Summary of the Care Continuum for Clients 5 years of age and older on ART
Clients on ART can be differentiated into those who are: Clinically well and adherent on ART and Those who are clinically non-stable and/or struggling with adherence. Clients that are clinically well at their first clinical review one month after starting ART, only need to be seen again 2 months later for clinical review and their first viral load and serum creatinine. After that, taking treatmen
Clients on ART can be differentiated into those who are:
- Clinically well and adherent on ART and
- Those who are clinically non-stable and/or struggling with adherence.
Clients that are clinically well at their first clinical review one month after starting ART, only need to be seen again 2 months later for clinical review and their first viral load and serum creatinine. After that, taking treatment and clinical follow-up should be made as convenient as possible for the client. Therefore, they may continue to receive ART using a differentiated care approach, provided they meet the eligibility criteria of
- Having a suppressed VL,
- Being clinically well with no opportunistic infections (OIs),
- Not having any other uncontrolled chronic conditions that require clinical review more frequently than 6-monthly, and
- Not being pregnant.
The diagram Visit Schedule for Adults, Adolescents and Children 5 Years and Older on ART provides a summary of the components of care at different visits for clinically well and adherent clients during the first year on ART.
Clients who are enrolled in repeat prescription collection strategies (RPCs) should be rescripted for RPCs at their comprehensive clinical review at which a further VL will be taken.
Clients should not be required to come back the following month for VL result review prior to rescript. Rather, recall to the facility only those clients with elevated VL. For more detail on repeat prescription strategies (RPCs), see the DMOC standard operating procedure (SOP) 5 (facility-pick-up points, adherence clubs and external pick-up points).
If a patient comes from a different facility, it is critical that the patient be provided with treatment on the day of presentation to limit any further treatment interruption and its impact on viral suppression. While referral letters are helpful, a patient cannot be required to leave the facility without treatment to first obtain a referral/transfer letter.
Women with contraceptive needs should have contraceptive method options explained, specifically how each method impacts all required return visits' location (facility or outside of the facility) and visit frequency:
- Long-acting reversible contraception (LARC) removes any increased visit frequency or alignment concerns.
- The combined oral contraceptive pill (COCP) can be repeated 3-monthly, aligns well with ART and well-baby visit schedules (if applicable), and can be scripted through her preferred RPCs.
- The DMPA 3-monthly injection must be administered by a clinician but aligns with ART and well-baby visit schedules.
- The NET-EN 2-monthly injection also needs to be administered by a clinician, but will require additional visits by the mother.
- Where a woman chooses to continue clinician administered short-acting injectable contraception (e.g., DMPA or NET-EN), a facility-based pick-up point (FAC-PUP) or facility-based adherence club may be the preferred option provided visit alignment can be ensured.
See also Visit Schedule for Integrated Care for Clients on ART and Drug-Sensitive TB Treatment and Visit Schedule for Integrated Care for the Mother-baby Pair Living with HIV
Click here to open the above content in the original PDF view
2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates
June 2023 Version 4
Upload date: 31/07/2023