AEGiS-15IAC: WHO IMAI guidelines for ART and chronic HIV care in the context of primary health care.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

WHO IMAI guidelines for ART and chronic HIV care in the context of primary health care.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1314)

Gove S, Celletti F
World Health Organization, Geneva, Switzerland

ISSUES: Decentralization of ARV therapy (ART) and provision by non-doctors are essential to achieve the 3 by 5 target.

DESCRIPTION: WHO has coordinated the development of the Integrated Management of Adolescent and Adult Illness (IMAI) guidelines and training materials, based on a working group involving 22 WHO Departments and the African Regional Office, an international working group, and the 3 by 5 human capacity-building working group. These simplified and standardized guidelines support the delivery of ART within the context of primary health care, based at first-level health facilities or in district clinics. IMAI provides tools (guidelines and training courses) for rapid country adaptation and use to support efforts to achieve the 3 by 5 target. The modules cover chronic HIV care with ART, acute care, home-based palliative care, and general principles of good chronic care (to support the health system transition from acute to chronic care). Each module can be used alone or as an integrated package. Peripheral access to ART is supported by shifts of key tasks (including both clinical monitoring and initiation of a fixed-dose first-line ARV regimen in patients without complications) to nurses and other multi-purpose health workers. Preparing them to provide acute care for adults (based on a syndromic approach similar to IMCI) allows many common, less severe opportunistic infections to be treated and the patient stabilized for ART without referral. HIV care and prevention are integrated throughout. IMAI supports rapid expansion of human resources for HIV care; the addition of lay providers to the clinical team; and clinical capacity for effective management of other acute and chronic illnesses.

LESSONS LEARNED: An interim version of the IMAI guideline modules www.who.int/3by5/publications/documents/imai) was released on 1 Dec 2003. Results of country adaptation; fieldtesting of alternative, efficient training materials; and early use in the first 3 countries will be reported.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Primary Health Care, Guidelines, HIV Infections, Long-Term Care, Health Services, Research, Health, Referral and Consultation, Health Personnel, Delivery of Health Care, Adolescence, Adult, Humans, organization & administration, therapy

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