The HIV Programme at NUH provides both outpatient and inpatient services for Persons Living with HIV/AIDS (PLHA)
Outpatient care
Outpatient services are provided through the Multidisciplinary Infectious Diseases Clinic (MIDC), open to any PLHA seeking care at NUH. The MIDC operates twice weekly, staffed by a rotating roster of Infectious Diseases (ID) consultants and registrars, ID Nurses, medical social workers (MSWs) and Pharmacists. The MID Team also manages inpatients requiring hospital admission (see Inpatient section below).
Referrals to MIDC/BePrEP are made via:
Outpatient services include:
Inpatient care
Inpatient services cater to all PLHA admitted to NUH, including those already in MIDC follow-up, newly-diagnosed patients and PLHA followed-up elsewhere.
Inpatient services include:
Be Prepared (BePrep) Clinic
The NUH HIV Programme also supports the BePrep Clinic, a specialist clinic providing comprehensive and holistic services in sexual health for both men and women. The BePrep Clinic offers screening and counselling for STIs and HIV, as well as risk reduction packages, including Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP).
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
• Seminars that are conducted with public and private sector clinicians concerning latest advances in HIV care
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.
Sexual Health, HIV Medicine & Prevention Observership Diploma Program
A comprehensive, six weeks training program in HIV and sexual health medicine. Participants receive hands-on experience in the medical management of persons living with HIV (PLHIV) and sexually transmitted infections (STIs) in all stages of disease and from initial diagnosis to advanced treatment. Training takes place in the outpatient and inpatient medical settings and includes the opportunity to participate in the Division of Infectious Diseases (ID) / HIV Program educational efforts, clinical conferences, and other activities.
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.
Public and private clinicians Training
An annual NUP and GP update on HIV topics which are of interest to primary care healthcare providers is conducted by the MID team.
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.
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 5-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 Tan Tock Seng Hospital, Singapore General Hospital, Changi General Hospital and National University 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.
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 2014 include:
1. 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
2. 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.
3. 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.
4. 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.
Additional:
1. Dr Dariusz P Olszyna, Tiane Le, Prof Sophia Archuleta, (192) EVOLUTION FROM AN HIV PREP CLINIC TO A COMPREHENSIVE SEXUAL HEALTH SERVICE IN A TERTIARY UNIVERSITY HOSPITAL IN SOUTHEAST ASIA, The Journal of Sexual Medicine, Volume 21, Issue Supplement_4, May 2024
2. Koh MCY, Ngiam JN, Yong J, Tambyah PA, Archuleta S. The role of an artificial intelligence model in antiretroviral therapy counselling and advice for people living with HIV. HIV Med. 2024 Apr;25(4):504-508.
3. Choy CY, Wong CS, Kumar PA, Olszyna DP, Teh YE, Chien MFJ, Kurup A, Koh YL, Ho LP, Law HL, Chua NGS, Yong HYJ, Archuleta S. Recommendations for the use of antiretroviral therapy in adults living with human immunodeficiency virus in Singapore. Singapore Med J. 2024 May 1;65(5):259-273.
4. Choy CY, Wong CS, Kumar PA, Lin RTP, Low C, Toh MPHS, Huang F, Olszyna DP, Teh YE, Jaime Chien MF, Archuleta S. National HIV programme testing recommendations. Singapore Med J. 2023 May 19.
Ng DH, Beh DL, Sutjipto S, Archuleta S, Wong CS. The Greying Pandemic: Implications of Ageing Human Immunodeficiency Virus-Positive Population in Singapore. Ann Acad Med Singap. 2019 Dec;48(12):393-395.
5. Hung CC, Phanuphak N, Wong CS, Olszyna DP, Kim TH. Same-day and rapid initiation of antiretroviral therapy in people living with HIV in Asia. How far have we come? HIV Med. 2022 Oct;23 Suppl 4:3-14.
6. Choy CY, Wong CS, Kumar PA, Yeo B, Banerjee S, Leow Y, Olszyna DP, Tan KK, Tan RKJ, Ti J, Chan R, Le D, Kwok C, Archuleta S. Guidance for the prescription of human immunodeficiency virus pre-exposure prophylaxis in Singapore. Singapore Med J. 2022 Apr 3;65(5):308–11.
7. Teng VYM, Chua YT, Lai EEN, Mukherjee S, Michaels J, Wong CS, Shen L, Leo YS, Young B, Archuleta S, Ong CWM. Lack of latent tuberculosis (TB) screening and delay in anti-retroviral therapy initiation in HIV-TB co-infection: an 11-year study in an intermediate TB-burden country. Int J Infect Dis. 2021 Dec;113:178-183.
8. Brenda Mae Salada, Siew Fai Lee, Clarisse Chen, James S Molton, Sophia Archuleta, Jessica Michaels, 1907. Barriers at the Last Hurdle: Implementing Advance Care Planning for People Living with HIV, Open Forum Infectious Diseases, Volume 5, Issue suppl_1, November 2018, Page S548,
9. Tay, Woo, Chio, Martin, Ho, Benjamin, Archuleta, Sophia, Olszyna, Dariusz. (2023). Four cases of HIV infection in men taking pre-exposure prophylaxis in Singapore. Annals of the Academy of Medicine, Singapore. 52. 704-706. 10.47102/annals-acadmedsg.2023228.
HIV
HIV (human immunodeficiency virus) is a virus that attacks the body's immune system, making a person more vulnerable to other infections and diseases. It is spread through certain bodily fluids from a person with HIV, most commonly during unprotected penetrative sex (sex without using a condom) or through sharing injection drug equipment, such as needles. If left untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome).
There is currently no effective cure for HIV, but it can be controlled with proper care. By taking HIV medicine (called antiretroviral therapy or ART), people with HIV can live long, healthy lives and protect their partners. In addition, there are effective methods to prevent getting HIV through sex or drug use for people who are considered at risk for HIV, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
For more information about HIV, please visit:
• Healthhub
AIDS
AIDS, or advanced HIV infection, is a late or advanced stage of HIV infection that occurs when the body's immune system is badly damaged because of the virus. A person receives an AIDS diagnosis when:
• their CD4 cell count falls below 200 cells per cubic millimetre of blood (or 200 cells/mm3) (A healthy CD4 count is above 500 cells/mm3); or
• they develop one or more opportunistic infections regardless of their CD4 count.
Why should you get tested?
There are a number of good reasons for knowing your HIV status. To begin with, if you test negative, it will set your mind at ease. It will also be an incentive to stay negative, and thus avoid passing HIV on to any of your partner(s).
If you do test positive, you can take action now to stay healthy. Combination therapies can slow down or even stop HIV activity. Your doctor can check your immune system and help you decide if you need to start treatment. Pregnant women who are HIV+ can take treatment to reduce the risk of passing HIV on to the fetus.
Some people have not tested because they feel well, and therefore think they do not have HIV. But keep in mind that it takes up to 10 years on average before HIV-related symptoms appear; in some cases, even longer. You can only know for sure by testing.
Others are reluctant to test because they’re concerned about confidentiality. By testing anonymously, no one can find out your results, or know that you even tested in the first place.
Finally, some people put off testing because they think they won’t be able to deal with knowing they are HIV+. Testing positive can be a real crisis, but with information and support, many HIV+ people can learn to cope.
How is HIV transmitted?
HIV is transmitted when blood, semen, pre-cum, vaginal fluid or breast milk from a person with HIV and have not achieved undetectable viral status enters the blood stream of another person. Not every activity has the same risk. The riskiest activities are: sharing needles and condomless anal or vaginal sex.
You can greatly reduce the chance of transmitting or acquiring HIV if you:
• Use latex condoms with water-soluble lube during vagina or anal sex. Try putting the condom on your partner. This can make foreplay more erotic, and you will be sure the condom is on properly.
• Taking PrEP - Oral pre-exposure prophylaxis is a way for an HIV-negative person who is at risk of HIV infection to reduce their risk of getting HIV by taking antiretroviral drugs.
• Taking PEP – Oral post-exposure prophylaxis within 72 hours of exposure if your condom broke or forgot to use a condom.
• Avoid taking sexual fluids in the mouth. Oral sex is low risk because it is difficult for infected body fluids (blood, semen, pre-cum, vaginal fluid) to enter the bloodstream via the mouth. However, open cuts or sore in your mouth will increase the risk.
• Clean sex toys thoroughly before sharing.
• Use condoms with all your partners unless you know for sure that they are negative. Remember, you can’t tell whether or not they have HIV.
• Don’t let anyone talk you out of safer sex.
• Test regularly if you are sexual active, and test annually even if your activities have been low risk (oral sex).
NUH HIV Programme introduced the BePrEP Clinic in 2016, a sexual health clinic that provides counselling and testing of sexually transmitted infections (STIs) and HIV, as well as risk-reduction packages, including Post-Exposure Prophylaxis (PEP), Pre-Exposure Prophylaxis (PrEP) and DoxyPEP.
Why is sexual health important?
• Getting tested regularly for STIs including HIV can help keep yourself and your sexual partners healthy.
• Early treatment of STIs and HIV can reduce the severity of infections and result in better health outcomes.
• Talking to a qualified healthcare professional about your sexual health helps you protect yourself and your sexual partners in a way that works for you and your lifestyle.
Services BePrEP Clinic provide:
The BePrEP Clinic provides the following services tailored to individual needs:
About Pre-Exposure Prophylaxis (PrEP)
PrEP stands for “Pre-Exposure Prophylaxis”, meaning it is a tool to stop infection (“prophylaxis”) that is taken before you are exposed to HIV. PrEP is endorsed by the World Health Organization for people who are HIV negative and at risk for becoming positive. It has been shown to be effective at reducing risk for HIV when taken as prescribed. every day. The current clinical guidelines for PrEP recommend the use of Truvada, a combination of two anti-viral medications tenofovir disoproxil fumarate and emtricitabine (TDF & FTC) or its generic versions for maximum HIV prevention benefits. These medications are approved by both the U.S. Food and Drug Administration and Singapore's Health Sciences Authority.
However, PrEP does not protect against other sexually transmitted infections, and it is not a cure for HIV. It should be seen not only as a daily pill that prevents HIV, but a comprehensive sexual health plan that links you to ongoing care. In addition to getting a prescription from your doctor, PrEP will require ongoing visits with your doctor every three months to screen for HIV, side effects from the medication, and sexually transmitted infections.
How to take PrEP
Daily PrEP
PrEP is very effective against HIV transmission if taken daily – also correctly and consistently. Studies have shown it can reduce HIV transmission up to 99% through sex when PrEP is taken 7 days before sexual encounter(s) for men and 21 days for women. This will provide high level of protection from HIV for both vaginal and rectal exposure.
On-Demand PrEP
PrEP On-Demand is also known as PrEP 2-1-1 or event-driven PrEP. Rather than taking the medication once a day for a set amount of time, a person who is at risk of HIV transmission can take two pills anywhere between 2 to 24 hours before a sexual encounter, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose.
If you are considering PrEP
Give us a call at +65 6772 5858 for more information regarding PrEP.
About Post-Exposure Prophylaxis (PEP)
PEP is a four-week daily dose of anti-HIV medications that can potentially stop HIV infection after exposure. PEP must be started within 72 hours of exposure. Accessing PEP is especially important when you know your partner has HIV. It's often appropriate in cases when you don’t know their HIV status as well. The sooner you start taking it the better!
Consider getting PEP to stop HIV as soon as possible if you have:
• had a condom break during anal, vaginal, or front hole sex;
• had anal, vaginal, or front hole sex with no condom, or;
• shared syringes for injecting any substance.
If the exposure is during the weekday, contact the BePrEP hotline +65 6772 5858 and our staff will assist you. If the exposure is over the weekend or public holidays, head down to NUH Emergency Department (A&E).
To make your visit goes smoothly at the Emergency Department:
• You need to tell the front counter staff that you had an exposure to HIV and need access to PEP (Post-Exposure Prophylaxis).
• Be ready to discuss the type of exposure you had – this may need some honest, explicit details of the exposure so that the doctor can fully access the level of the risk you were exposed to.
• Bring someone who can help explain to the doctor of what your needs are. (optional)
• You will be given a starter kit of PEP of 5 days, in which the doctor will arrange for you to be follow-up at BePrEP clinic for the rest of the medications.
Referrals to BePrEP are made via:
• The NUH inpatient setting
• Non-NUH providers (i.e. DSC clinic, GPs that accept CHAS card, Polyclinics)
• Self-referral
Click for BePrEP brochure BePreP brochure 2019
We pride ourselves on our multidisciplinary and holistic approach to the treatment of HIV/AIDS. Patients that come to us will receive care from our team of nurses, doctors, pharmacists, and medical social workers to find a treatment and support plan tailored to your needs.
Choosing MIDC as your preferred centre for HIV treatment and care means putting your trust and confidence in us to ensure that your health will be looked after for many years; a responsibility we hold in high esteem.
Click for MIDC brochure MIDC Rapid ART Brochure - V3-cc
What is the next step after testing positive for HIV?
Whether you have tested positive for HIV at an anonymous testing service, private GP or other healthcare institutions, your mind must be overwhelmed with many questions, fears and concerns. It is important for you to remember that HIV can be treated effectively with medicines - you still have control of your own health.
Treatment with HIV medication (called antiretroviral therapy or ART) is recommended for people with HIV. It will help you in becoming ‘undetectable’ and to live a longer, healthier and happier life. Starting treatment earlier treatment will bring you greater health benefits. Start by seeing an HIV specialist to discuss when and how.
Same-Day ART Initiation
The standard treatment initiation procedures would allow a patient who tested positive to wait up to four weeks before medications can be administered. The waiting period before treatment can be filled with questions of costs, side effects and the psychosocial impact that can deterred a person to not seek treatment.
With the advancement of modern medicines and treatment programs, a patient can start on ART within 2 days from the time of diagnoses, improving linkage to care and reducing lost to follow-up.
Countries that implemented Same-Day ART initiation have shown many benefits to the health of patients and for the community keeping viral load under control to prevent further transmission of HIV.
Benefits of Same-Day ART Initiation:
• Reduce HIV-related morbidity and mortality
• Viral suppression (Undetectable = Untransmittable)
• Improve the body’s immune function (CD4 T cells)
• Reduction in HIV-associated complications, including AIDS- and non-AIDS related conditions
What you can expect when you choose your treatment with us:
• Guaranteed appointment within 96 hours to start treatment (see Same-Day ART)
• Knowledgeable and experienced HIV Specialists who have treated many people living with HIV. All our specialists can recognise symptoms and address complications associated with treatment regimens that are best suited for you.
• A holistic approach to your HIV treatment by a team of medical social workers, pharmacists, MIDC nurse and clinic staff working alongside the doctors in order to find treatment that is suitable to your needs.
• Your diagnosis and test results will be communicated thoroughly and presented in an understandable manner, both to you and to the person whom you trust that accompanied you.
• A treatment plan that tailored to your needs, whether you decide to start treatment immediately or postpone to timing when you are ready, our team will support your decision.
• A direct line that you can call for all your inquiries.
Choosing MIDC as your preferred centre for HIV treatment and care means putting your trust and confidence in us to ensure that your health will be looked after for many years; a responsibility we hold in high esteem.
Inpatient care
Inpatient services are provided to all PLHA admitted to NUH including:
• Patients already on follow-up at MIDC
• Newly-diagnosed patients
• PLHA known to be HIV positive but on follow-up elsewhere
Services provided by the MIDC team include:
• 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
Referrals to the MIDC are made via:
• The NUH inpatient setting
• Non-NUH providers (i.e. DSC clinic, AFA, GPs, Polyclinics)
• Self-referral
Achieving Undetectable HIV Status (U=U)
Being ‘undetectable’ is when your antiretroviral therapy (ART) has reduced your HIV to such small quantities (<200 copies per milliliter or other even lower definitions) that it can no longer be detected by standard blood tests. People living with HIV who have an undetectable viral load cannot pass HIV through sex.
Being ‘undetectable’ does not mean your HIV is cured. There is still HIV in your body, except that it has been reduced to very small amounts. This means that if you stop taking treatment, your viral load will increase – affecting your health and making HIV transmittable again.
To know that you’re ‘undetectable’, you must have your viral load monitored regularly.
For more information on our patient’s journey at MIDC, click on the PDF MIDC Moving Forward Fact Sheet 2025
Sexually transmitted infections (STIs)— or sexually transmitted diseases (STDs) — are generally acquired through sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, prolong skin to skin contact or vaginal and other bodily fluids.
You may have noticed that we started using Sexually Transmitted Infections (STIs) instead of the older terminologies, VD and STD, but why? Using the term infection is scientifically more accurate at describing what we are dealing with. Diseases only refer to the signs and symptoms that they may present with. In fact, many of the common STIs have little to no signs or symptoms at all!
The shift from using infections signifies that STIs can be treated. This will lower the stigma and burden that people with STIs, carry with them.
Some common STIs are:
• HIV, the virus that causes AIDS
• Chlamydia
• Gonorrhoea
• Herpes
• Syphilis
• Genital warts
For more information on STIs, click on the link: HealthHub (STIs)
How do I know if I have an STI?
Some symptoms are easy to spot while others do not present with any signs and symptoms at all.
Here are a few common ones:
Testing is simple, safe and non-judgemental
Finding out if you have an STI is as simple as approaching your doctor. These samples are then sent to the labs to be tested. Results will be ready in 3 to 5 working days and you will be notified accordingly.
Untreated STIs can have dangerous consequences
These consequences can range from inflammation, infertility, damages to the vital organs such as the liver and brain. In some extreme cases, untreated STIs can lead to blindness, stillborn child and even death. All of these are preventable with adequate treatment and medication. Many STIs can also be cured now and have little to no impact on the body when detected early.
Types of tests
• Vaginal swabs
• Rectal swabs
• Throat swabs
• Blood tests
• Urine samples
What happens if you have a positive result?
Our doctors and health advisers will discuss treatment options with you. Many STIs can be easily managed or even cured today.
Do the right thing and inform your sexual partners and encourage them to take a test to prevent the spread.
STIs can be prevented by:
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, T-Project, Project X, The Green House and Oogachaga in educational and outreach programmes such as AIDS Candlelight Memorial, MSM Singles workshop, training of staff and volunteers and the Singapore AIDS Conference.
BePrEP Clinic
• Operating Hours (*Strictly by appointment only)
Tues & Thurs: 2.00pm to 4.00pm
• To make an appointment
MIDC
To make an appointment to attend the MIDC clinic or for any patient related enquiries, please call (65) 6772 7800 ext. 2 or email: [email protected].
