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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
 

 

 

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Introduction

05-06-2008

Status of HIV/AIDS Epidemic

  • Zambia is one of Sub-Saharan African countries worst affected by HIV/AIDS pandemic.
  • AIDS is end stage of infection caused by HIV
  • Almost all infections in Zambia due to HIV-1, which progresses rapidly and has high morbidity and mortality
  • HIV transmission in Zambia mainly through heterosexual contact, exacerbated by high-risk sexual practices, gender inequality, poverty, stigma discrimination, and high prevalence of sexually transmitted infections (STIs) and TB
  • Remaining transmission is predominantly mother-to-child transmission (MTCT) during pregnancy, at birth, or through breast-feeding.
  • High prevalence of HIV-related illness has overburdened Zambian health care system at all levels.
Most medical institutions in Zambia provide no more than clinical care. Care for HIV+ persons and their families can be achieved by: 

  • -Counselling: Psychosocial support, including stress/anxiety reduction and promotion of positive living as well as helping individuals make informed decisions on HIV testing, planning for future, behavioral change and involving sexual partners in such decisions.
  • -Clinical management: Early diagnosis, rational treatment and planning for follow up care of HIV-related illnesses.
  • -Home-based and palliative care: To promote and maintain hygiene and nutrition, provide palliative care, educate individuals and families and practice universal infection control.
  • -Social support: Information and referral for participation in community-based PLHA support groups, welfare services and legal advice for individuals and families. Where feasible, technical and material assistance can also be given.
  • Care elements should be supported by an efficient referral mechanism for continuum of health care, as early access to the continuum ensures early treatment of TB, earlier recognition of HIV-related illnesses, maternal and child healthcare and better primary health care.
  • There is need to care for and manage patients with HIV & AIDS. Focus must be on providing cost-effective and quality health care and support as close to family as possible.
  • To achieve goals of national HIV &AIDS response, HIV+ individuals, family/community members and health care workers/volunteers at institutional and community level must have access to HIV & AIDS management and care guidelines.
  • Proper management of HIV infection and its complications has been shown to benefit patients by reducing transmission of HIV and opportunistic infections (OIs).
Zambian National HIV Guidelines

  • Purpose:
  • -To assist health care personnel in diagnosis, medical management, psychosocial referral and counseling of HIV+ persons and patients presenting with AIDS-defining conditions.
  • -To serve as teaching aid for health professionals at different levels
  • -To serve as a teaching aid for community-based volunteers and support groups.
  • -To assist in projecting resource requirements for HIV and AIDS epidemics by partially specifying resources required for patient care.
  • -To inform National M&E Framework through NARF
  • Designed to provide practical help in recognizing symptomatic HIV infection and OIs using clinical and laboratory criteria.
  • To be adhered to by all HIV governmental and nongovernmental organizations and individuals implementing programmes and projects providing treatment, care and support to PLHA.
Expanding Treatment Care and Support I'm unable to read Table 1 in my version of the guidelines, so I'll take your word on this. Joel

  • Provide universal access to antiretroviral therapy (ART) including access to Confidential Counselling and Testing (CCT) at all Treatment Centres
  • Expand treatment for TB, STIs and other OIs.
  • Strengthen home/community-based care and support including access to comprehensive palliative care and pain management
  • Support utilization of alternative and/or traditional medicines which have scientifically demonstrated efficacy
  • Promote appropriate nutrition and positive living for PLHA
Guiding Principles for the Management of HIV & AIDS

  • Multidisciplinary and multi-sectoral approach necessary.
  • Information and education as integral part of comprehensive management and care package for persons with HIV and/or presenting with advanced HIV infection.
  • A minimum health package of care and support for persons with advanced HIV infection should be made available to both patient and medical personnel attending to them.
  • A minimum health package of care and support for persons with advanced HIV infection should be made available to community based health service organizations (CBOs & FBOs )
  • Persons with advanced HIV infection should receive full medical care for the OIs and other conditions they may present with.
  • All persons with HIV&AIDS should be treated with dignity and care by all healthcare providers and should not be discriminated against as a result of their status.
  • Efficient referral, support and care systems for persons with HIV/AIDS should be utilized and made easily accessible in response to care needs of patients.
  • These guidelines apply to health care service providers in public and private sectors.

 
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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