Tools and Guidelines

The People Living with HIV Stigma Index conducted by the Cambodian Network of People living with HIV (2010) and a study conducted by the Asia Pacific Network of People Living with HIV (2012) revealed that people living with and affected by HIV experience discrimination in their daily lives, including denial of access to health services such as sexual and reproductive health services and dental care, and breach of confidentiality by health care providers. A recent study supported by Asia Catalyst has confirmed these practices continue even today. This training manual, titled Positive Protection: Empowering People Affected by HIV to Protect their Rights at Health Care Settings, will contribute to meeting the SDGs by empowering people affected by HIV in Cambodia with the information, skills and strategies they need, in order to ensure that their rights are respected when they seek health care services and to have access to legal redress in the event of rights violations and to work collectively to identify and propose solutions to systemic issues.

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. Implementing all the recommendations in these guidelines at the national and global levels will have important implications for programme priority-setting, funding and service delivery. As in 2013, operational guidance is included to help countries as they work to implement new approaches and strengthen the treatment cascade. These guidelines include 10 new recommendations to improve the quality and efficiency of services to people living with HIV. Implementation of the recommendation on universal eligibility for ART will mean that more people will start ART earlier. Importantly, in this guidance WHO emphasizes the need for differentiated approaches to care for people who are stable on ART, such as reducing the frequency of clinic visits and community ART distribution. Such efficiencies are essential if countries with a high burden of HIV infection are to manage their growing numbers of people receiving ART and reduce the burden on people receiving treatment and health facilities.

The guidelines contained in this document are intended to delineate the processes to be followed for prevention and management of TB in people living with HIV (PLHIV) at antiretroviral therapy (ART) centres. These guidelines describe the operational processes at ART centres for provision of single window services to PLHIV. The services include TB screening with 4S complex, referral for diagnosis of TB to DMC/CBNAAT, provision of daily anti-tubercular treatment (ATT), and initiation of Isoniazid Preventive Therapy (IPT) for TB prevention. The guidelines also describe the coordination required between NACP (ART centres) and RNTCP and provide direction to the managerial staff for smooth implementation of these initiatives. The guidelines serve as a ready reckoner on prevention and management of TB in PLHIV for healthcare providers at the ART centre.

Research is an integral part of the public health response – not only to learn about the current epidemic but also to build an evidence base for future epidemics. Research during an epidemic ranges from epidemiological and socio‑behavioral to clinical trials and toxicity studies, all of which are crucial. The importance given to communication during an infectious disease outbreak can make or break public health efforts, and WHO takes this very seriously. This document outlines the ethical principles that should guide communication planning and implementation at every level from frontline workers to policy‑makers.

Tuberculosis (TB) is a preventable and curable disease, but 1 million children suffer from TB and 210,000 children die of the disease worldwide in 2015. TB is a major challenge to public health in Myanmar. It is, in a sense, a ubiquitous disease, affecting all sections of the society and all age groups. It is, therefore, important to ensure equitable access to care of international standards for all children with TB. This guideline was first developed in 2007 but further updated in 2012 and 2016 to ensure the use of the latest evidence-based international recommendations on childhood TB. The guidelines will fill the gaps in a systematic approach to TB in children and will help to achieve an internationally recommended standard of care at all levels of the health system in Myanmar.

These new guidelines aim to reduce morbidity and mortality related to TB and HIV-associated TB among people who inject drugs (PWID) through the integrated delivery of a comprehensive and holistic package of care. The guidelines provide an update to the 2008 Policy guidelines for collaborative TB and HIV services for injecting and other drug users: an integrated approach, and consolidate the latest recommendations relating to the management of TB, HIV-associated TB, HIV, viral hepatitis B and hepatitis C, and drug dependence. Although the main focus of this guidance is to benefit PWID, many of the recommendations are also relevant for those who use drugs and do not currently inject, but are in need of the respective services. 

Sexual violence against children and adolescents is universally condemned but occurs much more frequently than people realize. It is a global human rights violation of vast proportions, with severe immediate and long-term health and social consequences. This document serves as a companion guide to the 2012 Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs which provides step-by-step guidance on the appropriate clinical/forensic care for children and adolescents who have experienced sexual violence and exploitation. The companion guide provides a basic framework, examples, resources, and contact information for health providers and managers to better understand and facilitate linkages with critical social and community services for comprehensive care of children and adolescents who have experienced sexual violence and exploitation beyond the clinical exam, take additional steps to help children and adolescents receive the information and support their needs, contribute to changes in sociocultural norms that perpetuate a culture of violence and silence that can also increase HIV risk and vulnerability.

This document provides a review of key issues related to intellectual property policies and their potential impact on access to HIV and other medicines. It is intended as an introduction to the issues for civil society engaged in the response to HIV and other health concerns. By the end of 2015, almost 16 million people living with HIV were accessing antiretroviral therapy. The world would never have reached this historic achievement had it not been for the dramatic decline in the price of antiretroviral medicines over the past two decades—from just over US$ 10 000 per patient per year in the late 1990s to around US$ 100 per patient per year in many sub-Saharan countries in 2015. This drop in price was the result of sustained advocacy on the part of countries and communities affected by HIV to increase the availability of quality-assured generic antiretroviral medicines, in part by addressing intellectual property rights (IPR) issues.

Positive Health, Dignity and Prevention for Women and their Babies: A treatment literacy guide for pregnant women and mothers living with HIV is intended for use by networks of women living with HIV, women’s groups, peer educators and others wishing to provide information and guidance to support women living with HIV through the decisions they will need to make before, during and after their pregnancy.  The facilitator’s manual and flipchart are intended to be used by leaders of support groups, peer educators or lay counsellors to facilitate small groups or community sessions with women living with HIV. Together, they provide accurate and comprehensive information to enable pregnant women and mothers living with HIV to know their rights and make informed decisions about their health, and the health of their baby.

Based on privacy, confidentiality and security principles an Assessment Tool was developed to assess in country the extent that the confidentiality and security of personal health information is protected at facility and data warehouse/repository levels and whether national guidelines exist including privacy laws. A Manual on the use of the Assessment Tool has been produced and is available below. A Working document, based on the Assessment Tool has been developed that can be downloaded and used to perform the actual assessments.