Monday, February 3, 2014

Uganda issues new HIV Treatment Guidelines

By Esther Nakkazi
Uganda has passed new updated HIV treatment guidelines that are integrated in the general healthcare family-centered system and promote sustainability of HIV services-treatment and care.

The new or revised guidelines first developed in 2011, incorporate the 2013 World Health Organisation (WHO) recommendations like expanding the eligibility criteria for ART by raising the cut-off CD4 point to 500cells/mm and to target key populations like sero-discordance.

They have also incorporated scientific evidence from existing national programs and promote integration of HIV services into the existing health care system in order to ensure universal access.

“These guidelines have been developed as an addendum to the 2011 National ART Integrated Guidelines for use by health workers at all levels of service delivery,” said Dr. Ruth Jane Aceng, the Director General health services Ministry of Health.

In effect, they will assist health workers to provide high quality and standardized HIV prevention, care and treatment services to people living with HIV.

Dr. Aceng said the key areas that have been incorporated in the 2013 guidelines are diagnosis and management of Cryptococcal infections, family planning in the context of HIV, which areas were not well addressed previously.

The new guidelines also recommend treating all children below 15 years irrespective of their CD4 count in order to improve enrolment of children into care and treatment. They also address key aspects of adolescents.

They consider key populations like Serodiscordants and TB patients co-infected with HIV who should be commenced on combination ART regardless of their CD4 count, recommend initiation of family planning services as an integral component of ART services- as women attending ART clinics have sustained contact with health workers and this can be used as an opportunity to provide them with family planning services.

Alice Kayongo Mutebi an HIV activist and advocate thanked fellow HIV advocates for all their efforts invested in influencing the adoption of these guidelines. “I am sure implementation of the same should start immediately,” she said.

The antiretroviral guidelines recommend that to prevent and Cryptococcal Disease in HIV, the health workers should carry out early screening and prevention of cryptococcal disease and its diagnosis.

Since 2011, the Ministry of Health has rolled out comprehensive HIV prevention, care and treatment with a significant focus on Prevention of Mother to Child Transmission of HIV (PMTCT), Infant Young Child feeding (IYCF), rapid scale up of ART among adults and children.

It has also developed integrated ART, eMTCT and IYCF guidelines. The current guidelines will facilitate integration of all these services and promote a family-centered approach to HIV prevention and care, treatment, a statement from Ministry of Health says.

They emphasize service integration and linkage especially in lifelong treatment for pregnant mothers. ART should be initiated and maintained in eligible pregnant and breastfeeding mothers and in infants at maternal and child health care settings with linkage and referral to ongoing HIV care and ART 18 months after delivery. They also recommend interventions like Mobile phone text messaging as a reminder tool for promoting adherence to ART as part of a package of adherence interventions.


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