| Class number | Topic | Duration, hrs |
| 1 | The HIV epidemic situation in Ukraine. Regulatory documents on HIV prevention and social protection. The relevance of the HIV problem in the world and in Ukraine. Laws on combating the spread of diseases caused by the human immunodeficiency virus and legal and social protection of people living with HIV, measures for prevention, testing for HIV and prescribing effective treatment methods | 2 |
| 2 | Social consequences of the spread of HIV infection. Combating stigma and discrimination in society and healthcare facilities. Social and economic consequences associated with HIV infection. Measures in society to combat stigma and discrimination | 2 |
| 3 | Etiology and pathogenesis of HIV infection, classification of disease stages. The causative agent of HIV infection, pathogenesis of the disease. Pathogenetic and clinical classification of the disease | 2 |
| 4 | Classification of clinical stages, diagnostic criteria – large and small. Clinical manifestation of HIV. Manifestations typical of the 1st, 2nd, 3rd, 4th clinical stage of the disease. Large and small criteria characteristic of HIV infection | 2 |
| 5 | The role of HIV infection in the formation of lymphadenopathy syndrome, differential diagnosis of this syndrome. Lymphadenopathy syndrome in HIV infection. Differential diagnosis with infectious diseases accompanied by lymphadenopathy, tuberculosis, oncology, etc. | 2 |
| 6 | HIV infection. Basic clinical criteria. General characteristics of opportunistic infections. The main clinical manifestations of HIV infection. AIDS-indicating diseases and opportunistic infections | 2 |
| 7 | NeuroAIDS. General issues, peculiarities of diagnosis and treatment. Lesions of the nervous system in HIV infection of viral, bacterial, fungal and protozoal genesis. Brain tumors in patients with HIV infection. | 2 |
| 8 | Features of the course, diagnosis and treatment of viral hepatitis in HIV-infected patients. Combination of HIV infection with parenteral viral hepatitis. Hepatitis treatment tactics and peculiarities of ART prescription for patients and convalescents with viral hepatitis B | 2 |
| 9 | The main aspects of HIV/tuberculosis coinfection. Forms of tuberculosis depending on the clinical stage of HIV. Features of treatment Pulmonary tuberculosis in HIV infection – the need for early ART initiation and adjustment of the regimen depending on the anti-tuberculosis drugs the patient is receiving and the need to prevent pneumocystis pneumonia. Other manifestations of tuberculosis (lymph node, urinary system, central nervous system, bone): features of detection and treatment | 2 |
| 10 | The role of early diagnosis in the spread of HIV infection. Features of the asymptomatic course of the disease Screening examinations for HIV infection. Indications for examination. Reasons for detecting patients in late stages | 2 |
| 11 | Rules for pre-test counseling and testing for HIV, educational work. Post-test counseling Pre-test and post-test consultation before HIV testing. Features of group testing, testing of children, testing in anonymous rooms | 2 |
| 12 | Methods of nonspecific and specific diagnosis of HIV infection Clinical and epidemiological indications for HIV testing. In which institutions it is possible to be tested for HIV infection. Options for specific diagnostics and features of modern testing according to WHO recommendations | 2 |
| 13 | Algorithm of HIV testing. The main regulatory documents Medical documentation required in the facilities/offices where HIV testing is performed. Documents that regulate the rules of examination of patients (pre-test consultation, blood sampling and testing using rapid tests of the third generation at the screening stage, confirmation of diagnosis, post-test counseling), entering into the MIS HIV system, prescribing tests to determine the number of CD4 cells, viral load. Documents that regulate the rules of blood sampling for testing and methods of analysis. | 2 |
| 14 | Providing psychological and psychiatric counseling to HIV-positive people Possibility to provide psychological support to the patient and/or his/her family, if necessary, drug and psychiatric support, and prescription of substitution therapy. Involvement of charitable organizations in social support and patient adherence to treatment | 2 |
| 15 | Preparing patients with HIV infection for lifelong antiviral therapy Documents that regulate the rules of examination of patients, reporting HIV to the MIS system, prescribing tests to determine the number of CD4 cells, viral load, examination for tuberculosis (radiation diagnostics and molecular genetic testing of sputum for MTB), prescribing preventive treatment against tuberculosis and opportunistic infections. Examinations of related specialists clinical blood tests, urine tests, biochemical blood tests, markers of viral hepatitis B and C. Based on the results of instrumental and laboratory tests, the choice of a starting treatment regimen | 2 |
| 16 | Principles and approaches to the treatment of patients with HIV infection. General characteristics of groups of drugs used in the treatment of HIV infection. HAART General characteristics of drugs used in the treatment of patients with HIV infection. Features of drug selection, possible contraindications and side effects of treatment, indications for changing the treatment regimen. When HAART is prescribed | 2 |
| 17 | Indications for changing the treatment regimen for HIV infection Outpatient monitoring of patients receiving ART, monitoring the effectiveness of therapy. Possible reasons for changing the treatment regimen or replacing individual drugs. Rules for filling in the relevant sections in the patient observation card and in MIS HIV | 2 |
| 18 | Peculiarities of providing ART to pregnant HIV-infected women, prevention of infection of newborns The need to adjust treatment for women who started ART long before pregnancy. Options for ART regimens for newly diagnosed HIV infection depending on the gestational age | 2 |
| 19 | Features of HIV treatment in children and adolescents Peculiarities of ART prescription in children and adolescents depending on age and comorbidities. Control over the timely detection of complications that require therapy correction and monitoring the effectiveness of treatment | 2 |
| 20 | Peculiarities of treatment and counseling for people who inject drugs Formation of adherence to treatment. Substitution maintenance therapy for injecting drug users. Preventive measures to prevent infection of contacts. The role of NGOs and social services in the support and social adaptation of HIV-positive people from this group | 2 |
| 21 | Monitoring the effectiveness of ART therapy. Causes of emergence of resistant strains Rules for blood sampling to determine viral load. Monitoring the effectiveness of treatment in the first years after ART initiation. Examination tactics in case of suspected ineffectiveness of the chosen regimen. When blood should be sent for the determination of antiretroviral-resistant HIV | 2 |
| 22 | Tactics in case of an emergency during the provision of medical care to a patient Blood emergencies in hospitals and their prevention. Algorithm of actions in case of an emergency. Post-exposure prophylaxis for healthcare workers and further laboratory monitoring | 2 |
| 23 | Post-exposure prophylaxis of HIV infection Post-exposure prophylaxis among the population. Criteria for appointment. Tactics when citizens apply after 72 hours after suspected infection | 2 |
| 24 | Pre-exposure prophylaxis of HIV infection Identification of high-risk groups for HIV infection. Combined pre-exposure prophylaxis. Drugs and regimens for daily pre-exposure prophylaxis. Medications and regimens for cisgender MSM “VCT if necessary”. Drugs for parenteral HIV prevention. Pre-exposure prophylaxis among military medics in the combat zone | 2 |
| 25 | Final modular control Differentiated credit: assessment of theoretical and practical training | 2 |
| SA3. Final control: differentiated credit, 80 scores | |
| 5 (Excellent)Outstanding performance without errors | 170 ≤ RD ≤ 200 68-80 points |
| 4 (Good)Above the average standard but with minor errors | 140 ≤ RD < 169 56-67 points |
| 3 (Satisfactory)Fair but with significant shortcomings | 120 ≤ RD < 139 48-55 points |
| 2 (Fail)Fail – some more work required before the credit can be awarded | 0 ≤ RD < 119 0-47 points |
| SA2. Assessment of the level of theoretical training, 24 scores | |
| 5 (Excellent)Outstanding performance without errors | 170 ≤ RD ≤ 200 21-24 points |
| 4 (Good)Above the average standard but with minor errors | 140 ≤ RD < 169 17-20 points |
| 3 (Satisfactory)Fair but with significant shortcomings | 120 ≤ RD < 139 15-16 points |
| 2 (Fail)Fail – some more work required before the credit can be awarded | 0 ≤ RD < 119 0-14 points |
| SA1. Oral survey, 96 scores | |
| 5 (Excellent)Outstanding performance without errors | 170 ≤ RD ≤ 200 82-96 points |
| 4 (Good)Above the average standard but with minor errors | 140 ≤ RD < 169 68-81 points |
| 3 (Satisfactory)Fair but with significant shortcomings | 120 ≤ RD < 139 58-67 points |
| 2 (Fail)Fail – some more work required before the credit can be awarded | 0 ≤ RD < 119 0-57 points |
List of questions for self-study:
Problems of HIV infection
The epidemic situation with HIV infection in Ukraine and worldwide. Regulatory documents on preventing the spread of HIV infection and social protection of the population. Social consequences of the spread of HIV infection.
Etiology and pathogenesis of HIV infection, classification of disease stages. Expanded definition of AIDS in adults and adolescents. Classification of clinical stages, major and minor diagnostic criteria.
The role of HIV infection in the formation of lymphadenopathy syndrome, differential diagnosis of this syndrome.
HIV infection: laboratory diagnosis, features of its conduct, differential diagnosis, complications, principles of treatment. Psychological foundations of communication with such patients. Principles and approaches to the treatment of patients with HIV infection. General characteristics of groups of drugs used in the treatment of HIV infection.
General and specific prevention of HIV infection. Safety measures and organization of the doctor’s work to prevent HIV infection of medical workers. Safety techniques for invasive procedures. Measures in case of contamination with infectious material in the workplace. Prognosis. Procedure for hospitalization, examination, and dispensary observation.
HIV-associated infections and diseases: features of clinical course, laboratory and instrumental diagnostics, differential diagnostics, principles of treatment.
List of professional skills
Be able to justify a preliminary clinical diagnosis of the most common infectious diseases with airborne and fecal-oral transmission mechanisms, as well as viral hepatitis.
Be able to recognize complications and emergency conditions in patients with the most common infectious diseases with airborne and fecal-oral transmission mechanisms, viral hepatitis.
Be able to recognize the enterotoxigenic and enteroinvasive nature of diarrhea.
Be able to prescribe an examination plan for patients with the most common infectious diseases with airborne and fecal-oral transmission mechanisms, acute forms of viral hepatitis.
Be able to perform clinical differential diagnosis of intestinal infections with diarrheal syndrome.
Be able to conduct clinical differential diagnosis of respiratory infections.
Be able to conduct differential diagnosis of typical and atypical pneumonia.
Be able to conduct clinical differential diagnosis of viral hepatitis and jaundice.
Perform clinical and laboratory differential diagnosis of infectious diseases with airborne and fecal-oral transmission mechanisms, acute and chronic forms of viral hepatitis.
Prescribe rational treatment for patients with infectious diseases with airborne and fecal-oral transmission mechanisms, viral hepatitis at various stages of medical care.
Be able to provide emergency care to patients with infectious diseases with airborne and fecal-oral transmission mechanisms, viral hepatitis.
Plan basic preventive measures for infectious diseases with airborne and fecal-oral transmission mechanisms, viral hepatitis.
Be able to justify a preliminary clinical diagnosis of the most common blood infections, infectious diseases with wound and multiple transmission mechanisms, and HIV infection.
Be able to recognize complications and emergency conditions in patients with blood infections, infectious diseases with wound and multiple transmission mechanisms, and HIV infection.
Be able to prescribe an examination plan for patients with the most common blood infections, infectious diseases with wound and multiple transmission mechanisms.
Perform clinical and laboratory differential diagnosis of the most relevant blood infections, infectious diseases with wound and multiple transmission mechanisms, and HIV infection.
Prescribe rational treatment for patients with blood infections, infectious diseases with wound and multiple transmission mechanisms, and HIV infection.
Be able to provide emergency care to patients with blood infections, infectious diseases with wound and multiple transmission mechanisms, and HIV infection.
Plan basic preventive measures for the most relevant blood infections, infectious diseases with wound and multiple transmission mechanisms.
Conduct general and individual prevention of HIV transmission.
Methodology for conducting a final module
After the completion of classroom sessions provided for in the curriculum, an exam is held, which is open to students who have no academic debt and have scored at least 72 points for current performance (current performance 72-120 points).
Ongoing assessment is carried out during each practical class in accordance with the specific objectives of the topic and includes standardized forms of assessment of theoretical training and professional skills. Ongoing assessment includes assessment of the level of knowledge (online testing during independent preparation), oral or written quick quizzes, test assessment using test tasks), assessment of the main stage of the practical class (assessment of professional skills during patient care, solving typical situational tasks of increased complexity), assessment of the final level of knowledge in the class (solving situational tasks of level III complexity, interpretation of the results of laboratory and other methods of patient examination).
The form of the final modular control of the academic discipline includes control of theoretical training (using standardized tasks, test tasks) and control of professional skills (level III situational tasks) in accordance with the program. Structure of the PMK:
Computer-based test control – maximum score of 20 points.
Written work – situational task and answers to theoretical questions – 60 points.
Example of written work.
1 Patient V., 19 years old, student. He consulted a doctor at a polyclinic with complaints of enlarged cervical lymph nodes, which he has had for 3 months. Objectively: skin of normal color, body temperature normal, condition satisfactory. Traces of IV injections on the arms. The posterior cervical, supraclavicular, and elbow lymph nodes are enlarged to 1 cm, the axillary lymph nodes are enlarged to 1.5 cm in diameter, dense, elastic, and painless.
1 a. Formulate a clinical diagnosis.
1 b. Prescribe tests to confirm the diagnosis, indicating the expected changes.
1 c. Prescribe etiotropic and pathogenetic therapy, mandatory prescription writing.
Reference answers to the task
HIV infection. Clinical stage I, persistent generalized lymphadenopathy.
Complete blood count (normocytosis with relative lymphomonocytosis, atypical mononuclear cells over 10%), immunological tests (decrease in the total number of T-lymphocytes in the blood, especially T-helpers 500 in 1 μl, T-killers; decreased CD4+/CD8+ ratio; significant increase in Ig A, G, E, D; decreased lymphocyte chemotaxis), virological methods (detection of viral RNA in polymerase chain reaction), serological reactions (immunoenzymatic and radioimmunoassays; immunoblotting (“western-blot”) confirms the diagnosis when detecting AT against viral antigens p41 and p110).
3. Observation at an AIDS prevention center with quarterly examinations and testing of CD4 count, viral load, and detection of opportunistic infections. If CD4 cells fall below 400 per microliter, antiretroviral therapy is prescribed (for life).
| Essential Reading | ||
| 1 | Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach, WHO, 2021 https://iris.who.int/handle/10665/342899 | |
| 2 | Therapeutic Guidelines for Antiretroviral (ARV) Treatment of Adult HIV Infection, BC-CfE, 2020 | |
| Supplemental Reading | ||
| 1 | Infectious diseases: textbook / O. A. Holubovska, M. A. Andreichyn, A. V. Shkurba etc. ; edit. O.A. Holubovska. — К. : AUS Medicine Publishing, 2018. — 664 p | |
| 2 | Global guidance on criteria and processes for validation: Elimination of Mother-to-Child Transmission of HIV and Syphilis, 2nd edition https://www.who.int/publications/i/item/global-guidance-on-criteria-and-processes-for-validation-elimination-of-mother-to-child-transmission-of-hiv-and-syphilis | |
| 3 | Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. https://www.who.int/publications/i/item/9789240052390 | |
| 4 | Comprehensive package of care for infants and young children exposed to HIV https://www.who.int/publications/i/item/9789240040236 | |
| Web-based and electronic resources | ||
| 1 | Ukrainian Center for Socially Dangerous Diseases Control http://ucdc.gov.ua/ | |
| 2 | International HIV/AIDS Alliance in Ukraine http://www.aidsalliance.org.ua | |
| 3 | Center for Disease Control http://www.cdc.gov/ | |
| 4 | The World AIDS Program http://www.unaids.org | |
| 5 | Official website of the Ministry of Health of Ukraine http://www.moz.gov.ua/ua/portal/ | |
| 6 | European Union on HIV http://eacsociety.net/ | |
| 7 | International HIV Association http://www.iasociety.org/ | |
| 8 | Website of the Department of Infectious Diseases with Epidemiology of the Institute of Medicine of Sumy State University http://infection.med.sumdu.edu.ua/ | |
