Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations

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Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations

Recommendations

The correct and consistent use of condoms with condom-compatible lubricants is recommended for all key populations to prevent sexual transmission of HIV and sexually transmitted infections (STIs)

All individuals from key populations who inject drugs should have access to sterile injecting equipment through needle and syringe programmes

All people from key populations who are dependent on opioids should be offered opioid substitution therapy in keeping with WHO guidance, including those in prison and other closed settings

All key populations with harmful alcohol or other substance use should have access to evidence-based interventions, including brief psychosocial interventions involving assessment, specific feedback and advice

People likely to witness an opioid overdose should have access to naloxone and be instructed in its use for emergency management of suspected opioid overdose

Naloxone is effective when delivered by intramuscular, intranasal, intravenous and subcutaneous routes. Persons administering naloxone should select the route based on formulation available, skills in administration, setting and local context

In suspected opioid overdose, first-responders should focus on maintaining an airway, assisting ventilation and giving naloxone

After successful resuscitation following administration of naloxone, the affected person’s level of consciousness and breathing should be closely observed – where possible, until the person has fully recovered.

HIV post-exposure prophylaxis should be considered for people presenting within 72 hours of a sexual assault. Use shared decision-making with the survivor to determine whether HIV post-exposure prophylaxis is appropriate

ART should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Individuals with HIV and active TB disease

ART should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Individuals coinfected with HIV and hepatitis B virus (HBV) with evidence of severe chronic liver disease

ART should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Partners with HIV in serodiscordant couples should be offered ART to reduce HIV transmission to uninfected partners

Community-based HIV testing and counselling for key populations, with linkage to prevention, care and treatment services, is recommended, in addition to provider-initiated testing and counselling

As a priority ART should be initiated in all individuals with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4 counts of ≤350 cells/mm3

All pregnant and breastfeeding women living with HIV should initiate triple antiretrovirals (ARV), which should be maintained at least for the duration of risk of mother-to-child transmission. Women meeting treatment eligibility criteria should continue ART for life (CD4 <500 cells/mm3)

People from key populations with HIV and HBV coinfection who have severe chronic liver disease should be offered ART with a tenofovir (TDF) and lamivudine (3TC) (or emtricitabine (FTC))-based regimen irrespective of CD4 count or WHO clinical stage

HCV serology testing should be offered to individuals from populations with high HCV prevalence or who have a personal history of HCV risk exposure/behaviour

An alcohol intake assessment is recommended for all persons with HCV infection, followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake

Assessment for antiviral treatment of all adults and children with chronic HCV infection is recommended, including for people who inject drugs

Periodic screening of people from key populations for asymptomatic sexually transmitted infections (STIs) is recommended

Oral PrEP (containing tenofovir disoproxil fumarate (TDF)) should be offered as an additional prevention choice for key populations at substantial risk of HIV infection as part of combination prevention approaches

We suggest offering periodic presumptive treatment (PPT) for asymptomatic sexually transmitted infections (STIs) to female sex workers in settings with high prevalence and limited clinical services

Programmes should implement a package of interventions to enhance community empowerment among sex workers

In generalized epidemic settings ART should be initiated and maintained in eligible pregnant and postpartum women and in infants at maternal, newborn and child health-care settings, with linkage and referral to ongoing HIV care and ART where appropriate

In settings with a high HIV prevalence (≥5%) among TB patients, ART should be initiated for HIV-positive individuals with TB in TB treatment settings, with linkage to ongoing HIV care and ART

In settings with a high burden of HIV and TB, TB treatment should be provided for individuals with HIV in HIV care settings where TB diagnosis has also been made

In settings where opioid substitution therapy is provided, ART should be initiated and maintained in people with HIV who are eligible for ART

Initiation of ART in hospitals, with maintenance of ART in peripheral health facilities

Initiation of ART and maintenance of ART in peripheral health facilities

Initiation of ART at peripheral health facilities, with maintenance at the community level between regular clinic visits (i.e. outside of health facilities, in settings such as outreach sites, health posts, home-based services or community-based organizations)

Trained non-physician clinicians, midwives and nurses can initiate first-line ART

Trained non-physician clinicians, midwives and nurses can maintain ART

Trained and supervised community health workers can dispense ART between regular clinical visits (strong recommendation, moderate quality of evidence)

In all HIV epidemic settings, WHO recommends community-based HIV testing and counselling with linkage to prevention, care and treatment services for key populations in addition to provider-initiated testing and counselling

Community-based approaches can improve treatment adherence and retention in care of adolescents living with HIV