Essential prevention and care interventions for adults and adolescents living with HIV in resource-limited settings
ISBN 978 92 4 159670 1
People living with HIV (PLHIV) in resource limited settings should have access to essential interventions to prevent illness and HIV transmission. Under Universal access, agreed to by the G8, efforts to scale up all prevention interventions, to promote provider-initiated HIV testing and counselling services and to integrate these into the care and treatment of PLHIV are underway. Expansion of HIV testing and counselling will greatly increase the number of PLHIV who are aware of their HIV status and can benefit from comprehensive HIV-related prevention, care, and treatment services. All PLHIV for whom ART is clinically indicated should have access to it. But people with HIV for whom ART is not clinically indicated should also benefit from basic HIV prevention and care, including a core set of effective interventions that are simple, relatively inexpensive, can improve the quality of life, prevent further transmission of HIV, and for some interventions, delay progression of HIV disease and prevent mortality. Defining, implementing, and promoting access to a set of effective HIV prevention and care interventions, in addition to ART, through health facilities, and at the community level through outreach, are critical to achieving universal access.
This document is the result of an effort to review the evidence and develop recommendations for interventions to reduce illness associated with HIV infection and prevent HIV transmission. It follows on an expert panel convened in June 2006. This review meeting used a standardized rating system and a structured guidance development process. Recommendations were formulated covering thirteen areas of intervention seen as low cost and of particular importance for people living with HIV. These areas are:
- psychosocial counselling and support
- disclosure, partner notification and testing and counselling;
- co-trimoxazole prophylaxis;
- tuberculosis (TB);
- preventing fungal infections;
- sexually transmitted and other reproductive tract infections;
- preventing malaria;
- selected vaccine preventable diseases (hepatitis-B, pneumococcal, influenza vaccine, and yellow fever vaccines);
- family planning;
- preventing mother-to-child transmission of HIV;
- needle-syringe programmes and opioid substitution therapy; and
- water, sanitation and hygiene.
While not all interventions will be needed or equally important in all countries, depending on local and national epidemiology, it is hoped that those most useful will be adopted, adapted as needed and provided to PLHIV. Once ART is begun, the utility of many of these interventions will not decrease and they should be maintained throughout the treatment course as well.