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Consolidated guidelines on the use of antiretroviral drugs for treating and preventing hiv infection
6. Th e continuum of care: linking people diagnosed with HIV infection to HIV care and treatment 6.1 Introduction It is critical for people living with HIV to enrol in care as early as possible. This enables both early assessment of their eligibility for ART and timely initiation of ART as well as access to interventions to prevent the further transmission of HIV, prevent other infections and comorbidities and thereby to minimize loss to follow-up. The 2012 WHO strategic HIV testing and counselling programme framework (1) especially emphasizes the importance of ensuring linkage between HIV testing and counselling programmes and prevention, treatment, care and support services.
6.2 Good practices for linkage to care Interventions to improve linkage to care need to be more rigorously evaluated. However, several systematic reviews and observational studies suggest that several good practices can improve linkage to care (2–4). These include integrating HIV testing and counselling and care services; providing on-site or immediate CD4 testing with same-day results; assisting with transport if the ART site is far from the HIV testing and counselling site; involving community outreach workers to identify the people lost to follow-up; ensuring support from peers or expert patients; and using new technologies, such as mobile phone text messaging.
6.3 General care for people living with HIV Countries should establish a package of general HIV care interventions, in addition to ART, for people living with HIV to reduce HIV transmission, prevent illness and improve their quality of life. Not all people living with HIV are eligible for ART and, of those eligible, not all will be able to access ART immediately. Others may choose to defer ART to later. Enrolment in care provides an opportunity for close clinical and laboratory monitoring and early assessment of eligibility for ART and timely initiation, and aims to minimize loss to follow-up. Many care interventions are relevant across the full continuum of care, including HIV-exposed individuals and people living with HIV before initiating, and during ART. General care includes basic HIV prevention, promoting the health of people living with HIV and the screening, prophylaxis and management of HIV-related coinfections and comorbidities. WHO has produced summary guidance on general care and prevention interventions (5–7) , and in 2008, recommended a package of 13 prevention interventions for adults and adolescents living with HIV in resource-limited settings (5). These include (1) psychosocial counselling and support; (2) disclosure and partner notification; (3) co-trimoxazole prophylaxis; (4) TB counselling, screening and preventive therapy; (5) preventing common fungal infections; (6) preventing sexually transmitted infections and supporting reproductive health needs, including prevention of and screening for cervical cancer; (7) malaria (co-trimoxazole, bed-nets and preventing malaria among pregnant women); (8) selected vaccine-preventable diseases; (9) nutrition; (10) family planning; (11) PMTCT; (12) needle and syringe programmes for people