Six months ARV dispensing (6MD) visits

Clinical description

Facility criteria

• Facilities can provide 6MD when they meet the facility criteria:

o Stable and reliable stock management for all HIV related commodities.

o Secure storage space for additional large volumes of commodities: identify and organize room for storage in advance before the stocks arrive.

o Ample current stocks for each ARV and other drugs needed (CPT, fluconazole, etc.) to avoid the need for rationing supplies for other patients.

Patient criteria

• Routinely give 6MD appointments for stable and adherent patients. Patients must meet all the

following criteria:

o At least 24 years old; ages 18-24 are eligible if they have a dedicated treatment supporter recognised by the clinic.

o On ART treatment for at least 6 months o On the current ART regimen for at least 3 months o Not on TPT (IPT or 3HP)

o No current ARV side effects o No opportunistic infections o Suppressed VL, collected in the last 12 months o No pending VL result o Not pregnant or breastfeeding

• Figure 4 shows how to align 6MD appointments with the standard VL monitoring schedule.
• Figure 5 shows an example for aligning the enhanced 6-monthly VL monitoring with the dispensing

visit schedule for a woman initiating ART in the 2nd trimester of pregnancy.

• Plan ahead: give a shorter appointment to maintain around 12 months between collection of VL

samples.

Figure 4: Alignment of 6 months dispensing with 12-monthly VL monitoring 12 month 12 months Collect VL Review VL Collect VL Review VL Collect VL Review VL VL monitoring Months on ART 0 3 6 9 12 15 18 21 24 27 30 33 36 39 Visit interval 1 1 1 3 3 6 3 3 6 3 3 6 (months)

Figure 5: Alignment of enhanced 6-monthly VL monitoring for pregnant and breastfeeding women with dispensing visit schedule Pregnant Breastfeeding 6 months 6 months 6 months 6 months 12 months Collect VL Review VL Collect VL Review VL Collect VL Review VL Collect VL Review VL Collect VL Review VL VL monitoring Months on ART 0 3 6 9 12 15 18 21 24 27 30 33 36 39 Visit interval 1 1 1 3 3 3 3 3 3 3 3 6 3 3 (months)

Management of labour and delivery