Goals: To introduce the Fellow to the management of infectious diseases in the outpatient setting.
A large part of this experience will be the HIV/AIDS continuity of care clinic. In addition to general Infectious Disease consultations and follow-up care, all levels of care including specialty and primary care are provided to HIV patients. Our Ryan White funded clinic is fortunate to have two social workers, a mental health provider and a nutritionist on staff. The first year Fellow will receive the HIV (+) patients from the fellow completing his/her training and all new HIV (+) patients presenting to the clinic to establish care during the first year. The Fellow will follow these patients throughout the two years of training.
Objectives: Care of the patient with HIV/AIDS
- immune evaluation
- recognition and management of opportunistic infections
- prophylactic agents, vaccinations
- antiretroviral therapy and monitoring; viral loads, genotypes, phenotypes
- sexually transmitted disease
- drug adherence
- psychosocial, alcohol and substance use disorder
- hospice care
- family support, confidentiality
- pain management
- management of substance use disorder
Outpatient management of:
- the patient with FUO
- the febrile patient with immune compromise
- infections in people who inject drugs
- the ill-returning international traveler
- the patient needing home intravenous antibiotic therapy
- assessment and treatment of the patient with:
- sexually transmitted diseases
- pneumonia, bronchitis
- upper respiratory infection
- urinary tract infections
- acute and chronic diarrhea
- viral hepatitis
- osteomyelitis and septic arthritis
- endocarditis
- cellulitis
- infectious diarrhea and parasites
- lyme disease
- line infections
- fever and rash
- parasities
- mycobacteria infection
- M.Tb
- Atypical AFB
- other viral infections
- HSV, CMV, HPV
Antimicrobial agents:
- adverse reactions
- drug monitoring
- appropriate use and cost containment
- home intravenous antibiotic management
Chemoprophylaxis, immune prophylaxis, cytokines, colony stimulating factors, monoclonal antibodies
Teaching environment: An ID attending is present throughout clinic. Each patient is reviewed with the attending and history and physical examination confirmed at the bedside. Assessment, plans and dictated note are reviewed. The fellow will also interact with the clinic nurse practitioner, social worker and regional AIDS service organization.
Patient characteristics and types of clinical encounters:
- Patients of all socioeconomic strata and ethnic mix.
Reading list:
- Mandell's text according to disease encountered
- Journal club
Pathological material: Gram stain and cultures
Evaluation: Immediate feedback on each patient presentation. Written evaluation by the ID attendings on service. The Fellow will also provide written evaluations of the rotation to the fellowship director.
