PIH Guide to the Community-Based Treatment of HIV in Resource-Poor Settings

From the Preface
In the course of the past decade, we have seen scores of handbooks and how-to guides about how best to respond to AIDS. Many of these are directed towards patients literate in English and are designed as consumer education manuals; others are directed towards subspecialists and are not readily decipherable by patients and their families. Most guides suggest courses of action and treatment that are completely impracticable in precisely those settings most beset by AIDS; those handbooks, guidelines, and sets of “best practices” have not typically been piloted under difficult field conditions. Moreover, most of the handbooks are written as if AIDS prevention and care are mutually exclusive activities or, worse, competing priorities.

The PIH Guide to the Community-Based Treatment of HIV in Resource-Poor Settings is meant to complement existing resources and also to address the shortcomings noted above. Ours is not a consumer guide, although many of those who collaborated in the project described in this book are themselves living with HIV. Nor is our guide meant to be a reference manual directed only to specialists. Great care was taken in writing each of the chapters and in developing algorithms to help nonspecialists manage problems commonly encountered in areas that lack the laboratory capacity readily accessed in the countries where modern AIDS therapy was developed. Most of all, we seek to show that high-quality AIDS care is possible in what are termed “resource-poor settings.” Indeed, we argue that introducing excellent AIDS care in such settings will not only save lives but will also enhance AIDS prevention efforts, revive flagging morale, and advance primary health care goals.

Partners In Health and its Haitian sister organization Zanmi Lasante (ZL) are able to make these claims because we have already piloted such an effort in the rural reaches of Haiti, one of the world’s poorest countries. This is the third handbook written and field-tested by a group of health care providers af- filiated with Partners In Health and its collaborators, which includes nongovernmental organizations in Peru and Russia, as well as Harvard Medical School and the Brigham and Women’s Hospital in Boston, Massachusetts.

Chapters include:

1. Chapter 1: The Haiti Experience: Six Lessons
   • The History of HIV Prevention and Care in Rural Haiti
   • The Introduction of Antiretroviral Therapy
   • Community Health Workers and Social Support
   • A Syndromic Approach to HIV Management
   • Scaling Up HIV Prevention and Care in Central Haiti: Can It Be Done?
2. Chapter 2: Initiating a Comprehensive HIV Prevention and Care Program: The Cange Model
   • Public Clinics and Basic Health Care
   • The Four Pillars of HIV Prevention and Care
   • TB and HIV Co-Infection
   • Women’s Health and the Prevention of Mother-to-Child Transmission of HIV
   • Diagnosis and Treatment of Sexually Transmitted Infections
   • Conclusion
3. Chapter 3: Treatment Guidelines for the Management of Patients with HIV and AIDS
   • Initial Evaluation of a Newly Diagnosed HIVPositive Patient
   • When to Start Therapy
   • Recommended First-Line Regimens for Adults
   • Management of Children Born to HIV-Positive Mothers
   • Monitoring Patients after Initiation of ART
   • Management of Adverse Reactions to Treatment
   • HIV Resistance and Changing ART Regimens
   • Post-Exposure Prophylaxis
   • Prophylaxis Against Common Opportunistic Infections
   • Common AIDS-Related Complications
   • Adherence
   • Keeping HIV Patients Healthy
   • Conclusion
4. Chapter 4: Monitoring and Evaluation: Data Collection, Record Management, Electronic Telecommunications
   • Data Collection and Analysis in Resource-Poor Settings
   • Information and Telecommunications
   • The Electronic Medical Record
   • Patient Tracking
   • Conclusion
5. Chapter 5: New Challenges
   • Prevention and Treatment: Inseparable Parts of a Continuum of Care
   • Infrastructure: Opportunities and Constraints
   • Lessons Learned and the Way Forward
   • New Initiatives
   • Conclusion

Partners In Health is a nonprofit corporation based in Boston, Massachusetts, USA. Established in 1987, Partners In Health (PIH) is committed to making a preferential option for the poor by working with community-based organisations on projects designed to improve the well-being and health of people living in poor communities. Partners In Health aims to provide technical and financial assistance, medical supplies, and administrative support to partner projects in Haiti, Peru, Russia, Mexico, and the United States. "The goal of these partnerships is neither charity nor development, but rather “pragmatic solidarity”– a commitment to struggle alongside poor people and against the economic and political structures that cause and perpetuate their poverty and ill health."