Overview

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.

Contents

• FOREWORD
• ABBREVIATIONS AND ACRONYMS
• ACKNOWLEDGEMENTS
• EXECUTIVE SUMMARY
• SUMMARY RECOMMENDATIONS
• 1. INTRODUCTION
  • 1.1. Background and rationale
  • 1.2. Objectives
  • 1.3. Target audience
  • 1.4. Guiding principles
  • 1.5. Methods for developing the guidelines
  • 1.6. Organization of the guidelines
  • References
• 2. HIV TESTING AND DIAGNOSIS
  • 2.1. Introduction
  • 2.2. HIV testing for a changing epidemic
  • 2.3. Mobilizing demand and pre-test services
  • 2.4. HIV testing service delivery approaches
  • 2.5. Post-test services and linkage to prevention, treatment and other services
  • 2.6. Strategies to make HIV testing services accessible
  • 2.7. Maintaining the accuracy and reliability of HIV diagnosis
  • 2.8. HIV diagnosis among infants and children
  • References
• 3. HIV PREVENTION
  • 3.1. Combination HIV prevention
  • 3.2. Pre-exposure prophylaxis for preventing the acquisition of HIV
  • 3.3. Post-exposure prophylaxis
  • 3.4. Infant prophylaxis
  • References
• 4. ANTIRETOVIRAL THERAPY
  • 4.1. Introduction
  • 4.2. Preparing people living with HIV for ART
  • 4.3. What to expect in the first months of ART
  • 4.4. When to start ART
  • 4.5. Timing of ART
  • 4.6. What to start
  • 4.7. Monitoring the response to ART
  • 4.8. Monitoring ARV toxicity
  • 4.9. ARV drug resistance
  • 4.10. Key ARV drug interactions
  • References
• 5. MANAGING ADVANCED HIV DISEASE
  • 5.1. Introduction
  • 5.2. Causes of morbidity and mortality among adults with advanced HIV disease
  • 5.3. Providing a package of care
  • 5.4. Overview of clinical management of cryptococcal disease
  • 5.5. Overview of clinical management of histoplasmosis
  • 5.6. Advanced HIV disease among children and adolescents
  • 5.7. Supporting decision-making for providing a package of care
  • 5.8. Programme considerations
  • References
• 6. GENERAL CARE AND MANAGING COMMON COINFECTIONS AND COMORBIDITIES
  • 6.1. Introduction
  • 6.2. General care for people living with HIV
  • 6.3. Co-trimoxazole prophylaxis
  • 6.4. Tuberculosis
  • 6.5. Hepatitis B and C
  • 6.6. Malaria
  • 6.7. Buruli ulcer
  • 6.8. Leishmaniasis
  • 6.9. Cervical cancer
  • 6.10. Noncommunicable diseases
  • 6.11. Mental health among people living with HIV
  • 6.12. Drug use and drug use disorders
  • 6.13. Sexually transmitted infections
  • 6.14. Vaccines for people living with HIV
  • 6.15. HIV-related skin and oral conditions
  • 6.16. Nutritional care and support
  • 6.17. Palliative care
  • 6.18. Noncommunicable diseases among children and adolescents
  • Additional resources relating to Chapter 6
  • Violence against women
  • Sexual and reproductive health guidelines for women living with HIV
  • Nutrition and HIV
  • References
• 7. SERVICE DELIVERY
  • 7.1. Introduction
  • 7.2. Linkage from HIV testing to enrolment in care
  • 7.3. Differentiated service delivery for HIV treatment
  • 7.4. People-centred care
  • 7.5. Initiating and maintaining treatment
  • 7.6. Continuity of care
  • 7.7. Task sharing
  • 7.8. Decentralization
  • 7.9. Integrating services
  • 7.10. Delivering HIV services to children
  • 7.11. Service delivery for adolescents
  • 7.12. Improving the quality of HIV care services
  • 7.13. Procurement and supply management systems for HIV health products
  • 7.14. Laboratory and diagnostic services
  • 7.15. Laboratory connectivity
  • References
• 8. MONITORING ART PROGRAMME FUNCTIONING
  • 8.1. Introduction
  • 8.2. Selection of key indicators to improve service delivery and assess impact
  • 8.3. Data collection and disaggregation
  • 8.4. Strengthening data systems
  • 8.5. Evaluation, including impact and programme performance
  • 8.6. Monitoring ARV drug toxicity
  • 8.7. HIV drug resistance
  • References
• 9. PUBLICATION, DISSEMINATION AND EVALUATION
  • 9.1. Publication
  • 9.2. Dissemination and implementation
  • 9.3. Useful analytical tools for planning
  • 9.4. Evaluation
  • References
• GLOSSARY
• ANNEX 1. DOSAGES FOR ARV DRUGS
• ANNEX 2. KEY DRUG INTERACTIONS FOR ARVS

Suggested citation:

Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

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