The elements or components should, amongst others, cover the following:
| 8.1 | HIV Policy development and implementation |
Respect for human rights is a non-negotiable principle of the NSP. Adherence to this principle also enhances the effectiveness of prevention and treatment. The NSP focuses on equal treatment for all, increased access to justice, and the reduction of stigma associated with HIV and TB.
| 8.1.1 | The policy should address, but not limited to: |
| (a) | Information, education and mass mobilisation. |
| (b) | Sexual transmitted infection detection and management. |
| (c) | Distribution of male and female condoms . |
| (i) | HCT campaigns should be held bi-annually (consider annually as minimum standards). |
| (ii) | The employer should ensure that voluntary HCT is offered to all employees at all health contact points. |
| (e) | Screening and referral for voluntary male medical circumcision. |
| (f) | Screening and referral for PrEP and PEP. |
| (g) | Strengthening of TB prevention through IPT roll-out in HIV positive individuals and those that are on ART. |
| (h) | Universal precautions for healthcare workers . |
| 8.2.2 | Treatment , care and support |
| (a) | Access to treatment , care and support . |
| (b) | Treatment should be instituted in line with the National HIV testing guidelines and test and treat policy. |
| (c) | The programme should serve to ensure HTS are integrated and linked effectively to all HIV prevention, treatment and care as well as other non-HIV health services (TB, NCDs) to reduce stigma and discrimination. |
| 8.2.3 | Clinical outcomes of people living with HIV |
| (a) | Provide 100% HIV counselling to all employees . |
| (b) | 90% of all people living with HIV will know their HIV status. |
| (c) | 90% of all people with an HIV diagnosis will receive sustained antiretroviral therapy . |
| (d) | 90% of all people receiving antiretroviral therapy will achieve viral suppression. |
| (e) | Ensure that 90% of confirmed HIV positive employees are linked to healthcare services and initiated on ART. |
| (f) | Laboratory confirmation of HIV positive screening test with ELISA 4th generation confirmation blood test. |
NOTE:
All employees should be inducted on HIV and encouraged to test.
Employees who consent to testing undergo voluntary counselling and testing for HIV.
Pre- and post-HIV test counselling must be performed for assisted or non-assisted screening testing done initially with a screening Abbots test or self-screening test.
An employee with a positive result must be referred to the clinic or General Practitioner for a laboratory confirmation test of HIV with an ELISA 4th generation test or as per the latest NDOH testing guidelines.
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| 8.2.4 | Achieve 90% viral suppression |
| (a) | Viral monitoring should be done at initiation of treatment. |
| (b) | Follow-up at 24 weeks to ensure compliance and adherence to treatment. |
| (c) | Follow-up at 52 weeks to ensure viral suppression . |
| (d) | Monitor achieved viral suppression annually . |
| 8.2.5 | CD4 count monitoring to assess immunological response to treatment |
| (a) | CD4 count should be done at initiation of treatment. |
| (b) | Follow-up at 24 weeks to ensure compliance to treatment. If on assessment of the CD4 count there is deterioration or a decrease in the CD4 count versus the initial count and the viral load remains undetectable <50copies , log <1.60 the employee must be referred to the clinic or General Practitioner to exclude the presence of opportunistic infections e.g. TB or lymphoma. |
| (c) | Monitor CD4 count annually to ensure immunological response to treatment. |
| 8.2.6 | Achieve a defaulter rate of less than 5% on ART |
| (a) | Promote treatment adherence through counselling , peer supporter programme, EAP, etc. |
| (b) | Ensure continuity of care of all employees through monitoring and treatment. |
| (c) | Implement an effective defaulter management mechanism (knowing the disease profile and collecting data on viral loads and CD4 counts). |
| (d) | Collect pertinent information or statistical data for evaluation purposes in readiness for completion of DMR 164 form and other required legislated forms . |
