AIDS Continuing Education--NCBTMB Approved

Chapter 3

Clinical Management


Clinical management includes infection control procedures, discussed in Chapter 2, to prevent direct contact with HIV-possible fluids. Used needles should be placed in puncture-resistant containers located at the point of use. Used needles should not be manipulated or re-sheathed. (Needle-stick injury is the primary cause of occupational HIV infection so especial care should be exercised. ) Hand washing and barriers such as gloves, masks, goggles and face shields, as appropriate to the situation, are important components of control.


3 Stages of Clinical Management

  • Investigation
  • Classification
  • Treatment Plan

    • Clinical management begins with the taking of an initial history, the initial physical examination, appropriate lab tests, confirmation of HIV infection, and the establishment of a staging classification using the CDC or WHO models. Staging may be used to determine eligibility for treatment with antiretroviral drugs.


    Two major classification systems for HIV are in use: the U.S. Centers for Disease Control and Prevention (CDC) classification system (1993) and the World Health Organization (WHO) Clinical Staging and Disease Classification System (2005). The CDC relies on CD4 counts while the WHO concentrates on clinical manifestations.


    The continuation of clinical management includes formulating a service plan, implementing the plan, coordinating, monitoring, follow up, reassessment, conferencing, crisis intervention and, eventually, case closure.


    The service plan may embrace a variety of disciplines to optimize care, including nursing, counseling, social support, and client education.


    Clinical case management is not a top-down procedure. The decisions do not flow from up above with automatic acceptance from the client below, Rather, clinical case management should involve the consent and participation of the client.


    Clinical case management can be divided into comprehensive case management (CoCM) and supportive case management (SCM). The comprehensive model is proactive, helping a client with complex needs, a long-term horizon and a commitment to assist in the process. SCM addresses immediate, short-term needs, perhaps for a client who is not willing to put forth the level of participation required by CoCM or one who is finished with CoCM but still needs a maintenance level of care. Repetitions of crises or problems in SCM should lead to encouragement of the client to enter CoCM.



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