Key Adherence Messages (DPOC SOP, 2023) and Summary of 1st Line ART Regimens

Key Adherence Messages

Summary of ART Regimens for Adolescent Girls (10-19 years) and Adult Woman Initiating ART

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KEY ADHERENCE MESSAGES (DIFFERENTIATED MODELS OF CARE STANDARD OPERATING PROCEDURES, 2023)¹¹ 

Step 1 Education about HIV - What does HIV do to your body? - How taking ART can help you? - The importance of VL suppressions for mother and baby. - Risks of poor adherence. - Side-effects of ART.

Step 2 Identify Life Goals - What are the things that make you want to stay healthy and alive?

Step 3 Identify Support Systems - Who could support you in taking your treatment? - Would you agree to have a CHW visit you at home?

Step 4 Coming to your appointments - What will you do if something prevents you from coming to your appointment (such as no money for transport, raining when you usually walk, taxi strike or a sick child, or any other reason)? - Go to the clinic as soon as possible if you do miss an appointment or run out of ART - Always take your medication with you to your clinic appointments to enable the HCW to better assist you

Step 5 Assess readiness to start ART - Do you feel ready to start treatment as soon as possible? If not, stay supportive. Invite client to express their beliefs or concerns. Correct misconceptions (avoiding judgments).

Step 6 Medication schedule - According to your schedule, what would be the best time for you to take your treatment?

Step 7 Reminders - What could you use to remind you to take your medication? (e.g. alarm, someone to remind them, when “Generations” is starting on TV, etc.)

Step 8 Missed Doses - What will you do if you miss a dose? Advise them to take the treatment as soon as they remember

Step 9 Storing your medication and extra doses - Do you worry about people seeing or stealing your treatment? - Which safe place could you identify to store your treatment? Check that it is outside the reach of children. - In case you don’t have access to your treatment at the time you are supposed to take it, how can you always carry 1 or 2 doses with you?

Step 10 Managing Side-effects - Side-effects such as dizziness, nausea, headache or diarrhea can happen when starting treatment. Most side-effects go away after a few weeks. If you vomit up to one hour after taking the medication, take your treatment again. Severe side-effects are rare. If you don’t feel well, it is important you don’t stop your treatment and come to the clinic.

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Do not turn away an ART client who reports to have run out of treatment and presents without a transfer letter!

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SUMMARY OF ART REGIMENS FOR ADOLESCENT GIRLS (10 – 19 YEARS) AND ADULT WOMAN INITIATING ART

Any WOCP with normal renal function, with or without TB,	Weight ≥ 30 kg	TDF 300 mg, 3TC 300 mg, DTG 50 mg (TLD) as a single fixed dose combination tablet taken once daily
	Weight < 30 kg	Replace TDF with Abacavir 300mg bd (or 600mg once daily)
	DTG requires boosting with TB treatment to 50 mg twice daily. This will require one standard fixed dose combination tablet of TLD to be taken at the normal time, and an additional single tablet of DTG 50 mg to be taken 12 hours later.
Abnormal renal function	Tenofovir (TDF) is contraindicated	Replace TDF with Abacavir 300mg bd (or 600mg once daily)
Known HIV positive women, who are not currently on ART, but are ART-exposed (e.g. previous VTP, or previous LTFU on ART)	Weight ≥ 30 kg	TDF 300 mg, 3TC 300 mg, DTG 50 mg (TLD) as a single fixed dose combination tablet taken once daily
	Weight < 30 kg	Replace TDF with Abacavir 300mg bd (or 600mg once daily)
For further information see the 2023 ART Clinical Guideline

 

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Click here for the pdf.

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South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023