Clinical Guidelines

Antiretroviral Management

Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy: Policy brief

Source: World Health Organisation
Publication Date: July 1, 2017

2017 policy brief from the World Health Organisation outlining new recommendations for HIV initiation and specialised care for HIV patients with advan... (more)

2017 policy brief from the World Health Organisation outlining new recommendations for HIV initiation and specialised care for HIV patients with advanced disease. Topics include: definition of advanced disease and a package of interventions aimed at standardising and implementing care for these patients. Rapid initiation of ART is aimed at linking diagnosed patients to care. Topics include recommendations, evidence supporting rapid initiation; and considerations for implementation of rapid and same-day start of ART.
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Implementation of the universal test and treat strategy for HIV positive patients and differentiated care for stable patients

Source: South African National Department of Health
Publication Date: September 1, 2017

September 2015 circular advising of new Universal Test and Treat (UTT) policy: to test all persons in clinical care for HIV and to recommend immediate...

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September 2015 circular advising of new Universal Test and Treat (UTT) policy: to test all persons in clinical care for HIV and to recommend immediate life-long treatment for all people who test positive, regardless of CD4+ cell count or clinical stage. The circular also outlines a strategy of differentiated streamlined ART delivery for those stable on antiretroviral therapy. Topics include: eligibility criteria for UTT, timing of ART initiation (including immediate priority, “fast track” initiation, and timing in the case of TB coinfection. Differentiated care for stable adult patients is also described as well as research implications for this new expanded policy.

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National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults

Source: South Africa National Department of Health
Publication Date: April 1, 2015

2015 update of the antiretroviral management guidelines from the South Africa National Department of Health, consolidating guidelines for adults, adol...

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2015 update of the antiretroviral management guidelines from the South Africa National Department of Health, consolidating guidelines for adults, adolescents, infant, children, and for prenatal care. Focus of the new guidelines included increasing effectiveness and efficiency of programmes; managing HIV as a chronic health condition; strengthening integration of services promoting human rights and health equity; promoting a family approach to HIV care; and strengthening the HIV continuum of care.

Topics addressed include HIV counselling and testing including introduction of patients into the continuum of care as well as managing those who test HIV negative (wellness programme); preparation for initiation on antiretroviral therapy (ART); principles of adherence, psychosocial care and support; HIV disclosure; standardised national eligibility criteria for starting ART regimens; standardised national ART regimens; standardised national monitoring for those with HIV; standardised national ART regimens for HIV-positive pregnant women and their infants; labour, delivery, and postnatal care for mothers and infants; ART prophylaxis for HIV-exposed infants; visit scheduling for adults with HIV; first-line therapy for treatment-naive patients; clinical and laboratory monitoring of patients on first-line treatment; adherence support, assessment, and monitoring; when to switch ART regimens; substituting drugs in the first-line regimen; treatment failure; standardised second- line regimens and third-line options for ART; clinical and laboratory monitoring of patients on second-line treatment; management of treatment failure after second-line treatment; management of patients previously treated with ART; treatment interruptions; patients with tuberculosis (TB); patients with hepatitis B virus; patients with anaemia (including during pregnancy and in infants and children); expectations regarding care; diagnosis and management of adverse events; drug-drug interactions with antiretroviral drugs; adverse events; routine patient management; TB screening, prevention, and diagnosis; isoniazid prophylaxis; clinical HIV stage; opportunistic infection diagnosis and management; CD4+ cell count and HIV-1 RNA monitoring; cotrimoxazole prophylaxis; sexually transmitted infection screening; Pap smear; immunizations; family planning; mental health screening; screening for Cryptococcus infection; HIV transmission and reinfection prevention; support provision; and contraindications and special considerations; data collection tools and reporting procedures.

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Use of fixed-dose combinations in place of lamivudine single agents

Source: South Africa National Department of Health
Publication Date: January 7, 2016

Circular advising of new policy to change persons on single-tablet lamivudine to combination agents whenever possible. It asks that clinicians reserve... (more)

Circular advising of new policy to change persons on single-tablet lamivudine to combination agents whenever possible. It asks that clinicians reserve the use of the 150mg lamivudine tablets, which will continue to be available, for complicated and paediatric cases. (less)

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Southern African HIV Clinicians Society adult antiretroviral therapy guidelines: Update on when to initiate antiretroviral therapy

Source: Southern African HIV Clinicians Society
Publication Date: November 1, 2015

Update and addendum to the 2014 Southern African HIV Clinicians Society recommendations for the use of antiretroviral therapy in adults with HIV infec... (more)

Update and addendum to the 2014 Southern African HIV Clinicians Society recommendations for the use of antiretroviral therapy in adults with HIV infection. Update addresses primarily the data surrounding the new recommendation of the Society that antiretroviral therapy be initiated in all persons with HIV infection. (less)

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Adult Antiretroviral Therapy Guidelines

Source: Southern African HIV Clinicians Society
Publication Date: January 1, 2017

2017 Southern African HIV Clinicians Society recommendations for the use of antiretroviral therapy in adults with HIV infection. Topics addressed incl...

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2017 Southern African HIV Clinicians Society recommendations for the use of antiretroviral therapy in adults with HIV infection. Topics addressed include key principles of antiretroviral therapy (ART); goals of therapy; standard of care; classes of antiretroviral (ARV) agents and their mechanisms of action; ARV agents currently available in Southern Africa, including dose and common adverse drug reactions; indications for starting ART (universal access); benefits of antiretroviral therapy in reducing transmission; starting ART in patients with tuberculosis; starting ART in patients with other opportunistic diseases/infections and acute illnesses; patient readiness for ART; commencing ART at first antiretroviral clinic visit; ART in primary infection; ART initiation in elite controllers; baseline monitoring; initial ARV regimens for the previously untreated patient; laboratory monitoring for ART efficacy; defining ART failure, including virologic criteria for treatment success or failure and CD4+ cell count response; indications for changing ART; second-line ART; third-line ART; stopping ART;  patients who return after defaulting therapy; drug interactions; ART in special populations, including patients with TB and pregnant patients; ART choice in pregnancy, breastfeeding, and postnatal period, partner engagement; ARV dosages in renal failure; ART in acute kidney injury; ARV dosages in liver impairment; hepatitis B coinfection; malaria; ARV toxicity monitoring and management; haematological toxicity; hepatotoxicity; hyperlactataemia and lactic acidosis; dyslipidaemia; lipodystrophy; hypersensitivity; nephrotoxicity; neuropsychiatric toxicity; dysglycaemia; gynaecomastia; immune reconstitution inflammatory syndrome; and support and counselling, including ART-related counselling; prophylaxis in patients receiving ART including OI and TB prophylaxis.

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Changes to South African Antiretroviral Treatment Guidelines in 2012

Source: South Africa National Health Systems Trust
Publication Date: December 1, 2012

2012 update to the 2010 South Africa National Department of Health Antiretroviral Treatment Guidelines. Topics addressed include changes/updates to th... (more)

2012 update to the 2010 South Africa National Department of Health Antiretroviral Treatment Guidelines. Topics addressed include changes/updates to the following: eligibility for antiretroviral therapy (ART) initiation; eligibility for fast track ART initiation; follow-up for new patients on ART; cryptococcal infection screening; and HIV testing and tuberculosis screening. (less)

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Reporting Adverse Drug Reactions in South Africa

Source: South Africa National Department of Health
Publication Date: December 1, 2012

2012 guidance from the South Africa National Department of Health and the Medicines Control Council intended to assist applicants in the reporting of ... (more)

2012 guidance from the South Africa National Department of Health and the Medicines Control Council intended to assist applicants in the reporting of adverse drug reactions associated with medicines and in the management of safety data, which arise during clinical trials. Topics addressed include: procedures for reporting; postregistration adverse effect reports; and preregistration adverse event reports. (less)

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Standard Treatment Guidelines and Essential Medicines List for South Africa

Source: South Africa National Department of Health
Publication Date: April 16, 2012

Essential medicines are defined as those that satisfy the priority healthcare needs of the population; they are intended to be available within the co...

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Essential medicines are defined as those that satisfy the priority healthcare needs of the population; they are intended to be available within the context of functioning health systems at all times in adequate quantities, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. This list includes medicines selected by the South Africa National Department of Health regarding disease prevalence, efficacy and safety evidence, and comparative cost. The list includes medications for the following organ systems, areas of care, and diseases: alimentary tract; blood and blood forming organs; cardiovascular system; dermatology; gynaecology; obstetrics; nephrologic/urologic disorders; endocrine system; systemic and nosocomial infections; HIV and AIDS; surgical antibiotic prophylaxis; pain; musculoskeletal system; neurological disorders; psychiatric disorders; respiratory system; ear, nose, and throat disorders; eye disorders; poisoning; emergencies and injuries; and anaesthesiology, nutritional support, and miscellaneous conditions.

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Accelerating Access to ART Services and Uptake

Source: South Africa National Department of Health
Publication Date: April 14, 2012

2012 circular from the South Africa National Department of Health providing recommendations to address delays in antiretroviral therapy initiation and...

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2012 circular from the South Africa National Department of Health providing recommendations to address delays in antiretroviral therapy initiation and decrease missed opportunities for early treatment.

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Clinical Guidelines for the Management of HIV & AIDS in Adults and Adolescents

Source: South Africa National Department of Health
Publication Date: April 1, 2010

2010 antiretroviral management guidelines from the South Africa National Department of Health. Topics addressed include standardised national eligibil...

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2010 antiretroviral management guidelines from the South Africa National Department of Health. Topics addressed include standardised national eligibility criteria for starting antiretroviral therapy (ART) regimens for adults and adolescents; standardised national ART regimens for adults and adolescents; standardised national monitoring for adults and adolescents with HIV; standardised national ART regimens for HIV-positive pregnant women and their infants; visit scheduling for adults with HIV; first-line therapy for treatment-naive patients; clinical and laboratory monitoring of patients on first line treatment; adherence support, assessment, and monitoring; what to expect in the first 4 months of therapy; when to switch ART regimens; substituting drugs in the first-line regimen; treatment failure; clinical and laboratory monitoring of patients on second-line treatment; management of treatment failure after second-line treatment; management of patients previously treated with ART; treatment interruptions; patients with tuberculosis (TB); patients with hepatitis B virus; patients with anaemia; expectations regarding care; diagnosis and management of adverse events; key adverse events; routine patient management; TB screening, prevention, and diagnosis; isoniazid prophylaxis; clinical HIV stage; opportunistic infection diagnosis and management; CD4+ cell count and HIV-1 RNA monitoring; cotrimoxazole prophylaxis; sexually transmitted infection screening; Pap smear; immunizations; family planning; mental health screening; HIV transmission and reinfection prevention; support provision; and contraindications and special considerations.

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Clinical Guidelines for Antiretroviral Therapy Management for Displaced Populations: Southern Africa

Source: Southern African HIV Clinicians Society, United Nations High Commissioner for Refugees
Publication Date: June 1, 2007

2007 recommendations for health care workers managing antiretroviral therapy (ART) for HIV-infected displaced persons, a unique group of individuals w...

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2007 recommendations for health care workers managing antiretroviral therapy (ART) for HIV-infected displaced persons, a unique group of individuals with special needs that sometimes require complex strategic decision making. Topics covered in these guidelines include: the responsibility of the healthcare worker; ART, including initiation criteria for patients with no ART history, patients presenting on ART or with a history of previous ART, contingency planning, ART-specific challenges, management of children, postexposure prophylaxis, and prevention of mother-to-child HIV transmission; non-ART considerations, including tuberculosis treatment, primary and secondary prophylaxis for opportunistic infections, other illnesses, language, and referral letters; advocacy; and other important issues including cultural issues, alternative treatments, psychosocial and mental health issues, prevention, reproductive health, sex-based exploitation and violence, orphans, end-of-life care, and death and body disposal.

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Policy Brief: Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: What’s New

Source: World Health Organisation
Publication Date: November 1, 2015

Update and addendum to the 2013 World Health Organisation recommendations for the use of antiretroviral therapy in persons with HIV infection. Update ... (more)

Update and addendum to the 2013 World Health Organisation recommendations for the use of antiretroviral therapy in persons with HIV infection. Update addresses primarily the data surrounding the new recommendation of the Organisation that antiretroviral therapy be initiated in all persons with HIV infection. The guideline also addresses use of TDF/FTC as pre-exposure prophylaxis in persons at high risk for HIV infection. (less)

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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach

Source: World Health Organisation
Publication Date: June 30, 2013

2013 World Health Organisation recommendations for providing for persons living with HIV across the continuum of care. Topics include: HIV prevention ...

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2013 World Health Organisation recommendations for providing for persons living with HIV across the continuum of care. Topics include: HIV prevention based on antiretroviral (ARV) drugs; HIV testing and counselling; good practices for linkage to care; and general care for people living with HIV; preparing people living with HIV for antiretroviral therapy (ART); what to expect in the first months of ART; when to start ART; what ART regimen to start with (first-line ART) (for adults, pregnant and breast-feeding women, and ARV drugs for their infants, for children younger than 3 years of age; children 3 years of age and older); tuberculosis cotreatment in children; monitoring response to ART and the diagnosis of treatment failure; monitoring and substitutions for ARV drug toxicities; what ART regimen to switch to (second-line ART) (for adults and adolescents and for children [including adolescents]); third-line ART. Prevention, screening, and management of common coinfections, including tuberculosis; cryptococcal infection; hepatitis B and C; malaria; sexually transmitted infections, and other opportunistic infections. Vaccines for people living with HIV. Preventing and managing other comorbidities and chronic care for people living with HIV.

Guidance on operations and service delivery; adherence to ART; retention across the continuum of care; good practices in providing chronic care; integrating and linking services; decentralising HIV treatment and care; building human resource capacity; task shifting for HIV treatment and care.

Laboratory and diagnostic services; implementation considerations and good practices; increasing access to HIV viral load testing; expanding diagnostic services to point-of-care settings; implementing comprehensive quality management systems; guidance for programme managers.

Monitoring implications of new recommendations; monitoring the outputs and outcomes of scaling up access to ARV drugs; HIV drug resistance; sentinel surveillance for ARV toxicity monitoring; evaluation, including impact and programme performance.

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Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment, and Care for Key Populations

Source: World Health Organisation
Publication Date: July 1, 2014

2014 World Health Organisation guidelines consolidating information on HIV prevention, diagnosis, treatment and care for five key populations – ...

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2014 World Health Organisation guidelines consolidating information on HIV prevention, diagnosis, treatment and care for five key populations – men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people – and updates selected guidance and recommendations for providing for persons living with HIV across the continuum of care. Topics include epidemiology of HIV in key populations, expanding coverage of these populations, establishing a comprehensive package of interventions, HIV prevention in various settings including harm reduction and behavioural interventions; HIV testing and counselling; linkage and enrolment in care; antiretroviral therapy; prevention of mother-to-child transmission; ART drug interactions; prevention and management of comorbidities and coinfections, TB, viral hepatitis, mental health issues; nutrition; sexual and reproductive health interventions; law and policy; stigma and discrimination; community empowerment; violence; service delivery strategies; integration of services; decentralization of services; task-shifting; decision-making, planning and monitoring processes.

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Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV

Source: International Association of Physicians in AIDS Care
Publication Date: June 5, 2012

Evidence-based guidance from an International Association of Physicians in AIDS Care panel to improve HIV care entry and retention and to increase ant...

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Evidence-based guidance from an International Association of Physicians in AIDS Care panel to improve HIV care entry and retention and to increase antiretroviral therapy (ART) adherence. Topics covered include: entry and retention of HIV-infected patients in medical care including monitoring, case management, intensive outreach for those not engaged in care during 6 months after diagnosis, and peer or paraprofessional patient navigators; monitoring ART adherence; interventions to improve ART adherence including ART strategies, adherence tools for patients, education and counselling interventions, and health system and service delivery interventions; special populations including pregnant women, persons with substance use disorders, persons with mental health disorders, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents; and recommendations for future research.

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Guidance for Development of National Laboratory Strategic Plans: Helping to Expand Sustainable Quality Testing to Improve the Care and Treatment of People Infected With and Affected by HIV/AIDS, TB and Malaria

Source: World Health Organisation, United States Centers for Disease Control and Prevention, Association of Public Health Laboratories
Publication Date: August 13, 2010

2010 guidance tool for country leaders for the development of a National Laboratory Strategic Plan. This document provides direction on the complex ma...

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2010 guidance tool for country leaders for the development of a National Laboratory Strategic Plan. This document provides direction on the complex matrix of influences at the national and international level required to build laboratory capacity, including in-country stakeholders, multilateral agencies, donors, the private and public sectors, communities, and others.

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Hepatitis Virus Coinfection

Management of HIV-Hepatitis B Coinfection

Source: Southern African HIV Clinicians Society
Publication Date: April 1, 2011

2011 recommendations on hepatitis B virus (HBV) screening, vaccination, and treatment in HIV-infected individuals. Topics addressed include: screening...

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2011 recommendations on hepatitis B virus (HBV) screening, vaccination, and treatment in HIV-infected individuals. Topics addressed include: screening for HBV infection in HIV-infected patients; vaccination of HIV-infected patients who screen negative for HBV; management of HIV/HBV-coinfected patients including lifestyle modification, antiretroviral therapy, management of coinfected patients with a CD4+ cell count > 350 cells/mm3, choice of the third drug in an antiretroviral therapy regimen for coinfected patients, and hepatitis flares in HIV-infected persons who do not know that they are HBV infected; and special populations, including pregnant women, newborns, children, and alternative treatment options for coinfected patients with high CD4+ cell counts.

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HIV Prevention and Sexual Health

National Contraception Clinical Guidelines

Source: South Africa National Department of Health
Publication Date: February 6, 2013

Contraception recommendations from the South Africa National Department of Health designed to support modern practice in South Africa and to reflect c...

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Contraception recommendations from the South Africa National Department of Health designed to support modern practice in South Africa and to reflect changes occurring during the last decade in the fields of HIV, contraceptive technology, and related research. Topics addressed include: an overview of the World Health Organisation’s medical eligibility criteria; key clinical practice issues in the South African context; long-acting reversible contraception; method-specific contraception guidelines, including contraceptive and fertility information and counselling offered as a component of a comprehensive HIV and sexual and reproductive health care package; guidelines for the provision of services for people with special needs, including adolescents, menopausal women, women with physical/mental disabilities, and women with chronic conditions; and issues relating to contraception and HIV, including HIV acquisition, transmission, disease progression, and drug interactions as well as specific contraception methods in the context of HIV.

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The South African National Strategic Plan on HIV, STIs and TB, 2012-2016

Source: South African National AIDS Council
Publication Date: January 27, 2012

Five-year strategic guide from the South African National AIDS Council designed to address challenges posed by HIV, sexually transmitted infections (S...

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Five-year strategic guide from the South African National AIDS Council designed to address challenges posed by HIV, sexually transmitted infections (STIs), and tuberculosis (TB) beginning in 2012. The plan describes a 20-year vision with broad goals of reducing new HIV infections by at least 50%, using combination prevention approaches; initiating at least 80% of eligible patients on antiretroviral treatment (ART), with 70% alive and on treatment 5 years after initiation; reducing the number of new tuberculosis (TB) infections and deaths from TB by 50%; ensuring an enabling and accessible legal framework that protects and promotes human rights in order to support implementation of the National Strategic Plan; and reducing self-reported stigma related to HIV and TB by at least 50%. Topics covered include epidemiology of HIV and TB; key populations for the HIV and TB response; addressing social and structural drivers of HIV, sexually transmitted infection (STI), and TB prevention, care, and impact; preventing new HIV, STI, and TB infections; sustaining health and wellness; ensuring protection of human rights and improving access to justice; effective communication; governance and institutional arrangements, including national, regional, and international obligations; monitoring and evaluation, including core indicators, coordination, baseline values, data flow, data auditing and archiving, and reviews; research including proposed research streams and approaches to mapping the way forward; and cost and financing of the initiative.

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Guidelines on Safer Conception in Fertile HIV-Infected Individuals and Couples

Source: Southern African HIV Clinicians Society
Publication Date: June 1, 2011

2011 guidance on making family planning as safe as possible for people living with HIV by informing decisions on contraception, adoption, fostering, c...

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2011 guidance on making family planning as safe as possible for people living with HIV by informing decisions on contraception, adoption, fostering, conception, and prevention of mother-to-child transmission. Topics addressed include: discussing fertility and childbearing with HIV-infected women and men; contraception for the HIV-infected individual or couple who does not want a child; the HIV-infected individual or couple who wants a child, including engaging couples, optimising HIV therapy and addressing other health concerns, preconception workup, and safer conception strategies; and special issues, including pre- or postexposure prophylaxis.

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National HIV Counselling and Testing Policy Guidelines

Source: South Africa National Department of Health
Publication Date: January 1, 2010

2010 recommendations aimed at providing core requirements and guidance to ensure the delivery of standardised, high-quality, and ethical HIV counselli...

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2010 recommendations aimed at providing core requirements and guidance to ensure the delivery of standardised, high-quality, and ethical HIV counselling and testing services; outlining different types of HIV counselling and testing approaches for different circumstances and target groups; ensuring compliance with a legal and human rights approach to HIV counselling and testing; expanding access to HIV counselling and testing beyond formal healthcare settings into community, private sector, and non-healthcare environments; and ensuring appropriate referral to treatment. Topics addressed include: circumstances in which HIV testing takes place; individuals or couples wanting to know their statuses; clinical diagnosis; research and other screening purposes; domestic violence and rape; abandoned babies/children; medical male circumcision; types of HIV counselling and testing; client-initiated counselling and testing; provider-initiated counselling and testing; HIV counselling process; pretest counselling; posttest counselling; recommended HIV testing algorithm; issuing written confirmation of HIV test results; frequency of testing; core ethical principles related to counselling, informed consent, illiteracy or inability to write, inability to make a decision, appropriateness, confidentiality and privacy, shared confidentiality, nondiscrimination, and infection control; HIV testing and counselling for children, including circumstances in which a child may be tested, counselling before and after testing, consent, and confidentiality; HIV testing and counselling for infants, including testing infants younger than 18 months, testing abandoned babies, testing infants aged 18 months or older, and children not identified by prevention of mother-to-child transmission programme; HIV counselling and testing for child survivors of sexual assault and mandatory reporting of abuse; HIV counselling and testing of young people, pregnant women, healthcare providers, workers exposed to HIV, survivors of sexual assault, alleged sexual offenders, and male and female prisoners; basic requirements for quality assurance; communication and social mobilisation; importance of monitoring and evaluating the HIV testing and counselling programme; monitoring and evaluation objectives; reporting requirements; data management; information flow; and roles and responsibilities.

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Post-Exposure Prophylaxis

Source: Southern African HIV Clinicians Society
Publication Date: November 1, 2008

2008 guidelines aimed at specifically addressing the use of postexposure prophylaxis in South Africa. Topics covered include: scale of occupational an...

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2008 guidelines aimed at specifically addressing the use of postexposure prophylaxis in South Africa. Topics covered include: scale of occupational and nonoccupational injury; core principles for postexposure prophylaxis; prevention of HIV exposure in the workplace; special occupational exposure situations; postsexual exposure, including outside of a relationship where disclosure about the exposure is not desired and children; selecting patients for antiretroviral interventions; selecting antiretroviral regimens for postexposure prophylaxis; justification for 3 instead of 2 drugs and for alternatives to zidovudine; routine baseline and follow-up investigations; investigating the exposed person, including HIV testing, hepatitis B and C virus testing, and testing for other blood-borne pathogens; monitoring for adverse drug reactions; comorbidities; counselling issues, including anxiety management; and risk-taking interventions.

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Guidance on Couples HIV Testing and Counselling Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples: Recommendations for a Public Health Approach

Source: World Health Organisation
Publication Date: April 1, 2012

2012 World Health Organisation recommendations for increasing the offering of HIV testing and counselling as well as for offering antiretroviral thera...

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2012 World Health Organisation recommendations for increasing the offering of HIV testing and counselling as well as for offering antiretroviral therapy (ART) for HIV prevention in serodiscordant couples. Topics covered include couples HIV testing and counselling; ART for prevention in serodiscordant couples; guiding principles for implementation, including voluntary utilization of testing services, consent, confidentiality, counselling, correct test results, linkage to care, access to justice, human rights, and provision of earlier treatment; operational issues for implementation, including overarching issues, antenatal, perinatal, and postnatal care, other clinical settings, and community programmes and settings; adapting the guidelines; research gaps, including epidemiology of HIV serodiscordance and impact of couples HIV testing and counselling; and pre-exposure prophylaxis.

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The Joint WHO ILO UNAIDS Policy Guidelines for Improving Health Workers' Access to HIV and TB Prevention, Treatment, Care and Support Services

Source: World Health Organisation, International Labour Organisation, UNAIDS
Publication Date: November 1, 2010

Joint guidelines aimed at protecting, retaining, and empowering healthcare workers in dealing with the dual threat of HIV and tuberculosis (TB) infect...

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Joint guidelines aimed at protecting, retaining, and empowering healthcare workers in dealing with the dual threat of HIV and tuberculosis (TB) infection, based on a systematic literature review, an assessment of current practices in 21 countries, and the results of consultations with international experts and organisation constituents. Topics addressed include: introducing new national policies or refining existing policies that ensure priority access for healthcare workers and their families to services for the prevention, treatment, care, and support for HIV and TB; introducing new policies or reinforcing existing policies that prevent discrimination against healthcare workers with HIV or TB and adopting interventions aimed at stigma reduction among colleagues and supervisors; establishing schemes for reasonable accommodation and compensation including, as appropriate, paid leave, early retirement benefits, and death benefits in the event of occupationally acquired disease; developing, strengthening, or expanding existing occupational health services for the entire healthcare workforce so that access to HIV and TB prevention, treatment, care, and support can be attained; developing or strengthening existing infection control programmes, especially regarding TB and HIV infection control, and collaborating with workplace health and safety programmes to ensure a safer work environment; developing, implementing, and extending programmes for regular, free, voluntary, and confidential HIV counselling and testing, and TB screening, including addressing reproductive health issues, as well as intensified TB case finding in the families of healthcare workers with TB; identifying, adapting, and implementing good practices in occupational health and the management of HIV and TB in the workplace in both public and private healthcare sectors, as well as other sectors; providing information on benefits and risks of postexposure prophylaxis to all staff and provide free and timely postexposure prophylaxis for all exposed healthcare workers, ensuring appropriate training of postexposure prophylaxis providers; providing free HIV and TB treatment for healthcare workers in need, facilitating the delivery of these services in a nonstigmatising, gender-sensitive, confidential, and convenient setting when there is no staff clinic and/or their own facility does not offer antiretroviral therapy, or where healthcare workers prefer services off-site; in the context of preventing comorbidities, providing universal availability of a comprehensive package on prevention and care for all HIV-positive healthcare workers, including isoniazid preventive therapy and cotrimoxazole prophylaxis, with appropriate information on benefits and risks; developing and implementing training programmes for all healthcare workers that include preservice, in-service, and continuing education on TB and HIV prevention, treatment, care, and support, workers’ rights and stigma reduction, integrating these into existing training programmes and including managers and worker representatives; establishing and providing adequate financial resources for prevention, treatment, care, and support programmes to prevent both occupational or nonoccupational transmission of HIV and TB among healthcare workers; disseminating the policies related to these guidelines in the form of codes of practices and other accessible formats for application at the level of healthcare facilities and ensuring provision of budgets for the training and material inputs to make them operational; and developing and implementing mechanisms for monitoring the availability of the guidelines at the national level, as well as the dissemination of these policies and their application in the healthcare setting.

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Essential Prevention and Care Interventions for Adults and Adolescents Living With HIV in Resource-Limited Settings

Source: World Health Organisation
Publication Date: January 1, 2008

2008 guidelines established to provide global, technical, evidence-based recommendations for prevention and care interventions, other than antiretrovi...

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2008 guidelines established to provide global, technical, evidence-based recommendations for prevention and care interventions, other than antiretroviral therapy, that should be provided to people living with HIV in resource-limited settings as part of their healthcare services and to promote the expansion of provider-initiated interventions for HIV prevention and nonantiretroviral care and treatment for adults and adolescents living with HIV. These recommendations focus on prevention of transmission, initial illness, and opportunistic infections. Topics addressed include: psychosocial counselling and support, including comprehensive interventions, counselling and condoms, serodiscordant couples, seroconcordant couples, adherence interventions, and mental health; disclosure, partner notification, and testing and counselling of partners and family members; cotrimoxazole prophylaxis, including a discussion of pregnant women; tuberculosis counselling, screening, and preventive therapy; preventing fungal infections; sexually transmitted and other reproductive tract infections, including screening, diagnosis, and management; preventing malaria, selected vaccine-preventable diseases, including hepatitis B virus vaccine, pneumococcal vaccine, influenza vaccine, and yellow fever vaccine; nutrition assessment and support; family planning counselling and services including condoms and safe reproductive services; preventing mother-to-child HIV transmission; needle-syringe programmes and opioid substitution therapy; and water, sanitation, and hygiene.

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Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities

Source: World Health Organisation
Publication Date: January 1, 2007

Topics addressed include: scaling up client-initiated HIV testing and counselling; scaling up provider-initiated HIV testing and counselling; provider...

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Topics addressed include: scaling up client-initiated HIV testing and counselling; scaling up provider-initiated HIV testing and counselling; provider-initiated HIV testing and counselling in all HIV epidemic types including symptomatic patients, children, and men undergoing circumcision as an HIV prevention intervention; provider-initiated HIV testing and counselling in generalized epidemics including implementation in all health facilities and priorities for implementation; provider-initiated HIV testing and counselling in concentrated and low-level HIV epidemics; ensuring an enabling environment; pretest information and informed consent including minimum information for informed consent, additional information for women who are or may become pregnant, special considerations for children and adolescents, seriously ill patients, and follow-up where a test is declined; posttest counselling for HIV-negative and HIV-positive persons and for HIV-positive pregnant women; referral to other HIV services; frequency of testing; HIV testing technologies; programmatic considerations; and monitoring and evaluation.

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Metabolic Complications, Lipodystrophy and Adverse Effects

South Africa Dyslipidaemia Guideline Consensus Statement

Source: South Africa Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA)
Publication Date: March 1, 2012

2012 statement adapting several aspects of the European Society of Cardiology and European Atherosclerosis Society 2011 dyslipidaemia guidelines to th...

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2012 statement adapting several aspects of the European Society of Cardiology and European Atherosclerosis Society 2011 dyslipidaemia guidelines to the South African situation. Topics addressed include: when to use the cardiovascular risk score; when to start screening; how to screen using the Framingham Risk Score; measuring lipids including low-density lipoprotein cholesterol and total cholesterol, cost-effective testing, point-of-care finger-prick testing, additional testing, and secondary dyslipidaemias; strategy for intervention; treatment targets; management of dyslipidaemia including lifestyle modification, dietary supplements, statin therapy, statin toxicity, other cholesterol-lowering agents, and treatment directed at other components of the lipid profile; and special circumstances including metabolic syndrome, acute coronary syndromes, HIV infection, and unusual conditions.

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Guidelines for Renal Replacement Therapy in HIV-Infected Individuals in South Africa

Source: South African Renal Society, South African Transplant Society, Southern African HIV Clinicians Society
Publication Date: June 19, 2008

2008 recommendations directed toward South African clinicians with limited availability of dialysis and transplantation facilities. Topics covered inc...

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2008 recommendations directed toward South African clinicians with limited availability of dialysis and transplantation facilities. Topics covered include: dialysis in patients with HIV infection; management of kidney transplantation in HIV-infected patients, including organ sources, immunosuppressive protocols, transplantation kidney biopsy, psychological assessment and support, highly active antiretroviral therapy, and special considerations in children; and national South African health guidelines for chronic renal dialysis.

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Recommendations for Early Detection and Management of Chronic Kidney Disease

Source: South African Renal Society
Publication Date: March 1, 2006

Guidance from the South African Renal Society on early detection and optimal management of chronic kidney disease to prevent premature death. Topics c...

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Guidance from the South African Renal Society on early detection and optimal management of chronic kidney disease to prevent premature death. Topics covered include: definition of chronic kidney disease; risk factors for chronic kidney disease in adults and children; how to screen for chronic kidney disease; considerations for referral; and recommendations to preserve renal function in patients with chronic kidney disease.

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Paediatric Management

Guidelines for the Management of HIV in Children

Source: South Africa National Department of Health
Publication Date: January 1, 2010

2010 South Africa National Department of Health recommendations for caring for children with HIV infection. Topics addressed include antiretroviral th...

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2010 South Africa National Department of Health recommendations for caring for children with HIV infection. Topics addressed include antiretroviral therapy (ART) in South Africa; principles of HIV management in children; HIV infection and the human immune system; modes of transmission; disease progression; prevention of paediatric HIV infection; clinical features of HIV infection in children; clinical staging HIV infection; HIV testing in children; prevention of mother-to-child transmission follow-up; confirmation of HIV status and initiation of ART; routine follow-up visits; cotrimoxazole prophylaxis; additional preventive care for HIV-infected children; counselling and support; nutrition interventions; nutritional support; guidelines for feeding children with asymptomatic HIV infection; guidelines for feeding children with symptomatic HIV infection; feeding problems; food supplementation; management of severely malnourished children with HIV; principles for ART; delivery of ART; goals of ART; eligibility for ART; initiating ART in children; routine monitoring; second-line regimens; salvage treatment; single drug substitution of stavudine with abacavir; administration of antiretrovirals; concomitant tuberculosis (TB); grading of adverse events; response to adverse events; lactic acidosis; nevirapine hepatotoxicity; abacavir hypersensitivity reaction; lipodystrophy syndrome; important drug interactions; immune reconstitution inflammatory syndrome; Bacillus Calmette-Guérin adverse events; anaemia in HIV-infected children; respiratory complications, including bacterial pneumonia, Pneumocystis jiroveci pneumonia, TB, and lymphoid interstitial pneumonia; gastrointestinal conditions, including acute gastroenteritis, dysentery, persistent diarrhoea, and candidiasis; common skin conditions in HIV-infected children, including herpes simplex virus, chickenpox (varicella), herpes zoster, seborrhoeic dermatitis, molluscum contagiosum, warts, impetigo, tinea (ringworm), dry skin and itching, and drug-related skin reactions; other complications and opportunistic infections, including cryptococcal meningitis, cytomegalovirus infection, disseminated infection with mycobacterium avium complex, toxoplasmosis, HIV encephalopathy, wasting syndrome, and malignancies; managing pain in HIV-infected children; supportive care of terminally ill children; home care for terminally ill children; considerations for ART in adolescents; postexposure prophylaxis (PEP) and safe working practices, including universal precautions, procedure for sharps injury or other exposure, and PEP following alleged penetrative sexual abuse; psychosocial support; legal issues, including HIV testing of children; pre- and posttest counselling; confidentiality in counselling; adherence issues, including the role of the healthcare team, strategies to promote adherence, and basic adherence package at initiation; reasons for disclosing HIV status to children; and guidelines for the disclosure of HIV status to children.

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Childhood Tuberculosis Guidelines of the Southern African Society for Paediatric Infectious Diseases

Source: Southern African Society for Paediatric Infectious Diseases
Publication Date: January 1, 2009

2009 guidelines from the Southern African Society for Paediatric Infectious Diseases designed to increase awareness of the burden of childhood tubercu...

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2009 guidelines from the Southern African Society for Paediatric Infectious Diseases designed to increase awareness of the burden of childhood tuberculosis (TB) in Southern Africa, to increase case finding, and to align management with more standard contemporary practice. Topics covered include: epidemiology; clinical presentation including hypersensitivity phenomena, constitutional symptoms, pulmonary disease, and extrapulmonary disease; diagnosis including symptom-based approach, tuberculin skin test, chest radiograph, microscopy and culture, interferon gamma release assays, and nucleic acid amplification tests; referral for specialist opinion; management of infection; personal protection; treatment including uncomplicated TB, complicated TB, TB meningitis, miliary TB, indications for the use of corticosteroids, retreatment cases, drug-related adverse events, paradoxical reactions, and advice to parents and caregivers; recording and reporting; special issues to consider including drug-resistant TB, and TB/HIV coinfection in children; and prevention including preventive therapy, Bacillus Calmette-Guérin immunisation, and babies born to TB-infected mothers.

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Manual on Paediatric HIV Care and Treatment for District Hospitals

Source: World Health Organisation
Publication Date: January 1, 2011

2011 guidance from the World Health Organisation on caring for infants and children infected with or exposed to HIV. Topics covered include: common ch...

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2011 guidance from the World Health Organisation on caring for infants and children infected with or exposed to HIV. Topics covered include: common childhood illnesses and opportunistic infections in HIV-exposed and HIV-infected children; cough or difficulty breathing, including differential diagnosis, pneumonia, Pneumocystis jiroveci pneumonia, lymphoid interstitial pneumonitis, pulmonary tuberculosis infection, bronchiectasis, and cytomegalovirus infection; diarrhoea and other gastrointestinal problems, including persistent diarrhoea and hepatitis; fever; sepsis; malnutrition; anaemia and other haematologic conditions; paediatric HIV care and treatment; diagnosis of HIV infection in infants and children, including early identification of HIV, diagnosis in breast-feeding infants, and counselling; routine care for HIV-exposed and HIV-infected infants and children, including immunisations, prophylaxis, nutrition, and infant feeding counselling and support; antiretroviral therapy in infants and children, including when to start, first-line and second-line antiretroviral regimens, clinical and laboratory monitoring, adherence, drug toxicity, inflammatory immune reconstitution syndrome, drug substitutions for toxicity, and defining treatment failure; nutritional support, including special considerations for HIV infection, prevention of mother-to-child transmission of HIV via breast-feeding, increased energy requirements of HIV-infected children, steps for assessing child feeding, caregiver counselling, and management of severly malnourished HIV-infected children; pain management in HIV-infected children, including recognition, assessment, and management of pain; and disclosure and psychosocial support for children, including adherence for treatment, support for development, and support for special circumstances.

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Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access—Recommendations for a Public Health Approach

Source: World Health Organisation
Publication Date: January 1, 2010

2010 recommendations from the World Health Organisation based on a public health approach to HIV care and harmonised with treatment guidelines for adu...

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2010 recommendations from the World Health Organisation based on a public health approach to HIV care and harmonised with treatment guidelines for adults, pregnant women, and for the prevention of mother- to- child transmission. Topics addressed include: establishing a diagnosis of HIV infection in infants and children; when to start antiretroviral therapy (ART) in infants and children; recommended first-line ART regimens for infants and children; clinical and laboratory monitoring; what to expect in the first 6 months of ART; antiretroviral drug toxicity; substituting drugs because of toxicity in infants and children; first-line treatment failure; when to switch regimens; choice of second-line regimens; considerations for infants and children with tuberculosis and HIV; nutrition for HIV-infected infants and children; considerations for ART in adolescents; adherence to ART; strategies in the event of second-line regimen failure; and drug resistance.

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WHO Recommendations on the Diagnosis of HIV Infection in Infants and Children

Source: World Health Organisation
Publication Date: January 1, 2010

Topics covered include: performance requirements of commercial and noncommercial HIV assays; tests to diagnose HIV in infants and children younger tha...

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Topics covered include: performance requirements of commercial and noncommercial HIV assays; tests to diagnose HIV in infants and children younger than 18 months of age; identifying exposure to HIV; testing symptomatic infants and children younger than 18 months of age; testing infants who are breast-feeding; tests required to diagnose HIV in children 18 months of age or older; performance of clinical algorithms where virologic testing is not available; and laboratory methods for diagnosis of HIV infection in infants and children, including serologic and virologic testing.

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Guidelines on HIV and Infant Feeding

Source: World Health Organisation
Publication Date: January 1, 2010

2010 principles and recommendations for infant feeding in the context of HIV from the World Health Organisation. Topics covered include: balancing HIV...

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2010 principles and recommendations for infant feeding in the context of HIV from the World Health Organisation. Topics covered include: balancing HIV prevention with protection from other causes of child mortality; integrating HIV interventions into maternal and child health services; setting national or subnational recommendations for infant feeding in the context of HIV; when antiretroviral drugs are not (immediately) available, breast-feeding may still provide infants born to HIV-infected mothers with a greater chance of HIV-free survival; informing mothers known to be HIV infected about infant feeding alternatives; providing services to specifically support mothers to appropriately feed their infants; avoiding harm to infant-feeding practices in the general population; advising mothers who are HIV uninfected or whose HIV status is unknown; investing in improvements in infant-feeding practices in the context of HIV; ensuring mothers receive the care they need; which breast-feeding practices and for how long; when mothers decide to stop breast-feeding; what to feed infants when mothers stop breast-feeding; conditions needed to safely formula feed; heat-treated, expressed breast milk; and when the infant is HIV infected.

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Patient Management

Hospice Palliative Care Association of South Africa Clinical Guidelines

Source: Hospice Palliative Care Association of South Africa
Publication Date: August 1, 2012

2012 guidelines designed to provide recommendations on palliative needs assessment, pharmacologic and nonpharmacologic symptom management, how to expl...

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2012 guidelines designed to provide recommendations on palliative needs assessment, pharmacologic and nonpharmacologic symptom management, how to explain the goals of treatment to patients and family members, and involving the interdisciplinary team or referring to a more experienced clinician when necessary. Topics addressed include: ethical considerations; World Health Organisation definition of palliative care; guidelines for pain management, including pain assessment and management, bone pain, neuropathic pain, incident pain, muscle spasm, myoclonus, and dystonia; management of respiratory symptoms, including breathlessness, cough, hiccup, and oxygen therapy; management of gastrointestinal symptoms, including dysphagia, nausea and vomiting, intestinal obstruction, ascites, diarrhoea, and constipation; constitutional symptoms, including anorexia, asthenia, cachexia, fever, and sweating; infective symptoms, including immune reconstitution inflammatory syndrome and neutropaenic sepsis; management of neuropsychiatric symptoms, including delirium, anxiety, depression, insomnia, and convulsions; management of urinary symptoms, including incontinence, urinary tract infection, urinary haemorrhage, and bladder and ureteric spasm; guidelines for pressure care and wound care; the terminal phase; vascular and haematologic disorders, including anaemia and blood transfusions, lymphoedema, and thromboembolism; palliative care emergencies, including haemorrhage, hypercalcaemia, spinal cord compression, and superior vena cava obstruction; general aspects of mouth care; and specific aspects of oral care.

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Palliative Care Strategy for HIV and Other Diseases

Source: Family Health International
Publication Date: February 1, 2009

2009 guidance focused on ways to extend palliative care for people living with HIV and their loved ones. The primary aims of this strategy are to incr...

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2009 guidance focused on ways to extend palliative care for people living with HIV and their loved ones. The primary aims of this strategy are to increase local capacity to deliver palliative care; support increased access to palliative care throughout the continuum of care; integrate palliative care into existing care, support, and treatment services; advocate for sustainable and holistic palliative care locally and globally; increase access to essential palliative care medicines and commodities; facilitate development of palliative care policies, programs, and training; and increase the quality of palliative care services.

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Interim WHO Clinical Staging of HIV/AIDS and HIV/AIDS Case Definitions for Surveillance: African Region

Source: World Health Organisation
Publication Date: June 16, 2005

Interim guidance from the World Health Organisation based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations ma...

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Interim guidance from the World Health Organisation based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations made by experts from African countries at a meeting held in Nairobi in December 2004. The goals of the proposed revisions are to: provide greater consistency between adult and paediatric staging systems; harmonise clinical case definitions and surveillance definitions; provide clinical and immunologic staging for adults and children based on the degree of immunocompromise and prognosis, but that facilitates follow-up care; provide guidance on the care of children younger than 18 months of age; facilitate the use of the clinical staging system and HIV/AIDS case definitions by nonspecialist and nonpaediatric healthcare workers at the basic level and in peripheral healthcare facilities; assist with clinical decision making, including decisions on starting, substituting, switching, and stopping antiretroviral therapy and with routine follow-up of patients on treatment; permit the inclusion of laboratory testing, especially CD4+ cell count, where available, so as to guide prognosis and assist in determining the need for antiretroviral therapy and other therapies; and provide surveillance definitions for advanced stages of HIV infection that reflect disease requiring antiretroviral therapy either immediately or in the near future.

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Cancer Pain Relief

Source: World Health Organisation
Publication Date: January 1, 1996

Pain management guidance with a focus on pharmacologic intervention. Topics addressed include: causes of pain; evaluation of pain; treatment strategy;...

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Pain management guidance with a focus on pharmacologic intervention. Topics addressed include: causes of pain; evaluation of pain; treatment strategy; use of analgesics; choice of analgesic, including nonopioid analgesics, opioid analgesics, drugs for neuropathic pain, and adjuvant drugs; and opioid availability, including impediments to cancer pain relief, the World Health Organisation strategy, difficulties obtaining opioids, the participants in the drug distribution chain, the drug distribution system, national estimates of medical need for opioids, communication between health personnel and regulators, obtaining a supply of opioids, the reporting system, assessment of whether the international system is working, regulation of healthcare workers, drug abuse vs patient need, and suggested guidelines for regulation of health professionals.

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Pregnancy

Framework for Accelerating Community‐Based Maternal, Neonatal, Child, and Women’s Health and Nutrition Interventions

Source: South Africa National Department of Health
Publication Date: June 1, 2012

2012 framework from the South Africa National Department of Health that builds on the existing community Integrated Management of Childhood Illnesss p...

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2012 framework from the South Africa National Department of Health that builds on the existing community Integrated Management of Childhood Illnesss programme to maximise service coverage and quality through 6 main service delivery modes: 1) regular home visits, 2) establishment of community‐based support groups, 3) joint outreach preventive and curative services by professional nurses and community healthcare workers, 4) twice yearly child health days, and 5) monthly visits to early childhood development centres; all of them supported by an effective community mobilisation strategy. Topics addressed include: maternal, newborn, and child health and nutrition status in South Africa; evidence of effective maternal, newborn, and child health and nutrition interventions; coverage of maternal, newborn, and child healh and nutrition interventions in South Africa; global practices and lessons learnt; government policies and initiatives; guiding principles; goals and objectives; strategies; community maternal, newborn, child, and women’s health and nutrition framework; package of services; community maternal, neonatal, child, and women’s health and nutrition systems, including community healthcare worker programme, recruitement and selection of community healthcare workers, remuneration of community healthcare workers, modus operandi, training of community healthcare workers, and equipment and tools; 10 important district level implementation steps; and community maternal, newborn, child, and women’s health and nutrition monitoring and evaluation framework.

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Strategic Plan for Maternal, Newborn, Child and Women’s Health (MNCWH) and Nutrition in South Africa, 2012-2016

Source: South Africa National Department of Health
Publication Date: May 24, 2012

2012 guidance from the South Africa National Department of Health aimed at identifying priority interventions that can be expected to have the greates...

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2012 guidance from the South Africa National Department of Health aimed at identifying priority interventions that can be expected to have the greatest impact on reducing maternal, newborn, and child mortality and enhancing gender equity and reproductive health. The plan also aims to provide a road map of how these interventions can be effectively implemented with a focus on improving coverage, quality, and equitable access to core services. Topics addressed include: priority interventions for maternal health, including basic antenatal care, HIV testing, access to antiretroviral therapy, improved access to care during labour, intrapartum care, and postnatal care within 6 days of delivery; priority interventions for newborn health, including promotion of early and exclusive breast-feeding, resuscitation of newborns and care for small/ill newborns according to standardised protocols, Kangaroo Mother Care, and postnatal visit within 6 days; priority interventions for child health, including promotion of breast-feeding and appropriate complementary feeding practices for infants and young children, preventive services, correct management of common childhood illnesses, management of ill children in hospitals, early identification of HIV-infected children and appropriate management, long-term health conditions of children, and improving provision of School Health Services; priority interventions for women’s health, including access to contraceptive services, improved reproductive health services for adolescents, cervical cancer screening, and gender-based violence and postrape services; priority interventions for community-based maternal and child healthcare services, including provision of a package of services by ward-based primary healthcare outreach teams, multisectorial action to reduce poverty and inequity, and development of a maternal, newborn, child, and women’s health communication strategy; maternal, newborn, child, and women’s health and nutrition strategic plan; key strategies for implementation of priority interventions and monitoring and evaluation framework; and critical success factors.

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Changes in Regime for HIV Positive Pregnant Women and Note on Those With a Psychiatric Illness

Source: South Africa National Department of Health
Publication Date: April 5, 2012

2012 recommendation from the South Africa National Department of Health for changes in the use of nevirapine and efavirenz for HIV-positive pregnant w...

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2012 recommendation from the South Africa National Department of Health for changes in the use of nevirapine and efavirenz for HIV-positive pregnant women.

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Clinical Guidelines: PMTCT (Prevention of Mother-to-Child Transmission)

Source: South Africa National Department of Health
Publication Date: January 1, 2010

2010 South Africa National Department of Health clinical guidelines on the prevention of mother-to-child transmission of HIV. Topics addressed include...

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2010 South Africa National Department of Health clinical guidelines on the prevention of mother-to-child transmission of HIV. Topics addressed include prevention of mother-to-child transmission (PMTCT) processes and goals of intervention, including antenatal care, labour and delivery, and postnatal follow-up of mother and infant; keeping women and children healthy, improving their quality of life, and reducing their mortality; provider-initiated counselling and testing; testing algorithm for pregnant women; posttest counselling; routine clinical care for HIV-positive pregnant women, including antenatal management (initial assessment, antiretroviral therapy [ART] prophylaxis, lifelong ART, special circumstances), intrapartum management (ART prophylaxis, ART treatment, special circumstances), safe delivery techniques, and postnatal care (care of HIV-positive women and their infants in the immediate postdelivery period, ART prophylaxis, infant prophylaxis); regimens; establishing safe infant feeding practices; and infant follow-up.

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Policy and Guidelines for the Implementation of the PMTCT Programme

Source: South Africa National Department of Health
Publication Date: February 11, 2008

2008 policy document from the South Africa National Department of Health aimed at providing continued guidance on successful reduction of mother-to-ch...

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2008 policy document from the South Africa National Department of Health aimed at providing continued guidance on successful reduction of mother-to-child HIV transmission. Topics addressed include: enrolment of pregnant women into the prevention of mother-to-child transmission (PMTCT) programme; voluntary counselling and testing; testing algorithm for pregnant women; posttest counselling; clinical care for HIV-positive pregnant women; antenatal care; managing opportunistic infections; nutritional support; antiretroviral interventions; care of HIV-positive women and their infants in the immediate postdelivery period; establishing safe infant feeding practices; infant follow-up; monitoring and evaluation; and implementation plan for the revised PMTCT policy and guidelines.

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Guidelines for Maternity Care in South Africa

Source: South Africa National Department of Health
Publication Date: January 1, 2007

Practice manual designed to guide healthcare workers providing obstetric and anaesthetic services for pregnant women in clinics, community health cent...

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Practice manual designed to guide healthcare workers providing obstetric and anaesthetic services for pregnant women in clinics, community health centres, and district hospitals in South Africa. Topics addressed include: maternity care in South Africa; maternal mortality; 10 recommendations from Saving Mothers 2002-2004; safe motherhood in South Africa; national strategy for maternity care; levels of maternity care, including the clinic, community health centre, hospital levels 1-3, and emergency transport; principles of antenatal care; the first and subsequent antenatal visits; Basic Antenatal Care Activities checklist; normal labour and puerperium; abnormalities in the first stage of labour; abnormalities of the second stage of labour; Caesarean section; emergencies during labour; immediate care of the newborn; abnormalities of the third and fourth stages; abnormalities of the puerperium; preanaesthetic evaluation; anaesthesia for Caesarean section; complications during obstetric anaesthesia; cardiopulmonary resuscitation in pregnancy; hypertensive disorders of pregnancy, including classification and grading, pathophysiology of pre-eclampsia, management of pre-eclampsia, management of eclampsia, labour care, delivery care, postpartum care, and chronic hypertension; intrauterine growth restriction; intrauterine death; antepartum haemorrhage; multiple pregnancies; breech presentation and transverse lie; preterm labour; prelabour rupture of membranes; chorioamnionitis; postterm pregnancy; induction of labour with a live baby; previous Caesarean section; rhesus incompatibility; poor obstetric history; birth defects and genetic disorders; medical disorders in pregnancy, including anaemia, diabetes mellitus, cardiac disease, asthma, thromboembolism, and epilepsy; infections in pregnancy, including abnormal vaginal discharge, genital ulcers, genital warts, syphilis, malaria, urinary tract infection, pneumonia and tuberculosis, and HIV; prevention of mother-to-child HIV transmission, including antenatal care, management of labour, post delivery, termination of pregnancy, and other considerations; risk factors for mother-to-child HIV transmission; collection of essential data; essential statistics; and maternal death notification.

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Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infections in Infants

Source: World Health Organisation
Publication Date: January 1, 2010

2010 recommendations from the World Health Organisation aimed at updating recommendations for the use of antiretroviral agents in pregnant women for t...

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2010 recommendations from the World Health Organisation aimed at updating recommendations for the use of antiretroviral agents in pregnant women for their own health and to prevent HIV infection in infants and young children and at simplifying and standardising current recommendations to support the global scale-up of more effective interventions to eliminate mother-to-child HIV transmission (MTCT) in resource-limited settings. Topics addressed include: antiretroviral drugs for treating pregnant women for their own health and to prevent HIV infection in their infants, including antiretroviral therapy (ART) eligibility for pregnant women, ART regimens for pregnant women eligible for treatment, ART regimens for women of childbearing age receiving treatment for their own health, antiretroviral prophylaxis for infants born to women receiving ART, and clinical and laboratory monitoring of pregnant women receiving ART for their own health and their infants; maternal and infant antiretroviral prophylaxis to prevent MTCT for HIV-infected women who do not need treatment for their own health, including antiretroviral prophylaxis for women and their infants to reduce perinatal HIV transmission, maternal zidovudine plus antiretroviral prophylaxis to prevent MTCT, maternal triple antiretroviral prophylaxis to prevent MTCT, women diagnosed during labour or immediately postpartum, and clinical and laboratory monitoring of pregnant women receiving antiretroviral prophylaxis and their infants; special considerations, including antiretroviral regimens for women previously exposed to antiretroviral drugs, women who acquire primary infection during pregnancy or breast-feeding, women with anaemia, women with HIV-2 infection, women with active tuberculosis, women with hepatitis B or hepatitis C virus coinfection, and pregnant women living with HIV who are injecting drug users; safety and risk of resistance to antiretroviral drugs in pregnant women and their infants; and health systems considerations of antiretroviral-based interventions for women and infants.

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Prevention of Mother-to-Child Transmission of HIV: Generic Training Package

Source: World Health Organisation, US Department of Health and Human Services, US Centers for Disease Control and Prevention, and Global AIDS Program
Publication Date: July 18, 2008

Recommendations for a comprehensive approach to the training of healthcare workers in the prevention of mother-to-child HIV transmission (PMTCT). Topi...

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Recommendations for a comprehensive approach to the training of healthcare workers in the prevention of mother-to-child HIV transmission (PMTCT). Topics covered include: scope of the worldwide HIV epidemic; transmission and natural course of HIV infection; introduction to mother-to-child HIV transmission; comprehensive approach to prevention of HIV infection in infants and young children; role of maternal and child health services in the prevention of HIV infection in infants and young children; antiretroviral therapy and antiretroviral prophylaxis for PMTCT; antenatal, labour and delivery, and postpartum management of women infected with HIV and women of unknown HIV status; care of infants who are HIV exposed and infants born to women of unknown HIV status; stigma and discrimination related to mother-to-child HIV transmission; HIV testing and counselling for PMTCT, including counselling skills, pretest information and counselling, HIV testing, and posttest counselling; infant feeing in the context of HIV infection; comprehensive care and support for pregnant women with HIV infection, mothers with HIV infection, HIV-exposed infants, and families with HIV infection; role of healthcare workers in the care and treatment of HIV-infected mothers and HIV-exposed infants; community linkages for treatment, care, and support services for mothers, HIV-exposed infants and families; safety and supportive care in the work environment, including standard precautions and creating a safe work environment, managing occupational HIV exposure, and supportive care for the caregiver; and PMTCT programme monitoring and data collection.

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Primary Care

Primary Health Care Supervision Manual: A Guide to Primary Health Care Facility Supervision

Source: South Africa National Department of Health
Publication Date: October 1, 2009

2009 guidance from the South Africa National Department of Health aimed at creating a supportive environment in which planning, monitoring, and evalua...

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2009 guidance from the South Africa National Department of Health aimed at creating a supportive environment in which planning, monitoring, and evaluation are conducted jointly between management and staff, through the use of structured supervision in their collective quest toward improving the quality of primary healthcare (PHC). The tools included in the manual enable management, supervisors, and staff to regularly identify critical areas that need urgent action. The tools also measure the overall progress that is being made towards the delivery of quality PHC. Topics addressed include: national norms and standards for PHC facilities; how to use the supervision manual; quality supervision, including purposes and objectives, guiding principles, PHC facility supervision work as processes and systems, problem solving at the PHC facility level, and monitoring quality improvements; supervisors’ support lists, including red flag, regular review list, notes, and quarterly supervision support; in-depth programme reviews, including women’s reproductive health, integrated management of childhood illness, diseases prevented by immunisation, sexually transmitted infections, comprehensive management and treatment of HIV and AIDS, tuberculosis, mental health and substance abuse, school health services, oral health, victims of abuse and violence, chronic diseases and geriatric care, rehabilitation services, and health promotion; District Health Information System for PHC facilities; and PHC facility committee.

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The Primary Healthcare Package for South Africa—A Set of Norms and Standards

Source: South Africa National Department of Health
Publication Date: March 1, 2000

An integrated package of essential primary healthcare services that should be made available to the entire population to provide the solid foundations...

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An integrated package of essential primary healthcare services that should be made available to the entire population to provide the solid foundations of a single, unified health system. Topics addressed include: patient rights charter and complaints procedure, core norms and standards, women’s reproductive health, integrated management of childhood illness, adolescent and youth health, management of communicable diseases, cholera and diarrhoeal disease control, dysentery, helminthes, sexually transmitted diseases, HIV/AIDS, malaria, rabies, tuberculosis, leprosy, prevention of hearing impairment due to otitis media, rheumatic fever and haemolytic streptococcal infection, trauma and emergency, oral health, mental health, victims of sexual offenses including domestic violence and gender violence, substance abuse, chronic diseases and geriatrics, diabetes, hypertension, rehabilitation services, community level water and sanitation, community level home-based care, directly observed treatment short course, integrated nutrition programme, school health services, and community-based rehabilitation.

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Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America

Source: HIV Medicine Association of the Infectious Diseases Society of America
Publication Date: November 13, 2013

2013 recommendations designed for healthcare providers who manage patients infected with HIV or who could be at risk for the acquisition of HIV infect...

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2013 recommendations designed for healthcare providers who manage patients infected with HIV or who could be at risk for the acquisition of HIV infection. Topics addressed include: modes of HIV transmission; optimal method for diagnosis of HIV infection; risk-screening measures appropriate for HIV-infected patients; behavioural intervention; initial evaluation and laboratory testing schedule for HIV-infected patients; baseline laboratory evaluation; HIV disease tests including serological assays for HIV, CD4+ and CD8+ T-cell lymphocytes and percentages, and plasma HIV RNA levels; HIV resistance testing; coreceptor tropism assay; safety laboratory tests, including complete blood count and chemistry panel, glucose-6-phosphate dehydrogenase, fasting lipid profile, HLAB*5701 screening, and urinalysis and calculated creatinine clearance; coinfection and comorbidity laboratory tests, including tuberculosis screening, serologic testing for Toxoplasma gondii, viral hepatitis screening and vaccination recommendations, screening and vaccination recommendations for herpesviruses, screening for syphilis, screening for other sexually transmitted diseases, screening for anogenital human papillomavirus, serum testosterone level, chest radiography, and other laboratory tests; staging of HIV disease; schedule of care evaluation for HIV-infected adults and children; special considerations for women, including contraception and preconception care, pregnancy testing, gynaecological evaluation for cervical cancer screening and prevention, breast cancer screening, and menopause; special considerations for mother-to-child transmission and children; long-term metabolic complications associated with antiretroviral therapy; and optimizing patient adherence to HIV care.

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Operations Manual for Delivery of HIV Prevention, Care and Treatment at Primary Health Centres in High-Prevalence, Resource-Constrained Settings

Source: World Health Organisation
Publication Date: December 2, 2008

2008 operational guidance from the World Health Organisation intended for use in countries with high HIV prevalence. The manual is designed to assist ...

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2008 operational guidance from the World Health Organisation intended for use in countries with high HIV prevalence. The manual is designed to assist health centres in planning and delivering HIV services in an integrated, efficient, and quality-assured manner. Topics addressed include: planning integrated services at the health centre, including essential and desirable interventions and estimating HIV service needs; service integration, linkages, and triage, including for nonpregnant adults and children, pregnancy and labor and delivery, the postpartum period, newborns, HIV-exposed infants, tuberculosis care, family planning and sexual and reproductive healthcare provision, sexually transmitted infection management, and adolescents; the role of the community in prevention, care, and treatment, including HIV and tuberculosis case finding and community health workers; infrastructure, including space needed for HIV services, privacy and confidentiality, tuberculosis infection control, HIV infection control, water supply and wastewater, hand washing and other hygiene practices, latrines/toilets, cleaning, health centre waste management, power, communication infrastructure, fire safety, waiting area, triage, registration, patient monitoring, group education and support, clinical consultation rooms, counselling, pharmacy/dispensary, outdoor space, labour and delivery rooms, and creating an enabling physical work environment; monitoring services, patients, and programmes; supply management; laboratory services, including specimen labelling and logging, quality instruction for all tests, instructions for blood sample collection, rapid tests for HIV, syphilis, and malaria, infant HIV diagnosis, estimating haemoglobin, urine dipstick for sugar and protein, pregnancy test, CD4+ cell count, full blood count, specimen transport, lab set up, human resources, equipment maintenance, and training materials; human resources, including ensuring an adequate number of staff, making task shifting effective, making sure staff have appropriate training, mentoring and supportive supervision, ensuring a safe work environment, and improving employee motivation and retention; leadership and management; and quality improvement.

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Resistance

The 2012 Southern African ARV Drug Resistance Testing Guidelines

Source: Southern African HIV Clinicians Society
Publication Date: November 1, 2012

2012 resistance testing recommendations from the Southern African HIV Clinicians Society. Topics addressed include recommendations for antiretroviral ...

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2012 resistance testing recommendations from the Southern African HIV Clinicians Society. Topics addressed include recommendations for antiretroviral (ARV) drug resistance testing, including in the diagnosis of HIV in children younger than 2 years of age, failure of ARV regimens, and acute infection; scenarios where ARV resistance testing is not recommended, including HIV diagnosis in adults and adolescents, ARV initiation in adults and children older than 2 years of age, and treatment interruptions without documented regimen failure; national integration of public sector laboratories; surveillance of ARV drug resistance; monitoring and evaluation; causes of and interventions for nonadherence, including inadequate treatment literacy, adverse effects, depression and mental illness, poverty and food insecurity, work-related issues, substance use, social problems, denial, pill burden, altered fertility intentions, and conflict of opinions; laboratory objectives; practical issues for genotypic ARV resistance testing; genotypic ARV resistance assays; and research priorities, including resistance assays and operational research activities.

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World Health Organization Global Strategy for the Surveillance and Monitoring of HIV Drug Resistance

Source: World Health Organisation
Publication Date: November 1, 2012

2012 recommendations aimed at providing an overview of the different strategy elements for population surveillance and monitoring of antiretroviral re...

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2012 recommendations aimed at providing an overview of the different strategy elements for population surveillance and monitoring of antiretroviral resistance, so as to inform its implementation in resource-limited settings. Includes identifying early warning indicators, surveillance of drug resistance before implementation of antiretroviral therapy (ART) programmes and among those receiving ART, cross-sectional surveys at representative ART clinics (both for those starting ART and after 12 months of receiving ART), surveys of resistance in children younger than 18 months of age, surveys of drug resistance in recently infected populations, and surveillance within national ART programmes.

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Tuberculosis and Other Opportunistic Infections

A Practical Guide for TB and HIV Service Integration at Primary Health Care Facilities

Source: South Africa National Department of Health
Publication Date: July 2, 2012

Practical guidance on integrating tuberculosis (TB) and HIV services including initiation and management of antiretroviral therapy at primary healthca...

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Practical guidance on integrating tuberculosis (TB) and HIV services including initiation and management of antiretroviral therapy at primary healthcare (PHC) facilities in the South African public healthcare sector. This document is primarily intended for PHC facility managers and secondarily for those who support PHC facilities, namely PHC supervisors, subdistrict managers, and district management teams. Topics addressed include: a discussion of why TB/HIV integration is necessary; principles and guidelines for integrated TB/HIV services; roles and responsibilities in the delivery of integrated TB/HIV services; step-by-step guide to integration of TB/HIV services; logistical arrangement of integrated TB/HIV services; and integrated TB/HIV monitoring and evaluation.

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Multi-Drug Resistant Tuberculosis: Policy Framework on Decentralised and Deinstitutionalised Management for South Africa

Source: South Africa National Department of Health
Publication Date: August 1, 2011

2011 South Africa National Department of Health assessment of the need for and benefit of decentralized and deinstitutionalised care and treatment of ...

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2011 South Africa National Department of Health assessment of the need for and benefit of decentralized and deinstitutionalised care and treatment of multidrug-resistant (MDR) tuberculosis (TB), with recommendations for organisational structures and human resources required for decentralisation as well as expected functions of each level of operations and guidance on monitoring and evaluation. Topics addressed include description of decentralised and deinstitutionalised management of MDR TB, including the need for clarity of functions across all levels and for linkages to the entire health system; description of the elements of decentralised and deinstitutionalised MDR TB care; types, structure, levels, and functions of MDR TB units, including provincial level, districts or subdistricts, decentralised drug-resistant TB units, satellite MDR TB units, primary healthcare facilities, mobile teams, and direct observation of therapy supporters/caregivers at the community level; management teams/committees at different levels; treatment follow-up; infection control at home and during patient transport; monitoring and evaluation of the decentralised and deinstitutionalised MDR TB treatment programme; facility readiness assessment tool; example of provincial plan; and building treatment capacity to meet increasing MDR TB burden.

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Management of Drug-Resistant Tuberculosis

Source: South Africa National Department of Health
Publication Date: January 1, 2013

2013 South Africa National Department of Health guideline for the identification and treatment of drug-resistant (DR) tuberculosis (TB).  Topics ...

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2013 South Africa National Department of Health guideline for the identification and treatment of drug-resistant (DR) tuberculosis (TB).  Topics include; definitions of DR-TB; mechanisms of development of DR-TB; framework for managing DR-TB; prevention of DR-TB; legislative framework and public health ethics; international health regulation; patient management challenges; organisation of services (provincial, district, decentralised unites, satellite units, primary healthcare facilities, and mobile teams) including management teams; treatment follow-up teams; infection control teams and protocols; building capacity; case-finding strategies; diagnosis; signs and symptoms; patient assessment; management of patients with monodrug and polydrug resistance; standardised treatment regimens for adults and children 8 years of age and older; second-line and other drugs; basic principles of treatment; duration of treatment; treatment of extrapulmonary TB;’ terminal illnesses; management of extensively-drug resistant TB,  the role of surgery; monitoring and management of adverse drug reactions; recommended drugs for the treatment of adverse drug reactions; special situations (oral contraception use, pregnancy and breastfeeding, children, diabetics; renal insufficiency; liver disorders, seizure disorders, substance dependency, psychiatric disorders) management of DR-TB in HIV-infected patients, timing of ART; opportunistic infections, immune reconstitution syndrome, adverse drug reactions involving antiretroviral drugs; monitoring and evaluation of patients with DR-TB, including patient education and treatment compliance, managing contacts of patients with DR-TB, recording and reporting, heath care workers and DR-TB, forms and guidleines for DR-TB assessment, monitoring and management.

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Guideline for the prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons: 2013 update

Source: Southern African HIV Clinicians Society
Publication Date: June 4, 2013

2013 guideline from the Southern African HIV Clinicians Society on managing cryptococcal meningitis (CM) in HIV-infected patients with a focus on 7 ke... (more)

2013 guideline from the Southern African HIV Clinicians Society on managing cryptococcal meningitis (CM) in HIV-infected patients with a focus on 7 key areas: Screening and pre-emptive treatment; laboratory diagnosis and monitoring; management of a first episode of CM; amphotericin B deoxycholate toxicity prevention, monitoring, and management; timing of ART among patients with CM; management of raised intracranial pressure, and management of relapse episodes of CM. (less)

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INH Preventive Therapy (IPT) in HIV-Infected South African Children

Source: Southern African HIV Clinicians Society
Publication Date: June 1, 2011

2011 recommendations from an isoniazid preventive therapy (IPT) working group meeting sponsored by the Southern African HIV Clinicians Society. Topics...

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2011 recommendations from an isoniazid preventive therapy (IPT) working group meeting sponsored by the Southern African HIV Clinicians Society. Topics addressed include: World Health Organisation recommendations for IPT; description of the IPT working group; postexposure IPT; primary (pre-exposure) ITP; catch-up phase for children already receiving antiretroviral therapy for longer than 6 months; and drug dosage.

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Guidelines for Providing Palliative Care to Patients With Tuberculosis

Source: Hospice Palliative Care Association of South Africa
Publication Date: May 1, 2011

2011 guidance from the Hospice Palliative Care Association of South Africa on palliative care in the setting of tuberculosis (TB) infection. Topics co...

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2011 guidance from the Hospice Palliative Care Association of South Africa on palliative care in the setting of tuberculosis (TB) infection. Topics covered include: challenges associated with TB in the palliative care context; implementing TB care in palliative care programmes, including intensified case finding, infection control, isoniazid preventive therapy, and integration of HIV and TB; criteria for admission of patients with a confirmed diagnosis of multidrug-resistant TB to a palliative programme; managing TB in children; ethical considerations; palliative care for patients with TB, including clinical guidelines for the palliative care of TB patients, nutritional support, and families’/caregivers’ health; end-of-life care; and bereavement care.

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South African National Tuberculosis Management Guidelines

Source: South Africa National Department of Health
Publication Date: July 1, 2014

2014 TB recommendations from the South Africa National Department of Health designed to guide primary healthcare providers in addressing tuberculosis ...

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2014 TB recommendations from the South Africa National Department of Health designed to guide primary healthcare providers in addressing tuberculosis (TB) control challenges, including reduce transmission of infection in the communities; diagnose drug-sensitive and drug-resistant TB early; diagnose DS-TB and DR-TB early; initiate treatment in all patients diagnosed with TB early; retain patients in treatment and care until completion of treatment; and prevent TB in people living with HIV by initiating all eligible HIV-positive people on ART and Isoniazid preventive therapy. Topics include: transmission and pathogenesis of TB; primary TB infection; clinical presentation of TB;  diagnosis of TB; TB diagnostic algorithms and interpretation; registration of TB patients; contact investigaton; principles of TB treatment; essential TB drugs; fixed-dose combination tablets; standard treatment regimens for adults (aged 8 years or older); standard treatment regimen dosages; adverse effects of TB drugs (isoniazid, rifampicin, streptomycin, ethambutol, pyrazinamide, and pyridoxine); symptom-based approach to adverse effect management; monitoring the response to treatment; measuring and promoting adherence to treatment; directly observed treatment; education and adherence counselling; TB support team; special adherence considerations for children and adolescents; managing and minimising treatment interruption; treatment regimens in special circumstances (pregnant women, breastfeeding women, women using contraceptives, liver disorders, established chronic liver disease, acute hepatitis, and renal failure); TB preventive therapy in HIV infection; diagnosis and treatment of TB in HIV-positive patients; diagnosis and treatment of HIV in patients with TB; issues related to antiretroviral therapy and TB infection, including drug–drug interactions, immune reconstitution inflammatory syndrome, and counselling; factors contributing to multidrug- and extensively multidrug–resistant TB; prevention, diagnosis, and management of multidrug–resistant TB; treating mono- and polyresistance; non–Mycobacterium tuberculosis, including epidemiology, pathogenesis, clinical manifestations, bacteriology, and management; admission and discharge criteria for patients with TB; essential elements of in-patient care in TB hospitals; TB in health care workers; infection control, including administrative, environmental, personal respiratory, and healthcare personnel protection control measures; TB monitoring, evaluation, and surveillance; the electronic TB register; standard reports and information flow; programme monitoring indicators; and the TB and HIV/sexually transmitted infection integrated audit tool.

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Guidelines for the Management of Tuberculosis in Children

Source: South Africa National Department of Health
Publication Date: January 1, 2013

2013 TB recommendations from the South Africa National Department of Health focused particularly on the needs of children. Topics include: how childre...

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2013 TB recommendations from the South Africa National Department of Health focused particularly on the needs of children. Topics include: how children become infected; diagnosis in children; performing a Mantoux skin test; TB preventive therapy in children; immunisations; symptom screening; diagnosis; clinical presentation, HIV testing, chest X-rays, bacteriologic testing, TB lymphadenitis; TB meningitis; military TB; pleural effusion; TB treatment; use of steroids in children; monitoring response to treatment; managing a child who deteriorates; adverse events; nutritional support; congenital TB; TB in HIV-infected children, including managing TB therapy and ART, immune reconstitution inflammatory syndrome; cotrimoxazole prophylaxis; drug-resistant TB in children; monitoring and evaluation. Guidelines include forms and monitoring protocols.

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South African National Tuberculosis Management Guidelines

Source: South Africa National Department of Health
Publication Date: July 1, 2014

2014 TB recommendations from the South Africa National Department of Health designed to guide primary healthcare providers in addressing tuberculosis ...

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2014 TB recommendations from the South Africa National Department of Health designed to guide primary healthcare providers in addressing tuberculosis (TB) control challenges, including reduce transmission of infection in the communities; diagnose drug-sensitive and drug-resistant TB early; diagnose DS-TB and DR-TB early; initiate treatment in all patients diagnosed with TB early; retain patients in treatment and care until completion of treatment; and prevent TB in people living with HIV by initiating all eligible HIV-positive people on ART and Isoniazid preventive therapy. Topics include: transmission and pathogenesis of TB; primary TB infection; clinical presentation of TB;  diagnosis of TB; TB diagnostic algorithms and interpretation; registration of TB patients; contact investigaton; principles of TB treatment; essential TB drugs; fixed-dose combination tablets; standard treatment regimens for adults (aged 8 years or older); standard treatment regimen dosages; adverse effects of TB drugs (isoniazid, rifampicin, streptomycin, ethambutol, pyrazinamide, and pyridoxine); symptom-based approach to adverse effect management; monitoring the response to treatment; measuring and promoting adherence to treatment; directly observed treatment; education and adherence counselling; TB support team; special adherence considerations for children and adolescents; managing and minimising treatment interruption; treatment regimens in special circumstances (pregnant women, breastfeeding women, women using contraceptives, liver disorders, established chronic liver disease, acute hepatitis, and renal failure); TB preventive therapy in HIV infection; diagnosis and treatment of TB in HIV-positive patients; diagnosis and treatment of HIV in patients with TB; issues related to antiretroviral therapy and TB infection, including drug–drug interactions, immune reconstitution inflammatory syndrome, and counselling; factors contributing to multidrug- and extensively multidrug–resistant TB; prevention, diagnosis, and management of multidrug–resistant TB; treating mono- and polyresistance; non–Mycobacterium tuberculosis, including epidemiology, pathogenesis, clinical manifestations, bacteriology, and management; admission and discharge criteria for patients with TB; essential elements of in-patient care in TB hospitals; TB in health care workers; infection control, including administrative, environmental, personal respiratory, and healthcare personnel protection control measures; TB monitoring, evaluation, and surveillance; the electronic TB register; standard reports and information flow; programme monitoring indicators; and the TB and HIV/sexually transmitted infection integrated audit tool.

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Childhood Tuberculosis Guidelines of the South African Society for Paediatric Infectious Diseases

Source: South African Society for Paediatric Infectious Diseases
Publication Date: January 1, 2009

2009 recommendations on the diagnosis and treatment of tuberculosis (TB) in children. Topics addressed include: epidemiology; clinical presentation, i...

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2009 recommendations on the diagnosis and treatment of tuberculosis (TB) in children. Topics addressed include: epidemiology; clinical presentation, including hypersensitivity phenomena, constitutional symptoms, pulmonary disease, and extrapulmonary disease; diagnosis via the symptom-based approach, tuberculin skin test, chest radiograph, microscopy and culture, interferon-gamma release assays, and nucleic acid amplification tests; referral for specialist opinion; inpatient and outpatient infection control; personal protection; treatment of uncomplicated TB, complicated TB, TB meningitis, and military TB; indications for the use of corticosteroids; retreatment cases; drug-related adverse events; paradoxical reaction; advice to parents/caregivers; recording and reporting; special issues, including drug-resistant TB, and TB/HIV coinfection; preventive therapy; immunisation; and infants born to mothers with TB.

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Draft National Infection Prevention and Control Policy for TB, MDRTB and XDRTB

Source: South Africa National Department of Health
Publication Date: April 1, 2007

2007 South Africa National Department of Health recommendations for the prevention and control of tuberculosis (TB), multidrug-resistant tuberculosis,...

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2007 South Africa National Department of Health recommendations for the prevention and control of tuberculosis (TB), multidrug-resistant tuberculosis, and extensively drug–resistant TB. Topics addressed include why TB is a problem in HIV care settings; how Mycobacterium tuberculosis is spread; how TB disease in the lungs is diagnosed; vaccination with Bacillus Calmette-Guérin; difference between TB infection and TB disease; when TB is infectious; methods for reducing the risk of spreading M. tuberculosis in healthcare settings, including infection prevention and control plan, administrative support, staff training, patient education and community awareness, coordination and communication between the TB and HIV & AIDS Care Programme, and environmental control measures; protection of healthcare workers and staff by increasing awareness of TB, increasing access to HIV voluntary counselling and testing, and use of personal respiratory protection; multidrug-resistant TB; drug rehabilitation centres/correctional institutions; and operational research priorities.

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The Use of Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis: Interim Policy Guidance

Source: World Health Organisation
Publication Date: June 17, 2013

2013 interim guidance from the World Health Organisation (WHO) on the use of bedaquiline in conjunction with other WHO-recommended treatments for mult...

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2013 interim guidance from the World Health Organisation (WHO) on the use of bedaquiline in conjunction with other WHO-recommended treatments for multidrug-resistant (MDR) tuberculosis (TB). The objectives of this guidance document are: to evaluate the efficacy and safety of bedaquiline in addition to current WHO-recommended MDR TB treatments; to evaluate the balance between harms and benefits of the drug, its potential cost-effectiveness, patient and provider preferences and concerns, and the feasibility of introducing the drug into MDR TB programmes; and to provide, as appropriate, recommendations on the use of the drug as part of WHO-recommended MDR TB treatment regimens, including attention to concerns/constraints relevant to the potential use of a new drug for which phase III clinical trial data are not yet available.

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WHO Policy on Collaborative TB/HIV Activities. Guidelines for National Programmes and Other Stakeholders

Source: World Health Organisation
Publication Date: March 2, 2012

2012 World Health Organisation policy recommendations for the management of HIV-related tuberculosis. Topics addressed include goal and objectives of ...

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2012 World Health Organisation policy recommendations for the management of HIV-related tuberculosis. Topics addressed include goal and objectives of collaborative tuberculosis (TB)/HIV activities; recommended collaborative TB/HIV activities, including establishing and strengthening the mechanisms for delivering integrated TB and HIV services, reducing the burden of TB in people living with HIV and initiating early antiretroviral therapy, and reducing the burden of HIV in patients with presumptive and diagnosed TB; and national targets for scaling up collaborative TB/HIV activities.

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Rapid Advice: Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children

Source: World Health Organisation
Publication Date: December 1, 2011

2011 World Health Organisation rapid advice on managing cryptococcal disease in HIV-infected patients with a focus on 6 key areas: diagnosis of crypto...

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2011 World Health Organisation rapid advice on managing cryptococcal disease in HIV-infected patients with a focus on 6 key areas: diagnosis of cryptococcal disease; screening and prevention of cryptococcal disease; induction, consolidation, and maintenance antifungal treatments; prevention, monitoring, and management of drug toxicities; timing of antiretroviral therapy (ART) initiation; and timing of discontinuation of fluconazole maintenance treatment (secondary prophylaxis). The objectives of the document are to provide a summary of key evidence and its assessment and to provide recommendations on the prevention, diagnosis, and management of cryptococcal disease in HIV-infected adults, adolescents, and children, with an emphasis on resource-limited settings with a high burden of cryptococcal disease; to outline standards for high-quality care of persons living with HIV and patients with cryptococcal disease; to identify gaps and prioritize areas in need of further clinical and operational research.

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Guidelines on post-exposure prophylaxis for HIV and the use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children: recommendations for a public health approach

Source: World Health Organisation
Publication Date: December 1, 2014

December 2014 supplement to the World Health Organisation 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing ...

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December 2014 supplement to the World Health Organisation 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Topics include: new recommendations for postexposure prophylaxis (PEP); eligibility for PEP; PEP regimens for adults and children; prescribing; adherence; management of other exposures; follow-up; specific populations; research gaps; guidance for programme managers; monitoring and evaluation. Use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children, and infants; implementation considerations; research.

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WHO Treatment Guidelines for Drug-Resistant Tuberculosis

Source: World Health Organisation
Publication Date: May 1, 2016

2016 World Health Organisation recommendations for managing drug-resistant tuberculosis. This update is intended as a tool for use by health professio...

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2016 World Health Organisation recommendations for managing drug-resistant tuberculosis. This update is intended as a tool for use by health professionals in response to the 62nd World Health Assembly’s call for Member States to develop a comprehensive framework for the management and care of multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant TB. Topics addressed include rapid drug susceptibility testing for early start of appropriate treatment; monitoring the response to MDR TB treatment; composition and duration of second-line anti-TB regimens; use of antiretrovirals in patients on second-line anti-TB regimens; models of care for managing MDR TB; and potentially overlapping toxicities of antiretrovirals and anti-TB agents.

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Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children

Source: World Health Organisation
Publication Date: January 1, 2013

2013 World Health Organisation policy statement on the use of real-time nucleic acid amplification technology (Xpert MTB/RIF)  for detecting tube...

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2013 World Health Organisation policy statement on the use of real-time nucleic acid amplification technology (Xpert MTB/RIF)  for detecting tuberculosis and rifampicin resistance. Topics include using Xpert MTB/RIF to diagnose pulmonary TB and rifampicin resistance in adults (as a replacement test for smear microscopy; as an add-on test following microscopy; using Xpert MTB/RIFto detect smear-positive culture-positive; to detect smear-negative culture-positive; to detect pulmonary TB in HIV-negative and HIV- positive individuals; to detect rifampicin resistance); using Xpert MTB/RIF to diagnose extrapulmonary TB and rifampicin resistance in adults and children (Detecting lymph node TB in samples from biopsy or fine-needle aspiration; detecting pleural TB in pleural fluid;  detecting TB in samples of CSF; detecting TB in gastric fluid; detecting TB in tissue samples; detecting rifampicin resistance; using Xpert MTB/RIF to diagnose TB and rifampicin resistance in children; affordability and cost effectiveness of using Xpert MTB/RIF to diagnose TB; WHO policy recommendations on using Xpert MTB/RIFto diagnose pulmonary and extrapulmonay TB and rifampicin resistance in adults and children.

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Treatment of Tuberculosis: Guidelines

Source: World Health Organisation
Publication Date: January 1, 2010

2010 World Health Organisation recommendations on the treatment of tuberculosis (TB). Topics addressed include duration of rifampicin in new patients;...

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2010 World Health Organisation recommendations on the treatment of tuberculosis (TB). Topics addressed include duration of rifampicin in new patients; dosing frequency in new patients; initial regimen in countries with high levels of isoniazid resistance; TB treatment in persons living with HIV; sputum monitoring during TB treatment of smear-positive pulmonary TB patients; treatment extension in new pulmonary TB patients; previously treated patients; TB case definitions based on anatomical site of TB disease, bacteriological results, history of previous treatment, and HIV status; standard treatment regimens, including essential anti-TB drugs, standard regimens for defined patient groups, new patients, previously treated patients and multidrug resistance, standard regimens for previously treated patients, and overall considerations in selecting a country’s standard regimens; monitoring during treatment, including assessing treatment response in new and previously treated pulmonary TB patients, extrapulmonary TB, recording standardised treatment outcomes, management of treatment interruption, prevention of adverse effects of drugs, monitoring and recording adverse effects, and symptom-based approach to managing adverse effects of anti-TB drugs; comanagement of HIV and active TB disease, including HIV testing and counselling for all patients known or suspected to have TB; HIV prevention in TB patients; TB treatment in people living with HIV, cotrimoxazole preventive therapy, antiretroviral therapy (ART), drug susceptibility testing, patient monitoring during TB treatment, considerations when TB is diagnosed in people living with HIV who are already receiving ART, and HIV-related prevention, treatment, care, and support; supervision and patient support, including roles of the patient, TB programme staff, the community, and other providers, supervised treatment, using a patient-centred approach to care and treatment delivery, and prevention of treatment interruption; treatment of drug-resistant TB, including Green Light Committee Initiative, groups of drugs to treat multidrug resistant (MDR) TB, general principles in designing an MDR TB treatment regimen, programmatic strategies for treatment of MDR TB, selection of the country’s standard MDR TB treatment regimen, selection of individualised MDR TB regimens, monitoring the MDR TB patient, duration of treatment for MDR TB, treating TB with resistance patterns other than MDR, recording and reporting drug-resistant TB cases, and evaluation of outcomes; treatment of extrapulmonary TB; and treatment of TB in special situations.

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WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households

Source: World Health Organisation
Publication Date: January 1, 2009

2009 World Health Organisation policy recommendations on controlling tuberculosis infection in multiple settings. Topics addressed include national an...

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2009 World Health Organisation policy recommendations on controlling tuberculosis infection in multiple settings. Topics addressed include national and subnational activities to reduce transmission of tuberculosis (TB); reducing transmission of TB in healthcare facilities; infection control for congregate settings; reducing transmission of TB in households; prioritising measures and setting targets for TB infection control; and strength of the public health recommendations.

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Implementing the WHO Stop TB Strategy: A Handbook for National Tuberculosis Control Programmes

Source: World Health Organisation
Publication Date: January 1, 2008

2008 World Health Organisation recommendations for controlling tuberculosis. Topics addressed include tuberculosis (TB) case detection; treatment of T...

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2008 World Health Organisation recommendations for controlling tuberculosis. Topics addressed include tuberculosis (TB) case detection; treatment of TB; recording and reporting; TB in children; contact investigation; infection control in healthcare settings; isoniazid preventive therapy; Bacillus Calmette-Guérin vaccination; prevention through addressing risk factors; programmatic TB management, including drug-resistant TB, TB and HIV coinfection, laboratory services, anti-TB drug supplies, supervisory support to basic management units, development of human resources, monitoring and evaluation of programme performance, funding of TB control, and legal and regulatory issues; and ensuring comprehensive control of TB, including contributing to strengthening of health systems, engaging all care providers, a practical approach to lung health and other integrated approaches to health care, equity of and access to services for prevention of TB and treatment of patients, special groups and situations, involvement of communities and patients in TB care and prevention, advocacy, communication, social mobilisation, and the role of national TB control programmes in research.

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Essential Actions for Effective TB Infection Control: Safety Without Stigma

Source: World Health Organisation
Publication Date: January 1, 2008

Ten essential actions for implementing infection control interventions drafted by the Tuberculosis (TB) Infection Control Subgroup of the Global TB/HI...

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Ten essential actions for implementing infection control interventions drafted by the Tuberculosis (TB) Infection Control Subgroup of the Global TB/HIV Working Group in collaboration with the HIV/AIDS and Stop TB Departments at the World Health Organisation. The actions described are: include patients and community in advocacy campaigns, develop an infection control plan, ensure safe sputum collection, promote cough etiquette and cough hygiene, triage patients suspected of having TB infection for “fast track” or separation, assure rapid diagnosis and initiation of treatment, improve room air ventilation, protect healthcare workers, build capacity by incorporating training on TB infection control practices into broader infection control trainings at hospitals and facilities, and monitor infection control practices.

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Clinical Practice Guidelines for the Management of Cryptococcal Disease

Source: Infectious Diseases Society of America
Publication Date: February 1, 2010

2010 recommendations on cryptococcal disease management. Topics addressed include: treatment strategies for patients with cryptococcal meningoencephal...

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2010 recommendations on cryptococcal disease management. Topics addressed include: treatment strategies for patients with cryptococcal meningoencephalitis, including HIV-infected individuals, organ transplantation recipients, and non–HIV-infected, nontransplantation hosts; management of complications in patients with cryptococcosis, including persistence, relapse, elevated cerebrospinal fluid pressure, immune reconstitution inflammatory syndrome, and cerebral cryptococcomas; treatment strategies for patients with nonmeningeal cryptococcosis, including pulmonary disease in immunosuppressed and nonimmunosuppressed individuals and nonmeningeal, nonpulmonary cryptococcosis; and treatment in special populations, including pregnant women, children, individuals in resource-limited settings, and individuals infected with C gattii.

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