Nepal

Figure 8.2 Availability of HIV/AIDS care and support services (N=963)
76
45
45
10
5
2
5
Zonal and
above hospitals
District-level
hospitals
Private
hospitals
PHCCs HPs Stand-alone
HTCs
National
average
2015 NHFS
With respect to medicines, cotrimoxazole was found in a majority (76 percent) of the facilities that
offer HIV/AIDS care and support services. Condoms (93 percent) and first-line treatment for TB (67 percent)
were also widely available. An intravenous (IV) solution with infusion set was available in 61 percent of
facilities offering HIV/AIDS care and support services, and 39 percent had medications for pain management
available. A little less than one-half of facilities had fluconazole tablets or ointment.
8.4 ANTIRETROVIRAL THERAPY
Antiretroviral drugs inhibit the replication of HIV and thus can substantially prolong and improve
the quality of life of HIV-positive people. According to the national consolidated guidelines for treating and
preventing HIV in Nepal, adults, adolescents, and children older than age 5 with HIV are eligible for ART
only when their CD4 count is 500 cells/mm 3 or less. ART is recommended to be initiated regardless of CD4
count for people with HIV who have active TB or a hepatitis B virus infection coupled with severe chronic
liver disease, HIV-positive partners in sero-discordant couples, pregnant and breastfeeding women, and
children younger than age 5 (NCASC 2014). In Nepal, 11,922 people with HIV were estimated to be
receiving ART as of December 2015. Still, it is estimated that 37 percent of those linked to HIV care are yet
to initiate ART (NCASC 2016c).
The NCASC, together with partners, has embarked on improvements to the quality of ART
programs in Nepal. The national consolidated guidelines call for the prescription and provision of ART by
health personnel trained in clinical management of HIV. These personnel should regularly monitor the
condition of their clients to ensure that an effective ART regimen is being prescribed and that side effects
are properly managed.
Elements identified as important for providing good-quality ART services include the following:
Staff trained in the provision of relevant services
Protocols and guidelines for relevant care and support services
A consistent supply of ARVs and good storage practices to maintain their quality and security
A system for routine follow-up services
An individual client record to assure continuity of care for the client
HIV/AIDS and Sexually Transmitted Infections • 177