3.5 Communicable Disease Nursing: HIV, STIs, Tuberculosis & Leptospirosis

Communicable Disease Nursing: HIV, STIs, Tuberculosis and Leptospirosis

Infectious and inflammatory conditions, infestations and environmental disease make up much of the CARICOM Blueprint's list of common Caribbean health problems. This section covers the communicable diseases a Caribbean RN meets in clinics and wards, beyond the vector-borne diseases in Section 3.3.

HIV Infection

The Caribbean has long had one of the highest adult HIV prevalence rates of any region outside sub-Saharan Africa (UNAIDS). HIV spreads through unprotected sex, blood (shared needles, transfusion, sharps injuries) and from parent to child (pregnancy, birth, breastfeeding). It is not spread by touching, sharing cups, mosquitoes or caring for someone without contact with body fluids.

Testing and Treatment

• Offer testing routinely with pre-test information, consent and confidentiality. A reactive rapid test is confirmed by the national testing algorithm before diagnosis.
• The window period is the time between infection and when a test can detect it. A negative test soon after a high-risk exposure should be repeated.
• WHO's "treat all" policy (2015) starts antiretroviral therapy (ART) for everyone diagnosed, regardless of CD4 count, ideally on the same day or within 7 days.
• WHO's preferred first-line regimen is tenofovir + lamivudine + dolutegravir (TLD), one tablet daily.
• The aim is a suppressed viral load. A person who keeps an undetectable viral load does not transmit HIV sexually ("undetectable = untransmittable", U=U).
• Adherence is the main nursing focus. Explore barriers (stigma, food insecurity, side-effects, disclosure fears), use pill organisers and phone reminders, and link the client to adherence counsellors.
• Watch for opportunistic infections when immunity is low (CD4 under 200 cells/mm³): Pneumocystis pneumonia, TB, cryptococcal meningitis, oral candidiasis. Co-trimoxazole prophylaxis is given according to national guidelines.

Preventing Mother-to-Child Transmission (PMTCT)

Test every pregnant woman (opt-out) and offer lifelong ART. Give the infant prophylaxis after birth. Test the infant with a virological (PCR) test in early infancy, because maternal antibodies make antibody tests unreliable until about 18 months. PAHO's EMTCT Plus initiative aims to eliminate mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas disease. Infant feeding follows the national policy. Whatever is chosen, avoid mixed feeding (breast milk plus formula or other foods before 6 months), which carries the highest transmission risk.

Exposure and Prevention

• Post-exposure prophylaxis (PEP) must start as soon as possible, ideally within hours and no later than 72 hours, and continues for 28 days.
• Pre-exposure prophylaxis (PrEP) protects HIV-negative people at substantial risk.
• Sharps injury first aid: let the wound bleed freely, wash it with soap and water (do not squeeze or scrub with bleach), report immediately and assess the source patient. The approximate risk of infection after a needlestick from an infected source is about 0.3% for HIV, about 0.2% for hepatitis C, and much higher for hepatitis B in an unvaccinated worker (up to about 30% when the source is HBeAg-positive). This is why every health worker needs hepatitis B vaccination.

Confidentiality and non-stigmatising language ("person living with HIV") are part of the PC and COM domains as well.

Sexually Transmitted Infections (STIs)

Many STIs have no symptoms, especially in women, and they raise the risk of acquiring HIV. Where laboratories are limited, WHO syndromic management treats the syndrome (urethral discharge, vaginal discharge, genital ulcer, lower abdominal pain) for the likely organisms at the first visit.

Every STI visit includes the 4 Cs:

• Compliance: take the full treatment;
• Counselling: risk reduction;
• Condoms: promote and provide them; and
• Contact tracing: notify and treat partners.

Retest when the guideline calls for it.

Tuberculosis

TB is airborne and spreads through droplet nuclei from people with pulmonary or laryngeal disease. Suspect it with a cough lasting more than 2 weeks, fever, night sweats, weight loss or haemoptysis, especially in people living with HIV.

• Diagnosis: WHO recommends a rapid molecular test (for example Xpert MTB/RIF) as the initial test where available; it also detects rifampicin resistance. Sputum smear microscopy and culture are still used.
• Treatment of drug-susceptible TB: two months of isoniazid, rifampicin, pyrazinamide and ethambutol (2HRZE), then four months of isoniazid and rifampicin (4HR), given as directly observed therapy (DOT). Drug side-effects are covered in Section 7.2.
• Infection control: an airborne isolation room, an N95 respirator for staff, and a surgical mask for the client during transport. Clients usually become much less infectious after about two weeks of effective therapy.
• Public health: TB is notifiable. Do contact tracing, offer HIV testing, and give TB preventive treatment to eligible contacts.

Leptospirosis

Leptospirosis is a zoonosis spread through water or soil contaminated by the urine of infected rats and other animals. The bacteria enter through cuts or mucous membranes. Risk rises after flooding: after Hurricane Melissa (Category 5, landfall in Jamaica on 28 October 2025), relief agencies reported a leptospirosis outbreak. Farmers, sewer and sanitation workers, and anyone wading in floodwater are at risk.

• Presentation: sudden fever, headache, severe calf muscle pain and conjunctival suffusion. Severe disease (Weil's disease) brings jaundice, acute kidney injury, bleeding and pulmonary haemorrhage.
• Treatment: early doxycycline or penicillin. Severe cases need hospital care with fluid balance monitoring and possibly dialysis.
• Prevention: wear boots and gloves, cover cuts, control rodents, avoid wading or swimming in floodwater, and store food securely. Doxycycline chemoprophylaxis may be advised for high-risk exposure.

Infestations: Scabies, Lice and Intestinal Worms

The CARICOM Blueprint lists infestations as a separate category, including helminthiasis, scabies, pediculosis, filariasis and the vector-borne infections.

• Scabies (Sarcoptes scabiei) spreads by prolonged skin contact.
  • Signs: intense itching that is worse at night, with burrows and papules in the finger webs, wrists, waist and genitals.
  • Treatment: apply permethrin 5% cream from the neck down (including the head in infants), and treat all household and close contacts at the same time to prevent reinfestation. Wash clothing and bedding in hot water.
  • Teaching: itching can persist for 2–4 weeks after successful treatment. Crusted scabies in people who are immunosuppressed is highly contagious and needs contact precautions (Section 6.2).
• Head lice (pediculosis capitis) cause itching. Look for nits firmly attached near the scalp. Treat with a pediculicide as directed plus wet combing with a fine-toothed comb, check household members, and avoid sharing combs and hats.
• Intestinal worms (soil-transmitted helminths):
  • Roundworm (Ascaris) and whipworm are spread by the faecal-oral route.
  • Hookworm larvae penetrate bare skin and cause iron-deficiency anaemia.
  • Pinworm causes perianal itching at night; it is diagnosed with the sticky-tape test and the whole household is treated.
  • Control: WHO recommends periodic deworming of school-age children with albendazole or mebendazole where infection is common, together with hand washing, wearing shoes, safe water and sanitation.

Food- and Water-Borne Disease

Gastroenteritis, typhoid and hepatitis A spread by the faecal-oral route. Prevention depends on safe water (boiling or chlorinating stored water), hand hygiene, safe food handling and sanitation. Rehydration with oral rehydration salts (and zinc for children, Section 9.1) is the core of treatment. Clusters of cases should be reported promptly through the parish health department.