermatological disorders
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)
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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)
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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)
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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.
b.
c.
d.
e.
f.
g.
h.
i.
Hand hygiene (early on in year)- 0.5 hours
Aseptic and septic techniques (early on in year): 1.0 hours
Infection control overview-HIV and other blood borne pathogens (early on in year)- 1.0 hours
Infection control overview- TB, instrument process-overview (0.5 hours)
Effective infection control practices- one hour
Indwelling catheters – one hour
Managing medical waste- one hour
Post exposure prophylaxis: HCW exposure scenarios to review algorithms, discuss setting up a
system of reporting, tracking, and follow-up. ( 3 hour session)
Monitoring and evaluation of infection control practices 2 hours
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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Laboratory components(10 days)- Weave in with appropriate clinical sessions
VI.
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
2. Diagnosis of opportunistic infections (cultures, CNS infections, respiratory specimens, stool pathogens)
3. 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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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Social, Legal and Ethical Issues related to HIV
X.
(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,
Leadership in HIV programs
XI.
(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.
b.
c.
d.
e.
f.
Orphans and Vulnerable Children ; Early identification of HIV infected or exposed child; Management
of the HIV-exposed infant
Infant diagnosis; Clinical assessment of HIV infected child
Disclosure issues in Children
Growth & Development of a HIV infected child; Immunization, Nutritional support & counseling of
children with HIV infection
Identification and management of common illnesses and Opportunistic Infections in children
Antiretroviral therapy (ART); Management of children on ART- Adherence; ; follow up
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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
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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.
II.
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
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
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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 )
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XXII. TRAINING SKILLS:
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
Adult Learning Principles - 3 hrs
How to Develop Power Point Presentations-3 hrs
Training Methodologies -3hrs
Facilitation Skills- 1&1/2 hrs
How to Develop an Effective Training Programme -3hrs
How to Evaluate a Training Programme - 1&1/2hrs
How to write a Grant application- 3hrs
How to write a Good Abstract-3hrs
How to develop a Poster Presentation- 3hrs
How to develop a Case study-3hrs
XXIII. SCHEME OF PRACTICAL LEARNING DURING HIV FELLOWSHIP PROGRAM:
Skills
Able to
perform
independe
ntly
1. Counseling – Adult, Pediatric including Pre-Test, Post-Test,
Adherence and Nutritional
2. Laboratory Investigations like Fluid analysis, ZN staining,
gram’s staining, India Ink Preparation, , KOH Preparation,
3. Drug challenging Test and Cotrim Desensitization
+
4. Diagnosis and management of opportunistic Infections
+
5. Clinical staging and management of HIV patients
+
6. Procedures like Pleural, Peritoneal Tapping, Lumbar
Puncture, FNAC of Lymph Node and Bone Marrow
Aspiration
+
Able to
perform
under
guidance
Assist
Observe
+
+
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XXIV. 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
XXV. 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.
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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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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XXVI. 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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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XXVII. LEARNING RESOURCE MATERIALS
CONTENTS
1.TEXTBOOKS
PAGE
……………………………………………………………………………36
2.NATIONAL AND INTERNATIONAL GUIDELINES…………………..………………38
3.MEDICAL JOURNALS……………………………………………………….…………...41
4.INTERNET RESOURCES………………………………………………………………...44
5.TOPICWISE 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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
Page 35
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)
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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 editionClinical Management" and "Epidemiology & Prevention" AAHIV , 2007 edition
Epidemic Rothman / Park / Betty Kirkhood
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2. NATIONAL & INTERNATIONAL GUIDELINES:
World Health Organisation (WHO)
www.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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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
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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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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NATIONAL AIDS CONTROL ORGANISATION (NACO) GUIDELINES:
www.nacoonline.org/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 Postexposure
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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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CDC REFERENCES:
www.cdc.gov/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:
www.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
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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3.
MEDICAL JOURNALS:
New England Journal of Medicine : www.nejm.org
Journal of the American Medical Association: www.jama.ama-assn.org
The Lancet: www.thelancet.com
Clinical Infectious Diseases – University of Chicago Press:
www.journals.uchicago.edu/CID/index.htm
Journal of Infectious Diseases: www.journals.uchicago.edu/JID/home.htm
AIDS. Official journal of the International AIDS Society: www.aidsonline.com
Journal of Acquired Immunodeficiency Syndrome: www.jaids.com
AIDS and Behaviour Publisher: Springer Science+Business Media B.V., Formerly Kluwer
Academic Publishers B.V. www.springerlink.com/app/home/journal
AIDS Care. Psychological and Socio-medical aspects of AIDS/HIV
www.tandf.co.uk/journals/titles/09540121.asp
AIDS Patient Care and STDs. Publishers: Mary Ann Liebert Inc.
www.liebertpub.com/publications
AIDS Research and Human Retroviruses. Publishers: Mary Ann Liebert Inc.
www.liebertpub.com/publications
British Medical Journal www.bmj.com
Archives of Internal Medicine : http://archinte.ama-assn.org
Annals of Internal Medicine: www.annals.org
American Journal of Public Health: www.ajph.org
Journal of Association of Physicians of India www.japi.org
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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. www.aidsmap.com
AIDSinfo – HIV/AIDS information: HIV/AIDS treatment, prevention, medical research,
clinical trials, drugs, treatment guidelines, and vaccines for patients, health care providers,
Available at: http://www.aidsinfo.nih.gov/
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, ... www.unaids.org/
www.Clinicareoptions.com 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.
www.aegis.com/
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. www.amfar.org/ 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.
www.avert.org/
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, ...
www.cdc.gov/hiv/dhap.htm
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Elizabeth Glaser Pediatric AIDS Foundation A leading organization dedicated to identifying,
funding and conducting basic pediatric HIV/AIDS research. www.pedaids.org/
International AIDS Vaccine Initiative | IAVI - International AIDS ... aids vaccines IAVI.org is
the website of the International AIDS Vaccine Initiative. The International AIDS Vaccine
Initiative is a global organization www.iavi.org/ 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
...www.cdc.gov/hiv/pubs/facts.htm - More results from www.cdc.gov
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,
www.ias.se/
The John Hopkins HIV Guide http://www.hopkins-hivguide.org
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8. TOPICWISE REFERENCES:
A. HIV: BASIC SCIENCES AND LABORATORY TESTING
1. Gadkari DA, Moore D, Sheppard HW, et al. (1998) Transmission of genetically diverse
strains of HIV-1 in Pune, India. Indian J Med Res 107: 1-9.
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
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10.Kannangai R, Ramalingam S, Pradeepkumar S, Damodharan K, Sridharan G (2000) Hospitalbased 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.
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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. & GonzalezLahoz, 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 leukemiaassociated antigens. Gann 73(6), 848-9.
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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
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natural range of simian immunodeficiency virus-infected sooty mangabeys. J Virol 71(5), 395360.
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.
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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 HIV1 infected female sex workers in Nairobi. Lancet 1996; 347: 718-723.
FELLOWSHIP PROGRAM in HIV MEDICINE FOR MEDICAL PROFESSIONALS
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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.
http://www.nacoonline.org/guidelines/art_guidelines.pdf
Anti Retroviral Therapy for HIV infection in adults and adolescents in resource limited settings:
Towards universal access Recommendations for a public health approach
http://www.who.int/hiv/pub/guidelines/WHO%20Adult%20ART%20Guidelines.pdf
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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.
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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:
http://www.ihmf.org/journal/download/11Griffiths(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
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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
http://www.pmtct.org/wchiv
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
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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
http://www.unicef.org/programme/breastfeeding/feeding.htm
2. Joint WHO/UNAIDS/UNICEF statement on use of cotrimoxazole as prophylaxis in HIV
exposed and HIV infected children. Accessible at http://www.unaids.org/
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.
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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 http://www.who.int/hiv/pub/guidelines/en/index.html
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. www.cdc.gov/hiv/resources/factsheets/hcwprev.htm
2. www.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.
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http://www.cdc.gov/ncidod/hip/BLOOD/UNIVERSA.HTM
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.
http://hsc.virginia.edu/medcntr/centers/epinet/cdcestim.html
Immunisation Action Coalition. Hepatitis B and the health care worker
http://www.immunize.org
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.
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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.
http://medocs.ucdavis.edu/osu/421/orthopedic_ethics/case_6/case_6.htm
Selecting, evaluating and using sharp disposal containers.
http://www.cdc.gov/niosh/sharps
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:
http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf)
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The British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with
antiretroviral therapy 2005 (Available at:
http://www.bhiva.org/guidelines/2005/HIV/index.html)
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: http://www.who.int/hiv/pub/guidelines/adult/en/index.html)
NACO ART Guidelines (Available at:
http://www.nacoonline.org/guidelines/ART_Guidelines.pdf)
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
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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.
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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:
(http://www.niaaa.nih.gov/ResearchInformation/ExtramuralResearch/NIAAAResearchAreas/
AlcoholAIDS.htm). 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.
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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
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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
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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.
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21. Steingart KR, Ng V, Henry M, et al. Sputum processing methods to improve the sensitivity
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22. Managing the Revised National Tuberculosis Program in Your Area. ATraining Course;
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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
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29. Alwood K ea. Effectiveness of supervised, intermittent therapy for tuberculosis in HIV
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30.Onyebujoh P, Zumla A, Ribeiro I, et al. Treatment of tuberculosis: present status and future
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41. Treatment of Tuberculosis; 2003 June 20.
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tuberculosis in South Africa: a cohort study. Lancet 2002;359(9323):2059-64.
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infected with HIV: systematic review of randomised placebo controlled trials. Bmj
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50. Kumarasamy N, Chaguturu S, Mayer KH, et al. Incidence of immune reconstitution
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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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