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HIV Guide
 Zambia HIV National Guidelines


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  


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



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Adherence to HAART

  • Good adherence means:
  • -Drugs should be taken at approximately the same time of the day to maintain constant drug blood levels.
  • -Taking all medications at the right time, in correct doses, with or without food (if indicated).
  • -Not skipping doses or starting and stopping therapy.
  • NNRTIs have low genetic barrier to resistance; adherence essential to prevent development of resistance and ultimately treatment failure.
  • Give written dosing instructions to patients.
  • Provide one-on-one counseling to each patient:
  • -Several counseling sessions may be required before patient truly "ready" to start ART
  • -Counseling should include information about side effects: how to recognize serious adverse effects, when to seek care and how to prevent or manage mild side effects
  • Encourage patients to identify treatment supporters (family members, buddies) and include them in counseling
  • Find ways to help patients overcome obstacles, such as disclosure
  • Link patients with adherence support groups
  • Counsel patients to avoid drug abuse and to refrain from excessive alcohol use
  • All patients should be given information about how and when to contact their health care provider
Adherence Assessment:

  • Assess how patient is taking drugs at each visit
  • Use open ended and targeted questions and other tools (e.g. pill counts) in adherence assessment.
  • Assess adherence at every contact with adherence support worker or home-based care giver
  • Refer patients with suspected or identified non-adherence to ART care time immediately
  • Patients unlikely to volunteer information about non-adherence
  • Assessing adherence is not done with 1 simple question:
  • -Ask how patient is taking prescribed medications
  • -Probe, verify, ask follow-up questions
  • -Assess barriers to adherence and help patient to find ways to overcome them
  • -Pill counts can be helpful



Complications of Therapy



Opportunistic Infections

Organ System


Antimicrobial Agents




Zambia HIV National Guidelines


Antiretroviral Therapy

Laboratory Testing







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