NATIONAL CONSOLIDATED GUIDELINES FOR …

1 NATIONAL CONSOLIDATED GUIDELINES FOR COMPREHENSIVE HIV PREVENTION, CARE AND TREATMENT Continuum of HIV services refers to a comprehensive package of HIV prevention, diagnostic, treatment, care and support services provided for people at risk of HIV infection or living with HIV and their families August, 2018 Continuum of HIV services refers to a comprehensive package of HIV prevention, diagnostic, treatment, care and support services provided for people at risk of HIV infection or living with HIV and their families August, 2018 NATIONAL CONSOLIDATED GUIDELINES FOR COMPREHENSIVE HIV PREVENTION.

2 CARE AND TREATMENTC ontentsChapter 1 INTRODUCTION and Context for the CONSOLIDATED Guideline of the Guideline Audience Principles 3 Forward iAcknowledgement iiAcronyms and Abbreviations iiiChapter 2 HIV DIAGNOSIS AND PREVENTION HIV Testing Services Innovative HTS Approaches and Tools to Strengthen Targeted HIV Testing Service Quality Management , Ethical and Legal Considerations for HIV Testing and Counseling Linking People Diagnosed with HIV Infection Post Exposure Management including Prophylaxis Combination Prevention 33 Chapter 3 CARE AND TREATMENT OF PEOPLE WITH HIV INFECTION General care packages for PLHIV Preparing People Living with HIV for ART When to Start ART What ART regimen to start with (first-line ART)

3 Monitoring response to ART Re-engaging with care after ART interruption Diagnosis and management of antiretroviral treatment failure What ART regimen to switch to (second-line ART regimens) Implementation of Second Line ART at Health Center Level Identification and management of second-line treatment failure 82 Chapter 4 PREVENTION, SCREENING AND MANAGEMENT OF COMMON CO-INFECTIONS Co-trimoxazole preventive therapy Management of opportunistic diseases of the respiratory system Management of gastrointestinal opportunistic diseases Management of opportunistic diseases of the nervous system Cutaneous manifestations Visceral leishmaniasis Screening for co-morbidities 120 Chapter 5 SERVICE DELIVERY HIV service delivery Linkage from HIV testing to enrollment into care Disclosure

4 Retention in care Adherence to ART Task shifting for HIV treatment and care Decentralizing HIV treatment and care Integrating and linking services Delivering HIV services to adolescents Improving the quality of HIV care services Pharmaceuticals supply management system Laboratoryand diagnostic services 151 Chapter 7 MONITORING & EVALUATION Monitoring the implementation of the new recommendation Key Indicators Data reporting, data flow and quality assurance Supportive supervision and review meetings Other monitoring considerations 179 Chapter 6 GUIDANCE FOR PROGRAMME MANAGERS Guiding principles NATIONAL and local HIV epidemiology Program performance and response analysis Key parameters for decision-making Roles and responsibility Coordination mechanisms 163 Chapter 8 ANNEXES 180 Annex 1: Growth curves 181 Annex 2.

5 Instruction for MUAC measurement 186 Annex 3: Dosage of antiretroviral drugs for adults and adolescents 187 Annex 4. Table1. Simplified infant prophylaxis dosing 188 Annex 5: Pediatric ARV drug formulations,w side effects and special considerations in children192 Annex 6: Grading of toxicity in adults and adolescents 199 Annex 7:- Grading of adverse events in children 200 Annex 8. : Laboratory grading of adverse events in adults and adolescents (ACTG) 203 Annex 9: -Grading toxicities in children by selected laboratory findings 204 Annex 10: Pediatric TB screening tool 205 Annex 11: Adult TB screening tool 207 Annex 12: Client with high viral load follow-up form 209 Annex 13: Brief mental health disorders symptom screening tool and referral tool for PLHIV 212iForward antiretroviral treatment (ART) began in 2003 and free ART was launched in 2005.

6 According to the 2018 new spectrum estimate, 613,000 Ethiopians are currently living with human immunodeficiency virus (HIV) and all of them require ART in 2017. However, only 436,000 individuals are currently taking antiretroviral (ARV) drugs (2017 global AIDS monitoring report). Recognizing the need for antiretroviral treatment, the Government of Ethiopia (GOE) issued the first ARV GUIDELINES in 2003 to facilitate a rapid scale up of ART. The guideline was revised in 2005, 2008 and 2014 following the respective WHO guideline revisions.

7 Expanding and strengthening HIV prevention, care and treatment activities at regional, zonal, woreda and kebele levels through targeted social mobilization and active community participation are expected to create an enabling environment to prevent and control the spread of the epidemic. The process of task shifting; training of nurses and community health agents in prevention, treatment, care and support activities will further strengthen community linkages and ensure availability of standard minimum packages of HIV/AIDS services at primary health care level.

8 Currently there are more than 1361 health facilities providing HIV care and treatment revised edition of the GUIDELINES for use of ARV and opportunistic infection (OI) drugs in adults, adolescents and children is based on recent NATIONAL and global evidences and experiences. The Federal Ministry of Health believes that these GUIDELINES , along with other NATIONAL GUIDELINES and training manuals, will be instrumental in maintaining the standard of care and ensuring quality of HIV service Worku, MD,MPHS tate MinisteriiAcknowledgementThe Federal Ministry of Health expresses its appreciation for the institutions participated in the revision of this CONSOLIDATED HIV prevention care and treatment guideline.

9 Special thanks goes to USAID/PHSP, Clinton Health Access Initiative (CHAI) and Population Service International (PSI) for supporting the guideline revision workshops expense, WHO country office for the design and printing and ICAP-E for printing the guideline. The ministry also recognizes the following experts for their contribution in the revision/adaptation of the GUIDELINES :Name OrganizationDr Fethia KederFMOHMrs. Mirtie Getachew FMOHSr Seble Mamo FMOHDr Kassu KetemaFMOHDr Shewaminale YohannesFMOHDr Zelalem Tadesse ANNCCADr Ambachew TeferaFMOH/PHSPMr Dagim DamitewFMOHDr Eyerusalem KebedeFMOHMrs Kidist ZealiasEPHIMr Getnet HailuEPHIDr Eshetu Gezehagn PHSPDr Petros Mitiku PHSPDr Abera Refisa ICAP-EDr Yoseph GutemaICAP-EMr Asmamaw SileshCHAIDr Daniel AssefaCHAIDr Bahrie BeleteCHAIDr Ghion TirsiteWHODr Aschalew Endale WHOMs.

10 Tsion Tsegaye PFSAMr. Ismael AhmedCDCDr Chane TemesgenCDCDr Mesfin TilayeUSAIDMr Alexyv GizachewPSMMr Yalemsew DeribPSMMs Samrawit EjiguPSI/EthiopiaMr Dinku WorkuNEP+iiiAcronyms and Abbreviations3TC Lamivudine ABC Abacavir AFB Acid fast bacilli AIDS Acquired Immune Deficiency Syndrome ANCA ntenatal CareARV antiretroviral ASM Appointment spacing model AZT/ZDV Zidovudine CBC Complete Blood Count CD4 cellsType of T-lymphocyte, white blood cellsCMVC ytomegalovirusCPTC otrimoxazole Preventive TherapyCrAgCryptococcal antigenDBSD ried Blood SpotDTGD olutegravirDRVD arunavirDHSD emographic and Health SurveyDNA Deoxyribonucleic acid DOTS Directly Observed therapy Short Course EFV Efavirenz.