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HIV Guide
 Zambia HIV National Guidelines
 


Introduction  

HIV Counseling and Testing  

Sexually Transmitted Infections (STIs)  

General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

Adherence  

Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Guidelines>Zambia HIV National Guidelines>
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HIV Counselling and Testing

04-28-2008
Provider Initiated Counselling and Testing

  • Routine offer of HIV testing in health care settings: Should be provided to all patients:
  • -Attending sexually transmitted infection (STI) services.
  • -Attending antenatal clinic (ANC) and other reproductive health services.
  • -Attending TB clinic services (i.e to all patients suspected of having or diagnosed with TB infection).
  Diagnostic Counseling and Testing

  • Counselling and testing in a clinical setting: Should be considered standard of care in following situations:
  • -Diagnosing HIV for appropriate TB and HIV management.
  • -Patients who present with symptoms or signs that could be attributed to HIV.
Voluntary Counseling and Testing (VCT):

  • Routine testing of outpatients and inpatients may improve uptake and better integrate HIV testing as part of clinical diagnosis and patient management.
  • Patient-initiated HIV testing through VCT remains critical to effectiveness of HIV prevention.
  • Pre-testing counselling may be provided either on individual basis or in group settings with individual follow-up.
  • Patients have right to "opt out" (decline testing).
  • "Opt-in" testing: HIV test routinely recommended and offered to each patient; patient must explicitly consent to testing.
  • "Opt-out" testing: HIV test routinely recommended and provided to each patient; patient informed of his/her right to refuse testing
Mandatory HIV Screening

  • National blood transfusion policy supports mandatory screening for HIV and other blood-borne viruses of all blood destined for transfusion or manufacture of blood products.
  • Mandatory screening of donors required prior to all procedures involving transfer of bodily fluids or body parts(e.g. artificial insemination, corneal grafts and organ transplant.
  • National HIV policy does not support mandatory testing of individuals on public health grounds.
Anonymous and Unlinked HIV Testing

  • Mainly conducted in national surveys for purposes of ascertaining prevalence of disease burden through population-based methodologies.
CONFIDENTIALITY IN HIV TESTING

  • Confidentiality is key concern for patients. Essential that confidentiality be maintained when conducting HIV testing of any type.
  • All information about individual should be kept strictly confidential.
  • Careful record management is prerequisite for confidentiality
NATIONAL TESTING ALGORITHM  

  • Recommended test kits from Ministry of Health: Abbott Determine HIV-1/2 Test, Uni-Gold HIV Test, Bioline HIV 1/2 Test
  • 1st test: Abbot Determine. If negative report as negative.
  • If positive, perform 2nd test: Uni-Gold
  • If Uni-Gold positive, report as positive
  • If Uni-Gold negative, perform 3rd test: Bioline, or repeat test 6 weeks later
MEDICAL REFERRALS

  • All HIV+ patients should be referred to ART clinic for care.
  • National HIV Counselling and Testing guidelines encourage use of rapid tests so results are provided in timely fashion and can be followed up immediately with 1st post-test counselling session for both HIV-negative and HIV+ individuals/couples.
SOCIAL REFERRALS

  • Consider referral of patients who that test positive to other organisations for psychological, social and spiritual support. These may include PLHA support groups, religious circles, etc.
QUALITY ASSURANCE

  • Important consideration in providing HIV testing services. Any result, whether positive or negative, carries major implications in patient's life.
  • All components of QA must be adhered to.
  • Zambia moving towards using finger-prick blood collection and testing method, which has allowed non-medical staff to conduct HIV testing. Requires use of dried blood spots (DBS) on filter paper for QA procedures (DBS performed on every 20th patient).

REFERENCED WITHIN THIS GUIDE


 
Diagnosis
 


Complications of Therapy


Malignancies


Miscellaneous


Opportunistic Infections


Organ System

Drugs
 


Antimicrobial Agents


Antiretrovirals


Miscellaneous

Guidelines
 


Zambia HIV National Guidelines

Management
 


Antiretroviral Therapy


Laboratory Testing


Miscellaneous

Pathogens
 


Bacteria


Fungi


Parasites


Viruses

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