Task Shifting - Global Recommendations and Guidelines - unaids

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Annex 1 After decision for initiation of TB treatment, provide TB/ART cotreatment to patients other than sputum-positive pulmonary TB patients X X Monitor TB treatment response X X X Provide combined TB/ART directly observed treatment (DOT) if necessary Recognize side-effects of TB and/or HIV medications and encourage/ assist consultation or clinic visit when necessary X X X X X X X X Identify a patient with symptoms suspected for TB immune reconstitution inflammatory syndrome (IRIS) X X Manage suspected TB IRIS X X d. Manage Substitution or Switch of ARV Regimen MD NPC N CHW Switch to alternative first-line ARV regimens X X Switch to second-line ARV regimens X X e. Dispensing and Arranging Follow-Up MD NPC N CHW Dispense ARV and other drugs X X X X Arrange follow-up visit X X X X f. Supervision MD NPC N CHW Supervise NPCs, Ns and CHWs in the above activities X Supervise Ns and CHWs in the above activities X X Supervise CHWs in the above activities X X X 7. Long-Term Follow-Up (3 months after initiation of ART) a. Clinical Monitoring MD NPC N CHW Monitor and support ART adherence X X X X Take weight X X X X Take vital sings X X X X Determine functional status X X X X Request CD4 test and VL (if available and indicated) X X X Recognize/manage self-limiting ARV side-effects X X X X Manage headache and fever 10 months after initiation of d4T/3TC/ NVP Treat a patient on d4T/3TC/NVP with tingling in fingers and toes since 2 weeks X X X X X X Recommend another treatment for a patient on d4T/3TC/NVP with severe lipoatrophy or fat maldistribution Prescribe another treatment for a patient on d4T/3TC/NVP with severe and disturbing lipoatrophy or fat maldistribution X X X X Manage oral thrush 24 months after ART initiation (WHO clinical stage 4 at initiation) X X X Recognize treatment failure from clinical symptoms X X Manage rare severe toxicities associated with ART X Recognize/manage immune reconstitution syndrome X X 58
Annex 1 b. Manage TB Coinfection MD NPC N CHW Identify symptoms such as chronic cough and/or chronic fever and/ or weight loss as a TB suspect X X X Request sputum exam (Ziehl-Neelsen) for TB suspects X X X Request additional exams (such as X-ray) to establish the diagnosis of TB in TB suspects with negative sputum results Initiate TB/ART co-treatment with a first episode of pulmonary TB with positive sputum results X X X X X X Decide to initiate TB treatment for HIV+ patients with sputumnegative and/or extrapulmonary TB X X After decision for initiation of TB treatment, provide TB treatment to sputum-positive pulmonary TB patients with HIV After decision for initiation of TB treatment, provide TB treatment to patients other than sputum-positive pulmonary TB patients X X X X X X Monitor TB treatment response X X X Recognize side-effects of TB and/or HIV medications and encourage/ assist consultation or clinic visit when necessary Provide combined TB/ART DOT if necessary in a patient who is on ART > 3 months X X X X X X X X c. Manage Substitution or Switch of ARV Regimen MD NPC N CHW Switch to alternative first-line ARV regimens X X Switch to second-line ARV regimens Choose an appropriate third-line ARV regimen X X d. Dispensing and Arranging Follow-Up Visits MD NPC N CHW Dispense ARV and other drugs X X X X Arrange follow-up visits X X X X e. Supervision MD NPC N CHW Supervise NPCs, Ns and CHWs in the above activities X Supervise Ns and CHWs in the above activities X X Supervise CHWs in the above activities X X X 8. Clinical Management of HIV+ Pregnant Women a. Clinical Management of HIV, Including ART MD NPC N CHW Describe the benefits and risks of ART in the first trimester and throughout the rest of the pregnancy and general health principles for pregnant women X X X X Provide chronic HIV care X X X Establish eligibility for ART X X X Explain when to start ART; adherence and monitoring; management of mild side-effects When the pregnant woman is medically eligible for ART, prescribe a non-teratogenic ART When a woman on ART becomes pregnant, know when to substitute for efavirenz (first trimester) X X X X X X X X X X 59
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treat train retain HIV/AIDS Task Sh
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treat train retain HIV/AIDS Task Sh
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Contents Preface...................
Page 7 and 8:
summary of recommendations Summary
Page 9 and 10:
Summary of recommendations E. Recom
Page 11 and 12: ackground The plan is an important
Page 13 and 14: scope Scope These recommendations a
Page 15 and 16: summary of methods Summary of Metho
Page 17 and 18: summary of methods A total of 167 e
Page 19 and 20: Recommendations on adopting task sh
Page 25 and 26: Recommendations on creating an enab
Page 27 and 28: Recommendations on creating an enab
Page 29 and 30: Recommendations on ensuring quality
Page 39 and 40: Recommendations on ensuring sustain
Page 41 and 42: Recommendations on ensuring sustain
Page 43 and 44: Recommendations on the organization
Page 55 and 56: Annex 1 Annex 1 HIV clinical tasks
Page 57 and 58: Annex 1 Manage STIs X X X Assess fa
Page 59 and 60: Annex 1 Provide co-trimoxazole prop
Page 61: Annex 1 e. Supervision MD NPC N CHW
Page 65 and 66: Annex 1 Provide supportive care to
Page 67 and 68: Annex 1 Counsel on special nutritio
Page 69 and 70: ANNEX 2 1 WHO. The World Health Rep
Page 71 and 72: ANNEX 2 94 Akakpo M. Processus d’
Page 73 and 74: ANNEX 2 180 Ensor T, Savelyeva L. I
Page 75 and 76: ANNEX 3 shifting approach for the d
Page 77 and 78: ANNEX 3 The country studies were de
Page 79 and 80: annex 3 Additional information A to
Page 81 and 82: annex 4 Learning by doing Above all
Page 83 and 84: annex 6 Annex 6 Definitions Accredi
Page 85 and 86: annex 6 Registration Official recor
Page 87 and 88: annex 7 Dr Kevin De Cock, Director,
Page 89: annex 7 Dr Adele Webb, Executive Di
Page 92: Health Systems and Services (HSS) W
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Task Shifting - Global Recommendations and Guidelines - unaids

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