Bibliographic Info
GuidelineUpdated recommendations on service delivery for the treatment and care of people living with HIV
Year of Publication2021
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended in favor
Conditional
Certainty of evidence
Low
ART initiation may be offered outside the health facility
Notes and Remarks
- 1.WHO guidelines recommend a readiness assessment at ART start, including ART literacy, and a clinical assessment that includes CD4 cell count, to determine whether a person has advanced HIV disease and requires further diagnostic investigation and provision of prophylaxis (15). WHO further recommends that nurses be able to initiate ART (3), and this should be facilitated by supportive professional regulations.
- 2.Clients starting ART outside a health facility should be linked to a facility and enrolled in a long-term model of care. ART start should also be accompanied by appropriate counselling to ensure that individuals understand the importance of lifelong adherence and receive appropriate support. For those who are not ready to start, referral to care should be provided. Initiating ART outside a health facility needs to be accompanied by appropriate measures to ensure that risk assessment and counselling support are provided, including at the time of initiation and in the period thereafter.
- 3.This recommendation applies to all people living with HIV, including children and adolescents. However, there is very limited experience with ART initiation outside the facility for infants and young children; antiretroviral drug formulations, especially those for infants and younger children, may require additional practical advice on administration techniques and/or on storage conditions. Community health-care providers should be trained and provided with the tools to deliver effective counselling to caregivers to support and oversee appropriate administration (83). Additionally, it is important to ensure that adolescents are linked to psychosocial care and that children and parents are supported with disclosure and ageappropriate treatment literacy in the context of a holistic approach to family-based care.
- 4.Implementation of community ART initiation should consider health system requirements for supporting ART delivery at the community levels, including drug supply chain, laboratory services, training and supervising health personnel, providing preventive therapy and referral mechanisms for those who need higher-level care. Such adaptations may require a phased approach (for example, by starting implementation in settings in which community prevention and testing activities have been established). The provision of community HIV care should be included in national initiatives to ensure the quality of care.