NUH HIV Programme

The National University Hospital (NUH) HIV Programme provides clinical care through outpatient and inpatient services.

=Clinical care=

Outpatient care
Outpatient services are provided through the Multidisciplinary Infectious Diseases Clinic (MIDC) to any Person Living with HIV/AIDS (PLHA) who wishes to receive care at NUH.

The MIDC is held twice weekly. The clinic is staffed using a rotating roster of Infectious Diseases (ID) consultants and registrars, as well as ID Nurses, MSWs and Pharmacists. The MID Team also follows individuals as inpatient should a patient require admission to NUH (see inpatient section below).

Referrals to the MIDC are made via:
 * The NUH inpatient setting
 * Non-NUH providers (i.e. DSC clinic, AFA, GPs, Polyclinics)
 * Self-referral

Outpatient services provided by the MID team include: To make a referral, please refer to their contact details.
 * Medical management of HIV and its complications
 * Antiretroviral (ARV) therapy
 * Opportunistic infections therapy plus prevention, including nebulised pentamidine
 * Free partner testing
 * HIV counselling services for patients and their families
 * Disclosure support
 * Financial support
 * Adherence and medication counselling
 * Mental health care and support
 * Supportive counselling

Inpatient care
Inpatient services are provided to all PLHA admitted to NUH including: Inpatient services provided include:
 * Patients already in follow-up at MIDC
 * Newly-diagnosed patients
 * PLHA known to be HIV positive but on follow-up elsewhere
 * Medical consultation/management
 * ARV therapy
 * Nursing assessment
 * HIV counselling services for patients and their families
 * Disclosure support
 * Financial support
 * Adherence and medication counselling
 * Mental health care and support
 * Supportive counselling

Be Prepared Clinic
The NUH HIV Programme also supports the Be Prepared Clinic (BePrep Clinic), a specialist clinic that provides comprehensive and holistic services in sexual health screening and counselling for men and women. The BePrep Clinic also offers counseling and testing for STI and HIV as well as risk reduction packages including Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP). For more information, please click here.

=Education=

Educational efforts of the HIV Programme target the following groups: Infectious Diseases (ID) trainees Non-ID physicians Nurses Ancillary staff Health care workers outside of NUH People Living with HIV/AIDS (PLHA) Flagship education programmes: Healthcare Worker HIV Education Series Asia Pacific HIV Practice Course Education and Training to medical students (M3 and M5) Empowered Living Programme

ID Traineeship
The HIV Programme incorporates clinical and didactic teaching on HIV/AIDS into the ID training so that graduating NUH ID Registrars/Fellows will be competent in providing holistic care and applying best practices to the care of PLHA.

HIV Clinical Fellowship
The HIV Programme is accredited to provide a 12-month HIV Clinical Fellowship. The goal of the HIV Clinical Fellowship is to provide overseas physicians with the clinical knowledge and skills necessary to provide optimal HIV care according to international guidelines and practice standards.

Internal Medicine Residents Training
HIV topics are incorporated into the Internal Medicine residency curriculum, House Officers Handbook, Basic Specialist Training teaching and the Objective Structured Clinical Examinations to ensure that Residents are appropriately trained in HIV topics and care.

NUH Faculty Training
The HIV Programme has ensured that HIV topics are incorporated into the University Medical Cluster Medicine Rounds. Additionally, the Programme provides talks to departments which are likely to co-manage HIV patients or HIV complications in their specialty.

GP Training
An annual GP update on HIV topics which are of interest to GPs is conducted by the MID team.

Nursing Training
A programme to educate nursing staff on the appropriate nursing care for the PLHA has been developed in partnership with the Clinical Nursing Unit and Infection Control. The MID Team Nurses have also been involved in a number of overseas nursing education attachments, including Brunei and Hong Kong, with the aim to up-skill overseas nurses in best practice care.

Additionally, the HIV Programme has initiated projects such as the Red Ribbon Ambassador Project which aims to establish HIV Nursing Ambassadors in each hospital ward. Through this programme, which ran in conjunction with World AIDS Day in 2013, over 600 Nurses were trained at NUH.

Training for Health Care Workers outside of NUH
HIV education is provided to Nurses, Pharmacists and MSWs from private clinics, hospitals and community institutions such as Nursing Homes. The MID Team's Pharmacists, Nurses and MSWs will conduct education sessions on their specialities, providing invaluable insight into best practice care for PLHA. Of note, the MID Team has led educational sessions on topics such as Nebulised Pentamidine, ARV Therapies, Stigma and Discrimination, and caring for PLHA.

Education for PLHA
Working in partnership with the Singapore General Hospital, the HIV Programme conducts the Empowered Living Programme bi-annually. The Empowered Living Programme is an initiative conceived and implemented by the MSWs to better support newly diagnosed PLHA. The 2-day programme covers topics such as HIV basics, disclosure, treatment, nutrition and safer sex.

The Asia Pacific HIV Practice Course
The Asia Pacific HIV Practice Course (APHPC) aims to improve the knowledge and skills of healthcare workers working in HIV-related areas across the Asia Pacific Region. The course is jointly organised by the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital, Singapore General Hospital, and Action for AIDS. The 4-day course is conducted annually and is open to healthcare workers across Singapore and the Asia Pacific Region.

The Healthcare Worker HIV Education Series
The Healthcare Worker HIV Education Series is jointly organised by the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital. The Education Series is a modular education initiative that runs quarterly. The aim of the Education Series is to improve the HIV knowledge and skills of healthcare workers in Singapore.

HIV and PrEP Awareness Programme
Linkage to care and preventive health are prime areas in the effort to reduce HIV infection; as such, training services are offered to community healthcare workers and social service providers. These services serve to increase the knowledge and capability of community healthcare providers and highlights the importance of HIV testing, symptoms recognition and working with key affected populations. Training on HIV prevention and importance of adherence to treatment is also offered to organisations serving key affected populations.

=Research=

The NUH HIV Research Programme is involved in a number of operational, clinical and behavioural research projects. Working in partnership with external institutions such as the National University of Singapore, the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital and internally with the NUH Division of Infectious Diseases, all the research projects are focused on benefiting and improving the quality of care for PLHA in Singapore and the Asia Pacific Region.

To date, the research has helped bring about a re-evaluation of and significant improvements in HIV screening methods and treatment regimes. Notable research projects conducted since 2010 include:

Smibert OC, Trubiano JA, Cross GB, Hoy JF. Mycobacterium avium complex infection and immune reconstitution inflammatory syndrome remain a challenge in the era of effective antiretroviral therapy. AIDS Res Hum Retroviruses. December 2017, 33(12): 1202-1204. https://doi.org/10.1089/aid.2017.0030

TanXQ, Goh WP, Venkatachalam I, Goh D, Sridhar R, Chan HW, Archuleta S. Evaluation of a HIV voluntary opt-out screening program in a Singapore hospital. PLoS One. 2015 Jan 22;10(1):e0116987. doi: 10.1371/journal.pone.0116987. eCollection 2015.

Kapoor R, Martinez-Vega R, DongD, Tan SY, Leo YS, Lee CC, Sung C, Ng OT, Archuleta S, Teo YY. Reducing hypersensitivity reactions with HLA-B*5701 genotyping before abacavir prescription: clinically useful but is it cost-effective in Singapore? Pharmacogenet Genomics. 2015 Feb;25(2):60-72.

Lee CK,Tang JWT,Chiu L,Loh TP,Olszyna D, Chew N, Archuleta S, Koay ESC.Epidemiology of GB virus type C among HIV-infected patients in Singapore. J Med Virol. 2014 May;86(5):737-44.

Zaid M, Tan K, Smitasin N, Tambyah PA, Archuleta S. Henoch-schönlein purpura associated with adult human immunodeficiency virus infection: case report and review of the literature. Ann Acad Med Singapore. 2013 Jul;42(7):358-60.

Verrall A, Tan JH, Archuleta S. Acute retroviral syndrome mimics dengue in Singapore. Ann Acad Med Singapore. 2012 Dec;41(12):617-9.

Huggan PJ, Foo RM, Olszyna D, Chew NS, Smitasen N, Mukhopadhyay A, Archuleta S. Presentation and outcome amongst older Singaporeans living with HIV/AIDS: does age alone drive excess mortality? Ann Acad Med Singapore. 2012 Dec;41(12):581-6.

Archuleta S, Tay J, Chua A. The human immunodeficiency virus (HIV) epidemic in Singapore – Where are we now, and can we “Get to Zero”? Ann Acad Med Singapore. 2012 Dec;41(12):551-2. Ho J, Balm M, Huggan P, Chew N, Venkatachalam I, Archuleta S. Immune reconstitution inflammatory syndrome associated with disseminated Mycobacterium sherrisii infection. Int J STD AIDS. 2012 May;23(5):369-70.

Lee CK, Lee HK, Loh TP, Sethi SK, Koay ES, Tang JW. An in-house HIV genotyping assay for the detection of drug resistance mutations in Southeast Asian patients infected with HIV-1. J Med Virol. 2012 Mar;84(3):394-401.

=Community outreach=

​The HIV programme has developed a strong network of non-government and community partnerships in order to ensure PLHA receive the best possible care and support. By liaising with local organisations, the Programme has enabled PLHA to receive additional social and financial assistance when in need. Additionally, the HIV Programme works closely with its community partners to raise awareness of HIV in the community through the implementation and sponsorship of awareness programmes and events. Of note, the HIV Programme has worked closely with organisations like Action for AIDS and Oogachaga in educational and outreach programmes such as “AIDS Candlelight Memorial”, MSM Singles workshop, training of staff and volunteers and “Singapore AIDS Conference” etc.

=Administrative work=

Since its inception, the NUH HIV Programme has worked closely with the Ministry of Health (MOH) and other relevant institutions and departments to develop polices and workflows to ensure that PLHA receive the best possible care available. The HIV Programme has developed notification and reporting pathways from NUH to MOH, established the NUH Standard Operating Procedures (SOPs) and Hospital Administrative Procedures (HAPs) for the MIDC, and has created workflows for contact tracing and partner testing with MOH and the National Public Health Unit. Given the stigma associated with HIV, the MID Team needs to work with relevant institutions and departments to ensure that PLHA receive equitable care and treatment.

=Team=

In order to achieve the highest standard of clinical and non-clinical care, education and research, a multidisciplinary team consisting of the following professions was established. The MID Team includes:

HIV Physicians from the Division of Infectious Diseases (ID)
Our physicians are all trained to provide patients with medical care and advice. The MID Team Consultants are:


 * Dr Dariusz Olszyna - Programme Director
 * Dr Sophia Archuleta
 * Dr Nares Smitasin
 * Dr Gail Cross
 * Dr Brenda Salada

ID Nursing Staff
Our ID Nursing staff are all specialist-trained in HIV. In addition to supporting the ID Physicians, our Nurse provide nursing care, education, support and care to our patients. Our ID Nurse is:

Senior Staff Nurse Emma

ID Medical Social Workers (MSWs)
We have three specialist HIV-trained MSWs on our team. Our MSWs provide counselling, advocacy, and education to our patients. They also assist and support our patients to access financial aid. Our MSWs are:


 * MSW Virginie
 * Senior MSW Thomas
 * Senior MSW Ai Zhia

ID Pharmacists
Our ID Pharmacists are specialist-trained in HIV treatment. The MID Team pharmacists work closely with our Physicians and Nurses to help manage patients' treatment and care. They also provide education, adherence counselling and medication advice. Our Pharmacists are:


 * Senior Pharmacist Joy
 * Senior Pharmacist Tiffany

HIV Programme Manager
Our HIV Programme manager works closely with the MID Team to ensure the effective implementation of the clinical, education and research components of the programme.

The MID Team also collaborates with the Molecular Diagnosis Centre (MDC) to build the laboratory services required for the optimal care of PLHA.

=Contact details=

Appointment
To make an appointment to attend the MIDC, please call or email the University Medicine Cluster Clinic Appointment Line:

Phone: (65) 6772 8686

Email: umcapptline@nuhs.edu.sg

General enquiries
For any patient related enquiries, please call (65) 6772 7800 or email: nuh_midc@nuhs.edu.sg.

For non-patient related enquiries, please email: hiv_program@nuhs.edu.sg.

=See also=
 * PrEP in Singapore

=References=
 * https://www.nuh.com.sg/our-services/Specialties/Medicine/Infectious%20Diseases/Pages/HIV-Programme.aspx