HIV Care & Treatment
The goal of HIV care and treatment is to restore the immune system, reduce HIV and AIDS related morbidity and mortality, improve quality of life, decrease viral load and, reduce HIV transmission to partners of key population clients. HIV-positive key population clients must have access to HIV care and treatment in line with national guidelines.
Elements of HIV Care and Treatment: Key populations should have access to a core package of HIV care and treatment services, which includes assessments for staging and CD4 count, antiretroviral treatment for those eligible (based on WHO staging), management of opportunistic infections (OIs), prevention with positive interventions, palliative care and home-based care.
Aligned to WHO Guidelines (2011), areas for intervention of particular importance for key populations living with HIV are as follows
- Psychosocial counselling and support
- Disclosure, partner notification, and testing and counselling
- Cotrimoxazole prophylaxis for opportunistic infections
- Tuberculosis prophylaxis
- Prevention of fungal infections
- Prevention of sexually transmitted and other reproductive tract infections
- Prevention of malaria
- Vaccination for selected vaccine-preventable diseases (hepatitis B, pneumococcal, influenza and yellow fever vaccines)
- Family planning
- Preventing mother-to-child transmission of HIV
- NSPs and OST
- Water, sanitation and hygiene.
After initiation of ART, the utility of many of these interventions will not decrease and should be maintained throughout treatment. A follow up mechanism should be developed to ensure that the drop-out rate is minimized while maintaining principles of confidentiality.
Special Considerations for HIV Care and Treatment with Key Populations
- Ensure accessible services: To increase HIV care and treatment access by key populations, it may be beneficial to modify comprehensive care centres working hours to flexibly accommodate key population clients varied schedules, train service providers on delivering “key population friendly” services, and create demand for the services through targeted outreach.
- Ensure uninterrupted supply of ART and/or OI prophylaxis: Key population clients are highly mobile and move within and between Counties. Due to this high mobility, they may need to be provided with ARV supplies that cover longer periods of time or link to other clinics offering ARVs to ensure an uninterrupted supply of drugs.
- Tailored “prevention with positive” interventions: Prevention with positive interventions are designed to reduce HIV transmission between sex partners and increase the well-being of the person living with HIV. For key populations, positive prevention interventions may need to be modified to accommodate various key population parameters e.g. the primary source of income for sex workers is the exchange of sex for money, as such, they may not be able or willing to leave sex work. It therefore follows that tailored risk reduction counselling for HIV-positive sex workers will be a crucial component of positive prevention and should focus on reducing risk of HIV transmission through:
- Skills building for consistent and correct male and female condom and latex-compatible lubricant use
- Uninterrupted supply of condoms and lubricants
- Encourage 100% condom use with all sex partners
- Risk assessment and risk reduction counselling to reduce the number of sex partners (although this may be difficult for those in the sex trade) and other HIV risk behaviours (i.e. unprotected sex, sharing of drug injecting paraphernalia)
- Provision of services to expand choices beyond sex work. HIV positive sex workers suffer dual stigma of being HIV positive and a sex worker. Tailored psychosocial individual or group support may be warranted to address these issues.
- Screening and treatment for alcohol and drug abuse: Key populations often experience multiple and cross cutting levels of risk e.g. drug and alcohol abuse over and above their primary vulnerabilities. Alcohol and drug use interferes with adherence to ARVs and some illicit drugs are known to result in adverse reactions when combined with ARVs. Therefore service providers should screen key population clients for alcohol and drug abuse
Quarterly STI Screening: HIV-positive key population clients should be syndromically screened for STIs at least quarterly and provided with treatment. Quarterly screening provides an opportunity to detect and treat anal, oral, and genital STIs early, deliver risk reduction counselling and increase access to condoms and lubricants.