Transcription of ZAMBIA CONSOLIDATED GUIDELINES
1 ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection 2020 ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection This page was intentionally left blank i ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection Republic of ZAMBIA Ministry of Health ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection TABLE OF CONTENTS LIST OF FIGURES .. i LIST OF TABLES.
2 Ii ACRONYMS .. iii FOREWORD .. v ACKNOWLEDGMENTS .. vi INTRODUCTION .. 1 HIV TESTING SERVICES .. 2 PREVENTION .. 15 MANAGEMENT OF HIV EXPOSED INFANTS AND HIV INFECTED POPULATIONS .. 29 ART ADHERENCE .. 60 CO-MORBIDITIES .. 64 APPENDIX 1: Dosages of Antiretrovirals for Adults and Adolescents .. 118 APPENDIX 2: Key Drug-Drug Interaction for ARVs .. 121 APPENDIX 3: WHO Toxicity Estimates .. 123 APPENDIX 4: Co-Trimoxazole Desensitization Protocol For Adolescents And Adults .. 124 APPENDIX 5: Positive Health Dignity & Prevention (PHDP) .. 125 APPENDIX 6: Renal insufficiency screening algorithm (in the absence of Creatinine test) .. 126 APPENDIX 7: Formulae for calculating Creatinine Clearance in different patient populations.
3 127 GLOSSARY .. 127 i ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection LIST OF FIGURES Figure 1: HIV Self-Testing Algorithm .. 4 Figure 2: Index Testing and Partner Notification .. 6 FIgure 3: Index Testing Cascade .. 7 Figure 4: Partner Notification Services Algorithm .. 8 Figure 5: HIV Serological Testing Algorithm .. 11 Figure 6: Recent Infection Algorithm (RITA) with Viral Load Testing in Routine HIV Testing Services .. 13 Figure 7: PrEP Flow Chart .. 20 Figure 8: Algorithm for Evaluation and Treatment of possible Non-Occupational HIV Exposure .. 22 Figure 9: The Four Pillars/Prongs of EMTCT .. 23 Figure 10: Flow Diagram for HIV Care and Treatment from HIV Testing to ART Initiation.
4 30 Figure 11: Same Day ART Initiation Algorithm in Adults .. 34 Figure 12: Algorithm for Choosing DTG or EFV-400mg in Patients Initiating ART .. 38 Figure 13: Viral Load Monitoring in Patients on ART .. 43 Figure 14: Viral Load Monitoring in Pregnant and Breastfeeding Women on ART .. 44 Figure 15: Algorithm for Diagnosing Treatment Failure with Routine Viral Load Monitoring .. 50 Figure 16: Algorithm for Choosing a PI in Second-Line .. 52 Figure 17: Information Pathways for Patients Needing ATC Services .. 56 Figure 18: Barriers to Adherence .. 62 Figure 19: Process of Enhanced Adherence Counselling (EAC) .. 62 Figure 20: Algorithm for Active Interventions when HIV-Infected Clients are Late and determining their Attrition Status.
5 65 Figure 21: TB Screening Algorithm .. 66 Figure 22: Xpert MTB RIF Algorithm .. 73 Figure 23: Algorithm of Sputum Smear plus Priority Patients for Xpert MTB/RIF Testing .. 74 (for Facilities without Xpert Mtb/Rif Acc) .. 74 Figure 24: RR/DR TB Patient Triage Flow Chart .. 85 Figure 25: Causal Links between underlying drivers for NCDs, Behavioral Risk Factors, Metabolic/Physiologic Risk Factors and NCDs .. 95 Figure 26: Cervical Cancer Screening Algorithm with VIA .. 100 Figure 27: Cervical Cancer Screening Algorithm with HPV Testing .. 100 Figure 28: Human Resource Management in the ART Clinic .. 108 Figure 29: HIV Implementation Cascade for the Continuum of Care .. 109 Figure 30: Health Management Information System Data Flow Guideline.
6 116 ii ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection LIST OF TABLES Table 1: Timing of HIV Testing Services for Specific Populations .. 10 Table 2: PrEP Follow-up .. 19 Table 3: Post Exposure Prophylaxis Recommendations by Risk Category .. 21 Table 4: Pre-Pregnancy and Adolescents .. 24 Table 5: Infants and Children .. 25 Table 6: Simplified Infant Prophylaxis Dosing .. 27 Table 7: ARV Prescribers and Corresponding Regimens for ART Initiation .. 29 Table 8: WHO clinical Staging of HIV Disease by Specific Populations .. 31 Table 9: Eligibility Criteria for ART Initiation in Children, Adolescents, Pregnant and Breastfeeding Women and Adults.
7 32 Table 10: Pre-initiation Tasks .. 33 Table 11: Preferred First-Line ART and Alternative Regimens by Specific Populations .. 35 Table 12: Preferred First-Line ART and Alternative Regimens for HIV-2 .. 40 Table 13: Efficacy of Antiretroviral Therapy against HIV-2 Infection .. 41 Table 15: clinical and Laboratory Monitoring for HIV-Infected Pregnant and Breastfeeding Women .. 46 Table 16: Common ART Toxicities and Recommended Substitutes (for all populations) .. 47 Table 17: Recommended Second-Line ART Regimens by Specific Populations .. 51 Table 18: Summary of Preferred Second-Line ART Regimens for Adults and Adolescents .. 51 Table 19: Recommended Second-Line ART Regimens for HIV-2 .. 52 Table 20: Infant and Young Child Feeding Options.
8 58 Table 21: Specific BMI-Related ARV Drug Risks .. 58 Table 22: Reporting for Fluorescence Microscopy (FM) Results .. 69 Table 23: Reporting of Ziehl Neelsen (ZN) Results .. 70 Table 24: Interpretation of Results for LPA .. 70 Table 25: Interpretation of Results for Culture .. 72 Table 26: Properties of First-Line TB Drugs .. 76 Table 27: Recommended Regimens .. 76 Table 28: Weight Bands for Dosing of Anti-TB Drugs .. 78 Table 29: Recommended Doses of Adjuvant Steroid Therapy (Drug of Choice is Prednisolone) .. 79 Table 30: Summary of Sputum Monitoring by Smear in First-Line Treatment .. 80 Table 31: HIV-TB Co-infection Case Scenarios and Recommended Management for Susceptible TB .. 81 Table 32: Weight-based DR-TB Drugs in Adults 30 kg.
9 86 Table 33: DR-TB treatment monitoring schedule for conventional DR-TB regimen .. 88 Figure 25: Causal Links between underlying drivers for NCDs, Behavioral Risk Factors, Metabolic/Physiologic Risk Factors and NCDs .. 95 Table 34: Lifestyle Modifications to Prevent and Manage CVDs Among HIV-Infected Individuals .. 96 Table 35: Dyslipidaemia Screening, Diagnosis, and Initial Management for HIV-Infected Individuals .. 96 Table 36: Hypertension Screening, Diagnosis, and Initial Management for HIV-Infected Individuals .. 97 Table 37: Type 2 Diabetes Mellitus Screening, Diagnosis, and Initial Management for HIV-Infected Individuals .. 98 Table 38: Chronic Kidney Disease Screening, Diagnosis, and Initial Management for HIV-Infected Individuals.
10 99 Table 39: Recommended Tests for HIV Screening and Monitoring for Co-infections and NCDs .. 102 Table 40: Dosage for Isoniazid Preventative Therapy, Co-trimoxazole Prophylaxis, and Combination INH/CTX/Vit B6 Drugs . 104 Table 41: Criteria for Initiating, Discontinuing and Monitoring Co-trimoxazole Preventive Therapy .. 105 Table 42: Categorization of Services offered at Delivery Points .. 113 iii ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ZAMBIA CONSOLIDATED GUIDELINES for Treatment and Prevention of HIV Infection ACRONYMS 3TC Lamivudine FQ Fluoroquinolone ABC Abacavir H Isoniazid AIDS Acquired Immunodeficiency Syndrome HHD Isoniazid High Dose ALT Alanine Aminotransferase HIV Human Immunodeficiency Virus AFB Acid Fast Bacilli HPV Human Papilloma Virus ANC Antenatal Care HTS HIV Testing Services ART Antiretroviral Therapy Km Kanamycin ARV Antiretroviral Lfx Levofloxacin AST Aspartate Aminotransferase INH Isoniazid ATC Advanced Treatment Centre INSTIs Integrase Strand Transfer Inhibitors ATT Anti-Tuberculosis Treatment IPT Isoniazid Preventive Therapy ATV
