Tools and Guidelines

This is the third edition of the Guidelines for the Management of HIV Infection in Children in Myanmar. As in the second edition, published in 2007, this document is the result of a consultative approach. It is necessary to revise and update the previous guidelines to keep up with current changes in diagnosis and management of HIV infection in children.

These guidelines have been written to serve all medical personal treating patients with HIV in Myanmar. It is meant not only for the National AIDS-STD programme but also for local in international NGOs, hospital doctors, and general practitioners in the public and private sectors.

Guidelines have to be standardized and simplified as much as possible, while maintaining some flexibility, so that they may be used by the largest number of health personnel who do not need to be specialist to carry out Prevention of Mother-to-Child Transmission (PMTCT) treatment for the maximum benefit of a large number of pregnant women. The public health approach is a balance between the best proven strategy and what is feasible on a large scale in resource limited setting.

The checklists in this document are an important tool in ensuring greater safety and better quality medical care for women in prison, and are designed to assist a review of current policies and practices relating to women’s health in prisons. 

This document is a direct response to the urgent need to strengthen and expand HIV prevention for MSM and their partners and to improve MSM’s ability to access HIV care and treatment. It furthers PEPFAR’s renewed emphasis on matching interventions and investments with epidemiological trends and needs in order to improve impact. This guidance also builds upon and strengthens international efforts to encourage comprehensive HIV prevention programs for MSM in low- and middle-income countries.

In February 2008, the Secretary-General of the United Nations, Mr. Ban Ki-Moon, launched his Campaign "UNiTE to End Violence against Women", 2008-2015. Through the Campaign, the Secretary-General is spearheading the accelerated efforts of the United Nations system to address violence against women. This inventory gives an overview of past and ongoing activities on violence against women by the entities of the United Nations system, including those which will contribute to the achievement of the five key outcomes of the Secretary-General’s Campaign by 2015. It is compiled by the Division for the Advancement of Women, now part of UN Women, as a contribution to the work of the Task Force on violence against women of the Inter-Agency Network on Women and Gender Equality.

Pregnant women with STI can transmit the infection to their children, resulting in significant morbidity and mortality. Chlamydia trachomatis can cause neonatal pneumonitis and maternal endometritis. Neisseria gonorrhea can result in ophthalmia neonatorum, neonatal systemic infection, and maternal endometritis.

The main causes of death among children under 5 years of age are acute respiratory infection (17%) and diarrhoeal disease (16%), and children infected with human immunodeficiency virus (HIV) have greater morbidity and mortality related to these conditions (WHO, 2008). The World Health Organization (WHO) departments of Child and Adolescent Health and of HIV/AIDS reviewed the evidence on management of diarrhoea and pneumonia in HIV-infected children, because of the substantial effects of these conditions on morbidity and mortality, potential differences in etiological agents (and thus in recommended empirical regimens) from those for uninfected infants and children, potential changes in the susceptibility of pathogens to co-trimoxazole prophylaxis in these children, and the lack of specific recommendations for this high-risk group. These guidelines are part of a comprehensive set of normative documents being prepared by WHO for the prevention and treatment of common conditions affecting HIV-infected and -exposed infants and children.

The 2010 guidelines are developed to provide international standards, primarily for low- and middle income settings, in support of the global scale-up of more effective interventions aimed at preventing mother-to-child transmission of HIV (MTCT) in resource-limited settings. Once implemented, these recommendations could reduce the risk of MTCT to less than 5% (or even lower) in breastfeeding populations from a background risk of 35%, and to less than 2% in non-breastfeeding populations from a background risk of 25%, and will ensure increased maternal and child survival. The 2010 revision of the WHO guidelines on prevention of mother-to-child transmission of HIV (PMTCT) complies with the recently updated WHO guidelines development process, which requires systematic review of new evidence for key questions and recommendations, as well as a consideration of programme feasibility and the cost implications of potential new recommendations. WHO has simultaneously revised guidelines for adult ART as well as HIV and infant feeding. All three sets of guidelines were updated in a harmonized fashion.

Since the publication in 2006 of Antiretroviral therapy for HIV infection in adults and adolescents: Recommendations for a public health approach, new evidence has emerged on when to initiate ART, optimal ART regimens, the management of HIV coinfection with tuberculosis and chronic viral hepatitis and the management of ART failure. This evidence formed the basis for the recommendations contained in the 2010 update, which outlines a public health approach to the delivery of ART for adults and adolescents in settings with limited health systems capacity and resources. The recommendations were based on the preparation GRADE evidence profiles, systematic and targeted reviews, risk-benefit analyses, consultations with PLHIV, technical reports, and assessments of impact, feasibility and cost. This guideline revision was conducted in accordance with procedures outlined by the WHO Guidelines Review Committee and is based on the GRADE approach to evidence review. The process involved four separate working groups: the Internal WHO ART Guideline Working Group, the ART Guideline Drafting Group, the external ART Peer Review Panel and the full ART Guideline Review Committee.