Medication support

People hospitalised following late diagnosis and illness are often discharged with multiple medicines. In addition to antiretroviral therapy (ART) to reduce HIV viral load and improve immune function, they may require medicines to treat opportunistic infections and others to reduce the risk of other opportunistic infections developing while their CD4 count is low (below 200 cells/μL). This entails a significant pill burden, recognised as a barrier to adherence.[19] [20] [21]

Managing multiple medicines can be difficult, especially for clients who have never taken these medications before. Nurses can assess, assist, and supervise medication management. High, sustained levels of adherence to ART (over 95% of all prescribed doses taken) maximise its effectiveness, reduce the chance of new or recurrent illness, reduce short- and long-term mortality and prevent the onward transmission of HIV.[22] Of equal importance is adherence (doses taken and completion of the prescribed course) to medicines prescribed to treat opportunistic illnesses and the sustained use of those used to prevent new opportunistic infections (See Clinical manifestations of HIV disease).

Nurses also have a key role in educating clients about and monitoring for side-effects. (See Adherence support for more details). Nurses can also foster hope and optimism through educating clients that if they achieve an undetectable viral load by adhering to their antiretroviral therapy, they will not transmit the virus sexually - Undetectable = Untransmissible.

HIV-related stigma remains very real for many people. Inadvertent disclosure of a person's HIV status can have serious consequences for the person with HIV. Therefore, special care needs to be taken. Respect for people's privacy and confidentiality is essential and should be actively communicated. Strategies such as providing a locked box to store medicines and medical documentation about the person’s treatment and condition can help maintain privacy and confidence.

Access to and retention in HIV specialist clinical care, and safe medicine administration delivered by qualified and competent professionals underpin increased survival for people with HIV.[23] People diagnosed late should have access to the assistance of community nurses upon discharge from acute services and referral should be made early, even where an obvious nursing clinical procedure is not needed. Close collaboration and liaison between hospital- or clinic-based nurses, nurses in primary care and community nursing services are essential and are a strong feature of the HIV sector in Australia (see also Evolving roles of nurses in HIV care).