Human Immunodeficiency Virus – HIV (ARV)

1. I understand the questions above and have answered honestly. Any inaccurate or false information could potentially be dangerous to my health and safety.
2. The medication that is prescribed is for my personal use only. I understand the side effects (including potential liver and kidney damage) and effectiveness of the treatments.
3. I am 18 years or older.
4. I am currently living in South Africa.
5. I will have an in-person medical consultation at least once a year for comprehensive care and physical examination.
6. I understand that ARVs do not offer any protection against STIs. 
7. It is important to adhere to the medication to prevent resistance and virological failure
8. Treatment is prescribed as per South African medical guidelines. 
9. I acknowledge that a doctor will communicate with me via WhatsApp within 24 hours.
10. Please note that ID verification is required for all patients
11. I confirm that the contact information I have provided is correct and belongs to me. I understand that the platform relies on this information to communicate private healthcare information with me.

Consent: 

Treatment Information:
You have been prescribed a combination antiretroviral therapy (ART) called TLD, which includes Tenofovir, Lamivudine, and Dolutegravir. This once-daily tablet is highly effective in suppressing HIV, improving immune function, and reducing the risk of HIV transmission to others.

While this medication is generally well tolerated, it may cause side effects in some individuals. Please read the following carefully and notify a healthcare provider if you develop any concerning symptoms.

Possible Serious Side Effects:

1. Liver Problems (Hepatotoxicity)

This treatment may affect liver function. Seek urgent care if you notice:

• Yellowing of the skin or eyes (jaundice)
• Dark urine
• Pale stools
• Nausea, vomiting, or abdominal pain (especially upper right side)
• Unusual fatigue or loss of appetite
• Confusion

2. Lactic Acidosis (Rare but Serious)

A buildup of lactic acid in the blood can occur. Seek immediate medical attention if you develop:

• Deep, rapid breathing
• Muscle pain or weakness
• Extreme tiredness or weakness
• Abdominal pain with nausea and vomiting
• Cold or blue hands/feet

3. Kidney Problems

The treatment may affect kidney function. Routine kidney function tests are necessary during treatment. Notify your healthcare provider if you notice:

• Swelling in the legs or ankles
• Changes in urination (frequency or color)
• Fatigue
• Confusion

Routine kidney function tests are necessary during treatment.

4. Mental Health Side Effects

Some people may experience:

• Insomnia
• Anxiety or depression
• Suicidal thoughts or mood changes

Seek urgent care if you experience:

• New or worsening depression
• Thoughts of self-harm or suicide
• Severe sleep disturbances
  
  

5. Hypersensitivity or Allergic Reactions

Stop treatment and seek emergency help if you experience:

• Rash
• Fever
• Shortness of breath
• Swelling of the face, lips, tongue, or throat
• Difficulty breathing or swallowing

Important Treatment Information:

• Medication Adherence: For treatment to be effective, it must be taken daily, exactly as prescribed. Skipping doses can lead to resistance and treatment failure.
• Drug Interactions: Inform your healthcare provider about all medications you are taking, including traditional or herbal medicines (e.g. St. John's Wort, calcium or iron supplements), which may reduce the effectiveness of the treatment.
• Alcohol and Substance Use: Excessive alcohol use can increase liver and kidney risks. Please limit or avoid alcohol during treatment.
• Missed Dose: If you miss a dose, take it as soon as you remember. If it's almost time for your next dose, skip the missed one. Do not take a double dose.
• Monitoring: Routine yearly blood tests (kidney function, viral load, CD4 count) are required to ensure the treatment is working and safe.
• STIs: This treatment does not protect against sexually transmitted infections (STIs). It is important to use appropriate precautions to prevent spread of STIs/HIV e.g. condoms or other barrier protections.

Do not share your medication with anyone else. This treatment is prescribed based on individual clinical assessment.

Always read the medication leaflet provided in your package.

⛔Please urgently visit your nearest emergency dept or in-person doctor if you are experiencing symptoms such as severe pain, chest pain, difficulty breathing, allergic reactions, dizziness, weakness, or other severe symptoms. Telemedicine services are not suitable for emergency medical conditions.

If you require an invoice for medical aid, please fill out the below

Submitting this questionnaire with any “⛔ (do not proceed)” conditions will disqualify you from receiving a prescription.