Summary of key policies

Clinical description

• All HIV infected people should start ART as soon as possible for their own health and to

prevent on ward transmission of the virus.

• Rapid ART initiation should be offered on the same day to people who are ready to start.
• Serious HIV-related diseases can occur even in patients with high CD4 count (>500), without

any previous symptoms. Rapid ART greatly reduces this risk.

• Current ART regimens are easy to take and rarely cause serious side-effects.
• ART for all HIV infected people is the most effective HIV prevention method available:

Successful ART leads to very low levels of virus in the blood and in body fluids (viral suppression). Viral suppression greatly reduces the risk of sexual or mother-to-child transmission.

Table 1: Key new and existing policies eMTCT Strategy Page New Test all pregnant women and their sexual partners for hepatitis B at first antenatal 61 visit unless they are already known to be hepatitis B positive. Link all hepatitis B positives for treatment eligibility screening.

New In districts with high HIV incidence: Give an HIV self-test at discharge from 110 maternity for sexual partners who don’t come for professional testing to the facility. Re-test all breastfeeding women not known to be HIV positive at family planning/ MNCH/ EPI clinics between 6 to 9 months after delivery.

New Give 6 weeks of AZT/3TC/NVP (2P) prophylaxis to high-risk HIV exposed infants; 109 low risk infants receive 6 weeks nevirapine syrup as infant prophylaxis HIV-related diseases Old Short-course amphotericin B + flucytosine for induction phase treatment of cryptococcal meningitis.

New Single high dose liposomal amphotericin B + two weeks of flucytosine and 23 fluconazole for treatment induction of cryptococcal meningitis for adults Old Amoxicillin 500mg 8-hourly for 5 days as standard treatment for mild to moderate community acquired pneumonia New Amoxicillin 1000mg 8-hourly for 5 days as standard treatment for mild to 27 moderate community acquired pneumonia Old No corticosteroids pre-medication before IV paclitaxel administration for KS New Pre-medicate with corticosteroids before IV paclitaxel administration for KS 30 HIV and COVID-19 Page New Don’t use ARVs for HIV treatment for the prevention or treatment of COVID-19 35 New Recommend full COVID-19 vaccination to all eligible PLHIV, including pregnant and 35 breastfeeding women Standard monitoring of HIV patients New Use semi-quantitative rapid CD4 count test for PLHIV initiating ART or with 43 suspected clinical treatment failure where quantitative CD4 testing is not available.

Preventive services for HIV patients New Give 3HP to all PLHIV initiating ART (without contraindications) using a fixed-dose 50 combination tablet of rifapentine/isoniazid.

Management of non-communicable diseases New Screen all ART patients 40+ years annually for diabetes using blood glucose testing. 55 New Routinely screen all ART patients with treatment adherence challenges for 56 depression and substance abuse.

Understanding ART regimens and formulations Old Stopping any NVP or EFV containing regimen requires giving a 7-day ‘tail’ of the other 2 ARVs in the regimen New No need for a 7-day tail after stopping NVP or EFV 62 Prescribing and dispensing ARVs Old Patients initiating standard or alternative first line ART must be reviewed clinically after 1 month and then every month for the first 6 months New Patients initiating standard or alternative first line ART must be reviewed clinically 74 at month 1, 2, 3 and 6 after initiation Continuing ART Old Start / transition all children weighing 3 - 19.9kg to regimen 9P (ABC/3TC + LPV/r)

New Start / transition children weighing 3 - 19.9kg to regimen 15PP (ABC/3TC + DTG) 77, using dispersible 10mg DTG tablets 84 New Intensive adherence support for patients with unsuppressed viral load must be 86 provided by an experienced clinician or nurse, not by a lay provider New Emphatically welcome treatment interrupters to return to ART, either self- 87 motivated or after active follow-up. Openly advertise at OPD and HTS that interrupters are welcome to restart ART at this facility.

Old The first VL is scheduled 6 months after ART initiation for all ART patients.

Thereafter, a new VL is scheduled every 12 months after the last test.

New For children on paediatric regimens, pregnant and breastfeeding women, a new VL 91 is scheduled every 6 months after the last test.

Summary of key policies 9 Post exposure prophylaxis (PEP) Page Old Four weeks of AZT/3TC is the standard paediatric PEP regimen New Four weeks of ABC/3TC + DTG is the standard paediatric PEP regimen 113 Pharmacovigilance New Use the mobile phone-based electronic reporting form (Medsafe-360 USSD 118 platform) in addition to paper-based reporting of all suspected adverse drug reactions