Tanzania National Guidelines text - WHO

1 National Guidelines For the Management of HIV and AIDS. National AIDS Control Programme (NACP). third edition (revised February 2009 ). Copyright 2008 Government of Tanzania . Contents Abbreviations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Foreword- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3. Acknowledgements - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5. Chapter 1: Overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9. Epidemiology of HIV and AIDS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11.

2 Impact of HIV and AIDS- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12. National Response- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14. Basic Facts about HIV - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15. Chapter 2: Organization of HIV and AIDS Care and Treatment - - - - - - - - - - - - 23. Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25. Identifying People Living with HIV and AIDS in Need of Care and Treatment and Sensitization of Communities- - - - - - - - - - - - - - - - - - - - - - - - - - 25. Scope of Activities to Provide Care and Treatment- - - - - - - - - - - - - - - - - - - - - - - - 26.

3 Organization of Care and Treatment Services- - - - - - - - - - - - - - - - - - - - - - - - - - - - 27. Linkages Across a Continuum of Care - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 34. Certification of Health Facilities to Deliver HIV and AIDS. Care and Treatment - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 35. Management of Antiretroviral Medicines- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 41. Chapter 3: HIV and AIDS Prevention- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 47. Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 49. Treatment and Prevention of Sexually Transmitted Infections (STIs) - - - - - - - - - - 49.

4 Prevention of Mother to Child Transmission (PMTCT) of HIV - - - - - - - - - - - - - 49. Condom Programming - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 50. Workplace HIV and AIDS Policy and Programme for the Health Sector - - - - - - - 51. Prevention of HIV Transmission Through Blood Transfusion- - - - - - - - - - - - - - - - 51. HIV and AIDS Prevention for Sex Workers and Other Vulnerable Groups- - - - - - 51. Youth (in and out of school) and HIV and AIDS- - - - - - - - - - - - - - - - - - - - - - - - - 52. Voluntary Counselling and Testing (VCT)- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 52. Family Planning Services - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 52.

5 Reduction of Stigma and Discrimination - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 53. Male Circumcision- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 53. Chapter 4: HIV Prevention in a Health Care Setting- - - - - - - - - - - - - - - - - - - - - - 55. Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 57. Prevention of HIV Transmission through Standard Precautions- - - - - - - - - - - - - - 57. Post Exposure Prophylaxis (PEP)- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 65. Chapter 5: Laboratory Tests for HIV and AIDS- - - - - - - - - - - - - - - - - - - - - - - - - 79.

6 Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 81. Tests for HIV Diagnosis- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 81. Tests for Monitoring Disease Progress and Treatment Safety- - - - - - - - - - - - - - - - - 83. Tests for diagnosing Opportunistic Infections- - - - - - - - - - - - - - - - - - - - - - - - - - - - 86. Laboratory Safety Procedures- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 86. Sample Storage Procedures- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 86. Sample Transportation Procedure- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 86.

7 Chapter 6: Management of Common Symptoms and Opportunistic Infections in HIV and AIDS in Adolescents and Adults - - - - - - - - - - - - - - - 89. Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 91. Clinical Features Commonly Encountered in Patients with HIV and AIDS- - - - - 92. Prophylactic Treatment of Common Opportunistic Infections in HIV. and AIDS with Co-trimoxazole - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 98. Preventive Therapy against TB in PLHAs- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 101. Treatment of Opportunistic Infections- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 101.

8 Chapter 7: Pediatric HIV and AIDS-related Conditions- - - - - - - - - - - - - - - - - 109. Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 111. Diagnosis of HIV Infection in Infants - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 113. HIV and AIDS Manifestations in Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - 115. Management of Infants Born to HIV Positive Women - - - - - - - - - - - - - - - - - - - - 117. HIV Diagnostic Protocol for Abandoned Infants- - - - - - - - - - - - - - - - - - - - - - - - 118. Care of HIV infected Children- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 119. Clinical Manifestations of Paediatric HIV Infection- - - - - - - - - - - - - - - - - - - - - - 120.

9 Chapter 8: Antiretroviral Therapy in Adults and Adolescents- - - - - - - - - - - - - - 129. Introduction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 131. Types of Antiretroviral Drugs- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 131. Treatment Using ARV Drugs in Adults and Adolescents- - - - - - - - - - - - - - - - - - - 133. Recommended ARV Drugs in Tanzania - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 139. Adherence to Antiretroviral Therapy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 145. Changing Antiretroviral Therapy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 147.

10 Second-Line ARV Regimen - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 153. Monitoring Patients on ARV Therapy- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 154. Treatment Failure with Second Line Regimens - - - - - - - - - - - - - - - - - - - - - - - - - 161. In Case of Loss to Follow Up - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 162. Contraindications (relative) for initiation of ART - - - - - - - - - - - - - - - - - - - - - - - 162. Discontinuation of ART- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 162. What Happens to Adherence Over Time? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 163.