Tools and Guidelines

Significant obstacles remain to scaling up paediatric care, including limited screening for HIV, a lack of affordable, simple diagnostic testing technologies for children less than 18 months of age, a lack of human resources with the capacity to provide the care that is required, insufficient advocacy and understanding that ART is efficacious in children, limited experience with simplified, standardized treatment guidelines, and limited availability of affordable and practical paediatric ARV formulations. Health-care systems remain unable to meet the demands of national paediatric ART coverage. Consequently, far too few children have been started on ART in resource-limited settings. Moreover, the need to treat an increasing number of HIV-infected children highlights the primary importance of preventing transmission of the virus from mother to child in the first place. The WHO guidelines Antiretroviral therapy for HIV infection in infants and children are based on a public health approach to HIV care. Updated in 2010, these guidelines are harmonized with the treatment guidelines adopted for adults, pregnant women, and for prevention of mother- to- child transmission (PMTCT).  The present guidelines are part of WHO’s commitment to achieve universal access to the prevention, care and treatment of HIV infection in infants and children.

The purpose of the National Strategic and Action Plan (NSAP) 2011-2015 is to guide the national response of Lao PDR to HIV/AIDS. The review and revision of the NSAP was participatory, and this document reflects contributions from government, civil society, people living with HIV and development partners. The NSAP is aligned with the 7th National Socio Economic Development Plan (NSEDP) 2011-2015, and the 7th Health Sector Plan. The National AIDS Policy and the National HIV/AIDS Law have provided the guiding principles and overall strategic direction for the development of the NSAP 2011-2015. WHO six building blocks framework has been brought into consideration for situation and response analysis in order to integrate HIV interventions into health system strengthening for the next year plan (see annex 8). On the other hand, the NSAP is also one among several efforts of the government that contributes to the national poverty reduction programme.

Major progress in global tuberculosis (TB) control followed the widespread implementation of the DOTS strategy. The Stop TB Strategy, launched in 2006, builds upon and enhances the achievements of DOTS. New objectives include universal access to patient-centred treatment and protection of populations from TB/HIV and multidrug-resistant TB (MDR-TB). The Stop TB Strategy and the Global Plan to implement the new strategy make it necessary to revise the third edition of Treatment of tuberculosis: guidelines for national programmes, published in 2003.

These Guidelines for Addressing HIV in Humanitarian Settings aim to assist humanitarian and AIDS organizations to plan the delivery of a minimum set of HIV prevention, treatment, care and support services to people affected by humanitarian crises. These guidelines concentrate on the integration of HIV into the humanitarian response to crises, with a particular focus on two phases: the minimum initial response, which outlines a set of HIV-related interventions to be carried out during the early stages of any emergency regardless of the specific local or epidemiological context of the epidemic; and the expanded response, during which additional core HIV interventions should be planned and implemented as soon as possible, taking into account the local contexts and priorities, the epidemiological profiles and the capacity of different sectors to deliver the interventions. 

The Bhutanese concept of Gross National Happiness (GNH) is the foundation for development in Bhutan. GNH is based on the principle that happiness constitutes one of the highest of aims to strive for, and without which, sustainable development cannot be achieved. Included in GNH is a “middle path” approach in which spiritual and material pursuits are balanced. In the light of GNH, Bhutan also acknowledges the requirements and recommendations of the Global Fund to fight AIDS, Tuberculosis and Malaria (“the Global Fund”), concerning eligibility and accountability for grants from the Global Fund. The Country Coordinating Mechanism (“CCM”) was established as a national mechanism to represent key stakeholder constituencies for the three diseases in Bhutan, and in response to the requirements and recommendations of the Global Fund. As a national stakeholder coordination mechanism, the CCM has no legal foundation. The CCM seeks to establish legal authority for its activities by the end of 2012 in order to enhance eligibility for a wider range of funding sources.

A tool has been developed to support the completion of the WHO work planning and budgeting tool and the Pharmaceutical and Health Products List of the Global Fund proposal (the "Quantities Tool"). Currently this tool is only available for the HIV disease component. The primary objective of the quantities tool is to assist the user in calculating calculation of antiretroviral (ARV) drug quantities and unit costs. In addition, the quantities tool calculates the average unit cost for treatment per client for first- and second-line therapy for adults and paediatrics.

Gender-based violence against women has gained recognition under International law, in the jurisdictions of international courts and tribunals, in the Convention on the Elimination of Discrimination against Women (CEDAW) itself and under the Security Council's effort to broaden their approaches to peace and security. But an intertwined approach is still lacking and a concerted and coherent response from the UN system is needed.  All governments and legal authorities which fail to protect women and to discipline those found responsible for gender-based crimes are guilty of indemnity. Addressing this impunity raises the question of sexual violence, gender discrimination and patriarchal structures.

Considering the spread of HIV infection among women of the reproductive age, mother–to-child transmission has become a great concern in the area of HIV prevention and health services. The first mother-to-child transmission in Bhutan was reported in the year 2002. Seven cases have now been officially documented. This covers nearly 9% of the total HIV infection in Bhutan. It is inevitable that more pregnant women will be affected in the coming years.  Mother to-child transmission of HIV is the most significant source of HIV infection in children below age of 10 years. Transmission can occur during pregnancy, delivery and after delivery through breast milk. In the absence of appropriate interventions infected child are likely to survive infancy. The extent of HIV infection among pregnant women is often used as an indicator of HIV penetration into the population at large. The Royal Government has responded by adopting the prevention of mother to child transmission (PMTCT) as an integral part of the nation's response to the HIV/AIDS catastrophe. PMTCT will be a part of a wider response to HIV/AIDS, which includes expanding access to care and support for HIV infected mothers and their families, including treatment of opportunistic infections and accelerating access to treatment. PMTCT prevention should not stand in isolation, but it should be integrated to existing Health care infrastructures and Reproductive Health Services.

HIV stigma and discrimination adversely affect every aspect of life for people living with HIV and their families. In many settings, an HIV diagnosis still can be as devastating as the illness itself, leading to job loss, school expulsion, violence, social ostracism, loss of property, and denial of health services and emotional support. People living in fear are less likely to adopt preventive behavior, come in for testing, disclose their sero-status to others, access care and adhere to treatment. This user guide has been created for teams implementing the People Living with HIV Stigma Index in their communities. This user guide contains background information on the index and its intended purpose; an introduction to the questionnaire and the data gathering process; and practical guidance for training interviewers, ensuring the interview process is conducted in an ethical manner, and for effective data entry and analysis. The guide also includes tips for communicating the research findings and using them to advocate for the rights of people living with HIV.

The purpose of this operational tool is to raise awareness of how gender inequalities affect women's access to and experience of HIV/AIDS programmes and services and to offer practical actions on how to address or integrate gender into specific types of HIV/AIDS programmes and services. The target audience for this tool comprises primarily programme managers and health-care providers involved in setting up, implementing or evaluating HIV/AIDS programmes. It includes programme managers and health-care providers in the public sector at the national, district and facility levels, as well as those running private sector programmes, e.g. nongovernmental organizations (NGOs).