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HIV/AIDS Programme Strengthening Health Services to Fight HIV/AIDS

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HIV/AIDS Programme Strengthening Health Services to Fight HIV/AIDS HIV/AIDS Programme Strengthening health services to fight HIV/AIDS ESSENTIAL PREVENTION AND CARE INTERVENTIONS FOR ADULTS AND ADOLESCENTS LIVING WITH HIV IN RESOURCE-LIMITED SETTINGS WHO Library Cataloguing-in-Publication Data Essential prevention and care interventions for adults and adolescents living with HIV in resource-limited settings / coordinated by Kevin O’Reilly. 1.HIV infections - prevention and control. 2.HIV infections - therapy. 3.HIV infections - complications. 4.Developing countries. I.World Health Organization. II.Boothroyd, Jim. ISBN 978 92 4 159670 1 (NLM classification: WC 503.5) © World Health Organization 2008 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named editor alone is responsible for the views expressed in this publication. Printed in ESSENTIAL PREVENTION AND CARE INTERVENTIONS FOR ADULTS AND ADOLESCENTS LIVING WITH HIV IN RESOURCE-LIMITED SETTINGS Acknowledgements The work was coordinated by Kevin O’Reilly, Department of HIV/AIDS, World Health Organization, with the assistance and support of many others. Jim Boothroyd edited this guidance. ii CONTENTS Acknowledgements ......................................................................................................................ii Acronyms and abbreviations ........................................................................................................v Executive Summary .....................................................................................................................vi 1. Background and rationale .................................................................................................. 1 1.1 Involving people living with HIV ................................................................................ 3 2. Objectives .......................................................................................................................... 4 2.1 Target audience ........................................................................................................ 4 3. Methods ............................................................................................................................. 5 3.1 Strength and quality of the evidence ........................................................................ 5 4. Recommendations ............................................................................................................. 8 4.1 Psychosocial counselling and support .....................................................................8 4.1.1 Comprehensive interventions ........................................................................ 8 4.1.2 Counselling and condoms ............................................................................ 9 4.1.3 Sero-discordant couples ...............................................................................9 4.1.4 Sero-concordant couples ........................................................................... 10 4.1.5 Adherence interventions.............................................................................. 10 4.1.6 Mental health ...............................................................................................10 4.2 Disclosure, partner notifi cation and testing and counselling ...................................11 4.2.1 Partner notifi cation and disclosure ...............................................................11 4.2.2 Testing and counselling of partners and family members........................... 12 4.3 Co-trimoxazole prophylaxis .................................................................................... 13 4.3.1 Pregnant women and co-trimoxazole .......................................................... 15 4.4 Tuberculosis (TB) .................................................................................................... 16 4.4.1. Counselling ................................................................................................. 16 4.4.2. Screening for TB-disease ............................................................................16 4.4.3. TB-preventive therapy ..................................................................................17 4.5 Preventing fungal infections ....................................................................................20 4.6 Sexually transmitted and other reproductive tract infections ..................................23 4.6.1 Screening, diagnosis and management of STIs and RTIs .......................... 23 4.6.2 Genital herpes .............................................................................................24 4.6.3 Screening for ongoing risk behaviours and STIs......................................... 25 4.6.4 Screening for cervical cancer ..................................................................... 26 4.7 Preventing malaria .................................................................................................. 27 4.7.1 Co-trimoxazole for malaria .......................................................................... 28 4.7.2 Insecticide-treated mosquito nets ...............................................................28 4.7.3 Prevention of malaria infection in pregnant women with HIV ...................... 29 iii 4.8 Selected vaccine preventable diseases ..................................................................30 4.8.1 Hepatitis-B vaccine ..................................................................................... 31 4.8.2 Pneumococcal vaccine ............................................................................... 32 4.8.3 Infl uenza vaccine .........................................................................................33 4.8.4 Yellow fever vaccine .................................................................................... 34 4.9 Nutrition .................................................................................................................. 35 4.9.1 Nutrition assessment................................................................................... 36 4.9.2 Nutrition support and micronutrient supplements....................................... 36 4.9.3 Nutrition support for pregnant women ........................................................ 37 4.10 Family planning .......................................................................................................38 4.10.1 Family planning counselling and services .................................................. 39 4.10.2 Condoms and counselling .......................................................................... 40 4.10.3 Safe reproductive services ..........................................................................40 4.11 Preventing mother-to-child transmission of HIV ......................................................41 4.11.1 Pregnant women with indications for ART ...................................................41 4.11.2 ARV prophylaxis for preventing HIV infection in infants ...............................42 4.11.3 Recommended ARV regimen for preventing MTCT among women in labour who have not received antenatal antiretroviral prophylaxis ..........43 4.11.4 Infants born to HIV-infected women who did not receive antiretroviral drugs during pregnancy or labour .............................................................. 43 4.12 Needle-syringe programmes and opioid substitution therapy ............................... 44 4.12.1 Needle-syringe programmes ...................................................................... 45 4.12.2 Opioid substitution therapy .........................................................................46 4.13 Water, sanitation and hygiene .................................................................................47 4.13.1 Safe Water ...................................................................................................48 4.13.2 Sanitation ...................................................................................................
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