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Technical Manuals and Guidelines

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This publication is intended to serve as a reference tool for countries with limited resources as they develop or revise national guidelines for the use of ART in adults and postpubertal adolescents (see Annex 9 for pubertal Tanner staging; prepubertal adolescents should follow the WHO paediatric guidelines). The material presented takes updated evidence into account, including new ART treatment options, and draws on the experience of established ART scaleup programmes.

This document offers basic operational guidance on HIV testing and counselling in settings attended by people who inject drugs (PWID). It is intended for a wide audience, including policy-makers, HIV/AIDS programme planners and coordinators, care providers, nongovernmental organizations (NGOs) providing services for HIV-related conditions, and civil society groups.

The guidelines primarily target national-level programme planners and managers responsible for designing services for PMTCT and provision of ART for women. It should also be a useful resource for health care workers involved in efforts to reduce HIV infection in infants and young children and to provide treatment and care for women living with HIV.

WHO guidelines for the use of ART in children were considered within the guidelines for adults published in 2004. Revised, stand-alone comprehensive guidelines based on a public health approach have been developed in order to support and facilitate the management and scale-up of ART in infants and children.

The present guidelines are part of WHO’s commitment to achieve universal access to ART by 2010. Related publications include the revised treatment guidelines for adults (i.e. the 2006 revision), revised guidelines on ARV drugs for treating pregnant women and preventing HIV infection in infants, guidelines on the use of co-trimoxazole preventive therapy (CPT), and revised WHO clinical staging for adults and children.

In high-income countries, co-trimoxazole prophylaxis among children (both those exposed to HIV and those living with HIV) and adults and adolescents living with HIV has been the standard of care for many years. WHO and UNAIDS have not produced guidelines for national programmes in resource-limited settings. In the absence of clear guidelines, countries and programmes have been slow in adopting co-trimoxazole prophylaxis, a lifesaving, simple and inexpensive intervention. The objective of these guidelines is to provide global technical and operational recommendations for the use of co-trimoxazole prophylaxis in HIV-exposed children, children living with HIV and adolescents and adults living with HIV in the context of scaling up HIV care in resource-limited settings.

There is an urgent need for affordable, safe, quality antiretroviral (ARV) formulations appropriate for paediatric use, particularly solid fixed dose combination (FDC) formulations to facilitate programme planning, improve adherence and accelerate the pace of ART scale up using simplified standardized treatment approaches as outlined in the public health approach of WHO. Pharmaceutical industry and regulatory authorities are requesting guidance on the range and characteristics of the required antiretroviral products, including on formulation strength for single antiretroviral products and proportions of active pharmaceutical ingredients for fixed dose combination (FDC) antiretroviral products. Recently a number of antiretroviral FDC products for paediatric use have been developed. The WHO paediatric antiretroviral working group (PAWG) initially constituted to develop dosing recommendations for the WHO Paediatric ART guidelines has since met to prioritize single and fixed dose antiretroviral formulations needed, and agree upon key research and pharmacovigilance activities that are urgently required. This is a summary report of the working group findings and recommendations from 2006-2007.

On the eve of World AIDS Day, the World Health Organization (WHO) is releasing new recommendations on treatment, prevention and infant feeding in the context of HIV, based on the latest scientific evidence.

WHO now recommends earlier initiation of antiretroviral therapy (ART) for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.

The HIV counselling resource package for the Asia-Pacific is a modular, three-part resource and training package tailored to the sociocultural and epidemic contexts of the Asia-Pacific region. While there are many HIV counselling resources, few focus on regional aspects of the epidemic. This package, developed in consultation with experts throughout the region, concentrates on meeting the specific needs of individuals from socially marginalized populations, who are often most at risk of HIV and other sexually transmitted infections. It outlines the key activities and information involved in training HIV counsellors and goes beyond simple pre- and post-test counselling. The package takes into account the heterogeneity of counsellor trainees and their wide-ranging background. The intended audience is made up of trainers, counsellors in training, and working counsellors, but the materials may also serve as a useful guide for medical staff and care providers, counselling professionals, community-based workers, and lay counsellors.

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