These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
he starting point for this guideline is the point at which a woman has learnt that she is living with HIV and it therefore covers key issues for providing comprehensive sexual and reproductive health and rights-related services and support for women living with HIV. As women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities as well as from the health-care institutions where they seek care particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes. This guideline is meant to help countries to more effectively and efficiently plan develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address to achieve gender equality and support human rights.
The purpose of this document is to provide guidance to national AIDS programmes and partners on the use of indicators to measure and report on the country response. The 2016 United Nations Political Declaration on Ending AIDS, adopted at the United Nations General Assembly High-Level Meeting on AIDS in June 2016, mandated UNAIDS to support countries in reporting on the commitments in the Political Declaration. The Political Declaration on Ending AIDS built on three previous political declarations: the 2001 Declaration of Commitment on HIV/AIDS, the 2006 Political Declaration on HIV/AIDS and the 2011 Political Declaration on HIV and AIDS.
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.
The WHO consolidated guidelines on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease is an updated and consolidated summary of WHO recommendations on systematic screening for tuberculosis (TB) disease, containing 17 recommendations for populations in which TB screening should be conducted and tools to be used for TB screening. TB screening is strongly recommendations for household and close contacts of individuals with TB, people living with HIV, miners exposed to silica dust, and prisoners. In addition, screening is conditionally recommended for people with risk factors for TB attending health care, and for communities with risk factors for TB and limited access to care (e.g. homeless, urban poor, refugees, migrants). General population screening is recommended in high-burden settings (0.5% prevalence or higher). Symptoms, chest radiography (CXR), and molecular WHO-recommended rapid diagnostic tests for TB are recommended as screening tools for all adults eligible for screening. Computer-aided detection programmes are recommended as alternatives to human interpretation of CXR in settings where trained personnel are scarce. For people living with HIV, C-reactive protein is also a good screening tool. This guideline document is accompanied by an operational handbook, the WHO operational handbook on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease, that presents principles of screening, steps in planning and implementing a screening programme, and algorithm options for screening different populations.
BACKGROUND: Latent tuberculosis infection (LTBI), defined as a state of persistent immune response to prior-acquired Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB, affects about one-third of the world's population. Approximately 10% of people with LTBI will develop active TB disease in their lifetime, with the majority developing it within the first five years after initial infection. Currently available treatments have an efficacy ranging from 60% to 90%. Systematic testing and treatment of LTBI in at-risk populations is a critical component of WHO's eight-point framework adapted from the End TB Strategy to target pre-elimination and, ultimately, elimination in low incidence countries. OVERVIEW: Recognizing the importance of expanding the response to LTBI, in 2014 WHO developed Guidelines on the Management of Latent Tuberculosis Infection. The guidelines are primarily targeted at high-income or upper middle-income countries with an estimated TB incidence rate of less than 100 per 100 000 population, because they are most likely to benefit from it due to their current TB epidemiology and resource availability. The overall objective of the guidelines is to provide public health approach guidance on evidence-based practices for testing, treating and managing LTBI in individuals with the highest risk of progression to active disease. Specific objectives include identifying and prioritizing at-risk population groups for targeted intervention of LTBI testing and treatment, including defining an algorithm, and recommending specific treatment options. The guidelines are expected to provide the basis and rationale for the development of national guidelines for LTBI management based on available resources, epidemiology of TB including intensity of transmission, the health-care delivery system of the country, and other national and local determinants.
These consolidated guidelines are aimed at supporting the generation of responsive person-centred data from routine national health management information systems across the HIV cascade, from prevention, testing and treatment to longer-term health care. They build upon the 2017 Consolidated guidelines on person-centred HIV patient monitoring and case surveillance, which describe information that should be collected in primary HIV patient monitoring tools, and the 2020 Consolidated HIV strategic information guidelines, which cover aggregate indicators for managing and monitoring programmes. The purpose of this guideline consolidation is to provide the recommended data elements, indicators and guidance on data systems and their use across the spectrum of health sector HIV services in one place. This document focuses on strengthening the analysis and use of routine data at each stage of the cascade and emphasizes?/addresses? person-centred HIV prevention, testing and treatment, integration of HIV-related infections, the use of routine surveillance data to measure impact, and the development and use of digital health data systems and their governance. It also identifies the gaps and limitations in these data, and the need for strengthening the use of data in all HIV-related strategic information, including population-based surveys, modelling, community-led monitoring and other sources.
To ensure that countries can effectively benefit from digital health investments, “digital adaptation kits” (DAKs) are designed to facilitate the accurate reflection of WHO’s clinical, public health and data use guidelines in the digital systems that countries are adopting. DAKs are operational, software-neutral, standardized documentations that distil clinical, public health and data use guidance into a format that can be transparently incorporated into digital systems. For this particular DAK, the operational requirements are based on systems that provide the functionalities of digital tracking and decision support (DTDS) and include components such as personas, workflows, core data elements, decision-support algorithms, scheduling logic and reporting indicators. Web annexes provide certain components in additional detail including: data dictionary (Web Annex A), decision-support logic (Web Annex B), indicator definitions (Web Annex C), and functional and non-functional requirements (Web Annex D). Data elements within the DAK (Web Annex A) are mapped to standards-based terminology, such as the International Classification of Diseases (ICD), to facilitate interoperability. This DAK focuses on providing the content requirements for a DTDS system for HIV care used by health workers in primary health care settings. It also includes cross- cutting elements focused on the client, such as self-care interventions.
Addressing comorbidities and risk factors for tuberculosis (TB) is a crucial component of the World Health Organization (WHO)’s End TB Strategy. These consolidated guidelines on tuberculosis. Module 6: tuberculosis and comorbidities summarize the latest WHO recommendations on TB and key comorbidities. It is a living document and will include a separate section for each of the key TB comorbidities or health-related risk factors. This first edition focuses on interventions to address HIV-associated TB and is an update of the WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders. People with HIV are 12–16 times more likely to develop TB disease, have poorer TB treatment outcomes and have three-fold higher mortality during TB treatment compared to people without HIV. Despite advances in the screening, diagnosis, treatment and prevention of TB disease, TB remains the leading cause of death among people with HIV worldwide. These consolidated guidelines are intended for use by people working in ministries of health, particularly TB programmes and the relevant departments or programmes responsible for comorbidities and health-related risk factors for TB, as well as programmes addressing mental health and lung health, implementing partners including technical and funding agencies, civil society and representatives of affected communities, clinicians and public health practitioners.
