Integrated Guidelines for Prevention, Testing, Care and Integrated Guidelines for Prevention, Testing,

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  • Integrated Guidelines

    for

    Prevention, Testing, Care and

    Treatment of HIV/AIDS

    in Liberia

    2 nd

    Edition

    National AIDS and STI Control Program

    Ministry of Health and Social Welfare Republic of Liberia

    December 2007

  • For questions or expert advice related to the Integrated Guidelines or the

    National prevention, care and treatment program, please contact the National

    AIDS and STI Control Program:

    Phone Number (NACP Secretary): 06 522 573

    Email: nacp@nacp.gov.lr

  • i

    Foreword

    Worldwide, the HIV/AIDS epidemic is now a global crisis affecting all countries and

    to a greater or lesser degree. It constitutes one of the most formidable challenges to

    development and social progress in this century. In the most affected countries, the

    epidemic is eroding decades of development gains, undermining economies,

    threatening security and destabilizing families, communities and societies.

    In some counties in Sub Saharan Africa, the epidemic has created a state of

    emergency. It strikes hardest at vulnerable groups, including women and children,

    thereby increasing pre-existing gender inequalities and exacerbating the problem of

    child labor.

    In response to the AIDS epidemic, the Government of Liberia created the National

    HIV/AIDS/STI Control Program (NACP) in 1987 and the National AIDS

    Commission (NAC). The latter was re-constituted in June 2007 under the leadership

    of President Ellen Johnson-Sirleaf and Dr. Walter Gwenigale, the Minister of Health

    and co-chair of the NAC.

    This document emanates from the collective commitment of many individuals and

    organizations to mount a nationally integrated response to the need for prevention,

    treatment, care and support to mitigate the impact of HIV/AIDS in Liberia. The first

    edition of these guidelines, produced in 2005, was a milestone for the national

    response in Liberia. After broad consultation, however, it became clear that changes

    in the treatment guidelines were crucial as part of the long-term effort to improve the

    quality of HIV/AIDS care and treatment services. Major changes from the first edition

    include:

    • Updated HIV/AIDS treatment recommendations, which now correspond with

    the WHO 2006 recommendations and lessons learned from local experiences

    • Encouragement of routine provided-initiated testing, and the promotion of

    testing as an integrated part of prudent public health practices

    • Reconsideration of the first- and second-line antiretroviral therapy regimens:

    the NACP based these recommendations on the criteria of 1) doing no harm,

    2) lowest pill burden, 3) least toxicity, 4) highest efficacy, and 5) the ability to

    still expand access to these medicines throughout the population

    • Clear listing of contact information at the NACP, including a phone number

    and email address, through which questions and feedback may be received and

    properly addressed

    The creation of an integrated guideline that discusses prevention, testing, care and

    treatment for all eligible patients – men, women, pregnant women, and children –

    reflects the eagerness of NACP to learn from other countries and chart for the future.

    The guidelines now include recommendations on major topics such as standard

    precautions, infant testing, follow-up scheduling for patients who are not yet eligible

    for antiretroviral treatment, specific treatment for HIV-1, HIV-2 and HIV-1/HIV-2

    co-infection, adherence, co-management of patients with tuberculosis, treatment

    failure, and post-exposure prophylaxis.

  • ii

    These new guidelines will be used as the foundation for training health care providers

    throughout Liberia, and for the development of targeted interventions. The NACP

    looks forward to working with all health care providers involved in HIV counseling,

    testing, and treatment.

    The treatment of HIV is a rapidly evolving field and the Technical Working Group

    used the most up to date information available when making its recommendations.

    Revisions will be made as new scientific evidence is gathered.

    Khalipha M. Bility

    Program Manager

    National AIDS and STIs Control Program (NACP)

    Republic of Liberia

  • iii

    Acknowledgements

    In early 2007, a Technical Working Group was appointed to revise the national

    guidelines on care and treatment of HIV/AIDS in Liberia. The result of that effort is

    this document, the Integrated Guidelines for Prevention, Testing, Care and Treatment

    of HIV/AIDS in Liberia. This document is a product of not only the efforts of the

    members of the Technical Working Group, but also reflects the contributions of many

    other individuals, groups, and institutions. We can not possibly begin to express our

    gratitude to the dozens of individuals and organizations whose work – past and

    current – has contributed to the production of these Guidelines. The Ministry of

    Health and Social Welfare is particularly grateful for the support and guidance of the

    following institutions:

    A.M. Dogliotti Medical School

    AWARE

    Catholic Hospital

    Clinton Foundation HIV/AIDS Initiative

    ELWA

    ESTHER

    Firestone Hospital

    JFK Medical Center

    Archdiocese of Monrovia Catholic Church HIV/AIDS Program

    Merlin

    Ministry of Health and Social Welfare, Liberia

    Médecins Sans Frontières - Belgium

    National AIDS and STI Control Program, Liberia

    Phebe Hospital

    UNDP

    UNICEF

    University of Massachusetts

    University of Pennsylvania Department of Infectious Diseases

    WHO

    The Integrated Guidelines also draw upon the knowledge accumulated within the

    following documents, guidelines, and publications:

    Addis Ababa City Administration Health Bureau (2006) Standard Operating

    Procedures for Decentralizing ART Initiation and Follow Up Care to Public

    Health Centers and Private Facilities. Addis Ababa, Ethiopia.

    Bartlett JG and Gallant JE (2007) Medical Management of HIV Infection.

    Baltimore, MD: Johns Hopkins Medicine Health Publishing Business Group.

    Federal Ministry of Health, Disease Prevention and Control Department, Ethiopia

    (2005) Guidelines for Use of Antiretroviral Drugs in Ethiopia. Addis Ababa,

    Ethiopia.

    Federal Ministry of Health, Ethiopia (2006) Back Pocket Updates: Prevention of

    Mother to Child Transmission of HIV. Addis Ababa, Ethiopia.

    Federal Ministry of Health, Ethiopia (Dec. 2006) National Guidelines on

    Prevention of Mother to Child Transmission of HIV. Addis Ababa, Ethiopia.

    Federal Ministry of Health, Ethiopia (Jan. 2005) Guideline for Implementation of

    Antiretroviral Therapy in Ethiopia. Addis Ababa, Ethiopia.

  • iv

    Federal Ministry of Health, Ethiopia (Jan. 2007) Guidelines for Pediatric

    HIV/AIDS Care and Treatment in Ethiopia. Addis Ababa, Ethiopia.

    Federal Ministry of Health, HIV/AIDS Prevention and Control Office, Ethiopia

    (Dec. 2006) Guidelines for Use of Antiretroviral Drugs in Adolescents and

    Adults in Ethiopia, 2 nd

    Edition. Addis Ababa, Ethiopia.

    Federal Ministry of Health, Nigeria (2007) Guidelines for the Use of

    Antiretroviral (ARV) Drugs in Nigeria, Draft. Abuja, Nigeria.

    Federal Ministry of Health, Nigeria (2007) National Guidelines for Paediatric

    HIV and AIDS, Draft. Abuja, Nigeria.

    Ministry of Health and Child Welfare, Zimbabwe (2005) Guidelines for

    Antiretroviral Therapy in Zimbabwe. Harare, Zimbabwe: National Drug and

    Therapeutics Policy Advisory Committee and AIDS & TB Unit.

    Ministry of Health, National AIDS Control Programme, United Republic of

    Tanzania (2005) National Guidelines for the Clinical Management of HIV and

    AIDS. Dar es Salaam, Tanzania.

    Ministry of Health, National AIDS Control Programme, United Republic of

    Tanzania (2006) Standard Operating Procedures for HIV Care and

    Treatment. Dar es Salaam, Tanzania.

    National Department of Health, South Africa (2004) National Antiretroviral

    Treatment Guidelines. Johannesburg: Minuteman Press.

    Nigerian Institute of Medical Research (2005) Training Manuals for Doctors on

    the Use of Antiretroviral Drugs in Nigeria. Abuja, Nigeria.

    Partners in Health (2006) The PIH Guide to Community-Based Treatment of HIV

    in Resource-Poor Settings, Second Edition.

    Sharland M, S Blanche, G Castelli J Ramos and DM Gibb on behalf of the

    PENTA Steering Committee (2004) PENTA guidelines for the use of

    antiretroviral therapy, 2004. HIV Medicine 5 (Suppl. 2): 61-86.

    We are deeply grateful for the generosity of the above institutions, organizations,

    individuals and authors.

    Dr. Bernice Dahn

    Chief Medical Officer

    Deputy Minister of Health and Social Welfare, Republic of Liberia

  • v

    Table of Contents

    1. INTRODUCTION.....................................