Common Opportunistic Infections in HIV Infected Infants and Children : Part 2 Non-Respiratory Infections

Increased susceptibility to infections is the major cause of disease; end organ damage and death in human immunodeficiency virus (HIV)-infected children. This article will focus on prevention; diagnosis and management of the most common and less common severe infections that are specifically associated with HIV-related immune compromise; as well as some aspects relating to immune reconstitution inflammatory syndrome (IRIS)

The Role of Educational Strategies to Reverse the Inverse Performance Spiral in Academically Isolated Rural Hospitals

The importance of continuous professional development for health care workers is widely acknowledged; but the identification of optimal implementation strategies remains a challenge; particularly in academically isolated rural areas. We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province; South Africa. We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals. Doctors felt that participation in relevant learning activities improved their competence; increased the levels of job satisfaction they experienced; increased their willingness to stay in a rural environment; and impacted positively on the quality of services provided. However; the success of educational strategies is heavily dependant on the local environment (context); as well as the practical applicability and clinical relevance of the activities (process). Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals; however; this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities. The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care

Maintaining infants and children on highly active antiretroviral therapy

It needs to be emphasized that human immuno-deficiency virus (HIV) infection is not a curable disease and therefore highly active antiretroviral therapy (HAART) requires a life long commitment. This is why it is of paramount importance to ensure adequate preparation before HAART is initiated and to continue supporting the child and the caregiver/family throughout. Strict and non-wavering adherence is more important in the treatment of HIV than in any other infectious or chronic disease. This is clearly demonstrated by the fact that at least 95adherence is required to ensure an optimal virologic response in the majority of children. (Table 1) Achieving an optimal virologic response (undetectable viral load) is vital; as the development of drug resistance is far more rapid if this is not attained. Due to the rapidity with which resistance may develop; treatment failure is always a concern and careful follow-up is required to ensure treatment