Consolidated Guidelines On Hiv Prevention Testing Treatment Service Delivery And Monitoring

These consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring bring together existing and new clinical and programmatic recommendations across different ages, populations and settings, bringing together all relevant WHO guidance on HIV produced since 2016. It serves as an update to the previous edition of the consolidated guidelines on HIV. These guidelines continue to be structured along the continuum of HIV care. Information on new combination prevention approaches, HIV testing, ARV regimens and treatment monitoring are included. There is a new chapter on advanced HIV disease that integrates updated guidance on the management of important HIV comorbidities, including cryptococcal disease, histoplasmosis and tuberculosis. The chapter on general HIV care, contains a new section on palliative care and pain management, and up to date information on treatment of several neglected tropical diseases, such as visceral leishmaniasis and Buruli ulcer. New recommendations for screening and treating of cervical pre-cancer lesions in women living with HIV are also addressed in this chapter. Guidance on service delivery was expanded to help the implementation and strengthening the HIV care cascade. Importantly, this guidance emphasizes the need for differentiated approaches to care for people who are established on ART, such as reduced frequency of clinic visits, use of multi-month drug dispensing and implementation of community ART distribution. The adoption of these efficiencies is essential to improve the quality of care of people receiving treatment and reduce the burden on health facilities, particularly in resource limited settings.

These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

These consolidated guidelines are aimed at supporting the generation of responsive person-centred data from routine national health management information systems across the HIV cascade, from prevention, testing and treatment to longer-term health care. They build upon the 2017 Consolidated guidelines on person-centred HIV patient monitoring and case surveillance, which describe information that should be collected in primary HIV patient monitoring tools, and the 2020 Consolidated HIV strategic information guidelines, which cover aggregate indicators for managing and monitoring programmes. The purpose of this guideline consolidation is to provide the recommended data elements, indicators and guidance on data systems and their use across the spectrum of health sector HIV services in one place. This document focuses on strengthening the analysis and use of routine data at each stage of the cascade and emphasizes?/addresses? person-centred HIV prevention, testing and treatment, integration of HIV-related infections, the use of routine surveillance data to measure impact, and the development and use of digital health data systems and their governance. It also identifies the gaps and limitations in these data, and the need for strengthening the use of data in all HIV-related strategic information, including population-based surveys, modelling, community-led monitoring and other sources.

These guidelines provide new and updated recommendations and good practice statements in the following areas: starting ART, including initiating treatment outside the clinic and support for same-day ART start; frequency of clinical visits and ART refills; measuring adherence; tracing and re-engagement in care for all populations; psychosocial support for adolescents living with HIV; task sharing for diagnostic services; and service integration. This guideline seeks to provide support to Member States, programme managers, health workers and other stakeholders seeking to achieve national and international goals to end the HIV epidemic as a public health threat by 2030. WHO is currently in the process of collating all HIV normative guidance developed since 2016 in order to publish the third edition of the consolidated HIV guidelines in July 2021. This updated version will include the new service delivery guidance presented here.

The Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations outline a public health response for five key populations (men who have sex with men, trans and gender diverse people, sex workers, people who inject drugs and people in prisons and other closed settings). They present and discuss new recommendations and consolidate a range of recommendations and guidance from current WHO guidelines. Particularly for key populations, social, legal, structural and other contextual factors both increase vulnerability to HIV, viral hepatitis and STIs and obstruct access to health and other essential services. These guidelines highlight the critical importance of addressing structural barriers in all settings as a priority. In most countries, inadequate coverage and poor quality of services for key populations continue to undermine responses to HIV, viral hepatitis and STIs. All countries should prioritise reaching key populations and supporting key population communities to lead the response and provide equitable, accessible and acceptable services. In most countries, inadequate coverage and poor quality of services for key populations continue to undermine responses to HIV, viral hepatitis and STIs. All countries should prioritise reaching these key populations and supporting key population communities to lead the response and provide equitable, accessible and acceptable services to these groups.