15
Behavioral Intervention
Î General messages regarding risk reduction should be provided at all
healthcare encounters, regardless of risk behaviors reported by the
patient or perceived risk on the part of the healthcare provider. Such
messages can be delivered by the provider, by others in the healthcare
setting, or by educational materials (eg, pamphlets, posters, and
videos) in the healthcare setting (SR-L).
Î Tailored messages are critical for patients who report persistent
high-risk behavior or who have symptoms or signs of STDs. In nearly
all situations, the provider should offer brief counseling. In general,
persons exhibiting risk behavior should also be referred to programs
capable of offering more extensive intervention programs (SR-M).
Schedule of Care Evaluation for HIV-Infected Patients
Adults
Î Viral load is generally monitored every 3-4 months in untreated
patients and patients on stable ART. This interval may be prolonged to
6 months for adherent patients whose viral load has been suppressed
for more than 2-3 years and whose clinical and immunologic status is
stable. Viral load should be monitored more frequently after initiation
or change in ART: preferably within 2-4 weeks, and not more than 8
weeks, after initiation or modification, with repeat testing every 4-8
weeks until viral load becomes undetectable (SR-M).
Î CD4 cell counts should be monitored both to assess the urgency for
initiation of ART or the efficacy of ART and to determine the need for
prophylaxis against opportunistic infections (SR-H). CD4 cell counts
should generally be monitored every 3-4 months. For patients on
suppressive ART regimens whose CD4 counts have increased well
above the threshold for opportunistic infection risk, the CD4 count
can be monitored every 6-12 months unless there are changes in the
patient's clinical status (SR-M).
Î STD screening and tuberculosis screening tests should be repeated
periodically depending on symptoms and signs, behavioral risk, and
possible exposures (SR-M).
Î Vaccinations for pneumococcal infection (SR-H), influenza (SR-H),
varicella (SR-M), and hepatitis A (SR-H) and B (SR-H) should be
offered as indicated (Table 1). The likelihood of a response to any
vaccine is greatest in patients with higher CD4 cell counts and in
patients receiving suppressive ART.
