The evidence base for differentiated care for stable patients has grown in recent years. There has been less attention, however, to developing differentiated models of care for patients with advanced or unstable HIV disease. Current clinical guidelines and policies regarding optimal packages of care... for high-risk patients give few or no recommendations about how, by whom, or where they should be delivered for optimal impact.
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The objectives of these guidelines are to provide recommendations outlining a public health approach to managing people presenting with advanced HIV disease, and to provide guidance on the timing of initiation of antiretroviral therapy (ART) for all people living with HIV.
WHO recommends that a... package of screening, prophylaxis, rapid ART initiation and intensified adherence interventions be offered to everyone living with HIV presenting with advanced disease.
WHO strongly recommends that rapid ART initiation should be offered to people living with HIV following confirmed diagnosis and clinical assessment. Rapid initiation of ART is defined as within seven days of HIV diagnosis. WHO further strongly recommends ART initiation on the same day as HIV diagnosis based on the person’s willingness and readiness to start ART immediately, unless there are clinical reasons to delay treatment.
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Journal of the International AIDS Society Vol. 21 (2018) e25133
Many prevention of mother-to-child HIV transmission programmes across Africa initiate HIV-infected (HIV positive) pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care (“same-day” initiation...). However, there are concerns that same-day initiation may limit patient preparation before starting ART and contribute to subsequent non-adherence, disengagement from care and raised viral load. We examined if same-day initiation was associated with viral suppression and engagement in care during pregnancy.
The data suggest that same-day ART initiation during pregnancy is not associated with lower levels of engagement in care or viral suppression through 12 months post-delivery in this setting, providing reassurance to ART programmes implementing Option B+.
https://doi.org/10.1002/jia2.25133
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The five hepatitis viruses have different epidemiological profiles, and their impact, duration, and transmission route also vary. The most common transmission routes contributing to the spread of hepatitis are exposure to infected blood via blood transfusion or unsafe injection practices, consumptio...n of contaminated food and drinking water, and transmission from mother to child during pregnancy and delivery. Also, unsafe injection practices, including the use of unsterile needles and syringes, serve as a major pathway for the spread of hepatitis B and C, and reducing transmission of both diseases requires addressing these practices.
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Evaluation report November 2014
Integrated Management of Adolescent and Adult Illness
Integrated Management of Childhood Illness
Interim Guidelines for health workers at health centre or district hospital outpatient clinic
Vreeman RC et al. Journal of the International AIDS Society 2017, 20(Suppl 3):21497 http://www.jiasociety.org/index.php/jias/article/view/21497 | http://dx.doi.org/10.7448/IAS.20.4.21497