HIV TESTING SERVICES

• HIVST
 Consent now 15 years and above.
 target populations to include adolescent girls, Adolescent Girls, Youths and Women
 Blood based HIVST now in use and more options provided (>15 years). Previous
guidelines only considered oraquick.
• Index testing
 Biological Children recommended aged between 18 months to 19 years.
 If using Caregiver-assisted oral screening to conduct index testing for biological children,
then recommended ages are 2 years to 14 years.
 HFs offering ICT assessed annually and accredited to ensure adherence to minimum
standards around the 5Cs, Data sharing agreements and confidentiality requirements.
 IPV assessment and using the WHO recommended LIVES approach to manage
survivors. More about GBV screening and management under index testing setting. Page
75-78
• Linkage, Page 44-45
 intra-facility linkage revised to 7 days or on the same day,
 inter-facility and community linkages is at 14 days.
 Linkage of HIV negative clients
• HIV tester and site certification Page 49-50
 Guidance provided on the verification and confirmation of the requirements needed for
HIV testers and sites certification.

HIV PREVENTION
PREP.
• 2020 consolidated guidelines only talk of the Oral Pre- Exposure prophylaxis – More choices
introduced for better access. Dapivirine vaginal ring and Injectable cabotegravir (LA-CAB)
• Event driven PrEP for Cis gender men
• Use blood based self-testing kits for retesting before refills when RTKs are not available.

REVISED GUIDELINES FOR VMMC

Previous guidance Revised Guidance Rationale
1 Targeted testing for VMMC All VMMC clients be VMMC is an entry point
clients. tested for HIV for all HIV/TB services.
2 Shangring is offered to Males 13 years and above There are minimal chances
males 14 years and above are eligible for Shangring. of Adverse Events arising
from Shangring in males 13
years and above.
*All other guidelines remain as were in previous guidelines.
* Minimum acceptable age for Surgical/conventional circumcision remains 15 years and above.

Linkages, Retention and PSS

1.On Linkage.
*intra-facility linkage revised to 7 days or on the same day,
*inter-facility and community linkages is at 14 days
Note: If a client declines same day ART Linkage, follow up to ensure that client attends with in within 7
days page 41 Job Desk Job AID
2. On Retention –Refine Person-centered Continuity Of Treatment Interventions
IIT, Better understand who is at risk, where, and why and initiate RTT initiatives.
Utilize national CQI platforms and ongoing Interruption in Treatment QI initiative.
Community engagement, focus on PLHIV-led treatment literacy phase one activity.
Refining community services for enhanced early retention and COT (WRAIR)
remains as per previous guidelines
3.PSS
* Screening for depression among PLHIV using SRQ-20 algorithm- slide 156 (provide the SRQ20 tool),
Mental disorder slide 157, Alcohol use 158, Suicide risk 159, on Training slides.
*Provide 1AC when Viral load is greater than >200 copies /ml plasma-we maintain within 7 days upon
the vl results received at the facility from the previous guidelines.
Or >400 copies/ml DBS on page 166 Job Desk Aide
*6 IAC sessions are maximum whether with adherence scores below 95%
ADOLESCENT HIV SERVICES
• HIVST
 Consent now 15 years and above.
 target populations to include adolescent girls, Adolescent Girls, Youths and Women
 Blood based HIVST now in use.
• Index testing
 Biological Children recommended aged between 18 months to 19 years.
 If using Caregiver-assisted oral screening to conduct index testing for biological children, then
recommended ages are 2 years to 14 years.
 HFs offering ICT assessed annually and accredited to ensure adherence to minimum standards around
the 5Cs.
• Linkage,
 intra-facility linkage revised to 7 days or on the same day,
 inter-facility and community linkages is at 14 days.
• Optimized CALHIV audit tool update and utilization with keen service tracker on OVC
screening/Assessment and linkage or referral for enrolment.
• PRIORITIZE HIV CASE FINDING
Focus on pediatrics, adolescents, and the age band 20-34 through Optimized PITC, Recency, Focused
Community Testing, Index Testing, Scale up and HIVST through peer navigators.
Optimize utilization of Children and Adolescent Risk assessment tool to improve case identification in the
region.
Intensify SNS among YAPS, AYPLHIV peer leaders to improve targeted case identification.
GEN_GBV
Intensify Screening of all clients undergoing HTS and APN for IPV using the LIVES approach
Optimize utilization of GBV screening tool to improve S/GBV case identification.
Follow PEP guidance, focus on timelines, dosage (Adults and adolescents with weight >30Kg:
TDF+3TC+DTG or TAF+FTC+DTG (Preferred), TDF+3TC+ATV/r or TAF+FTC+ATV/r
(1stAlternative), TDF+3TC+EFV or TAF+FTC+EFV (2ndAlternative and for Children < 30kg :
ABC+3TC+DTG or TAF+FTC+DTG (preferred), ABC+3TC+LPV/r or TAF+FTC+LPV/r (alternative),
and uptake, completion and completion, theres great need to enforce demand creation for PEP services
across the region on addition to PEP are the utilization of Sexual Assault Kits.
AGYW
 using of LIVES technique provide complete package of post S/GBV clinical care to all AGYWs i.e
Provide psychosocial support and counselling to SGBV survivors, Screen for HIV, pregnancy, STI,
trauma and manage accordingly, Provide EC with in the 120 hours, PEP within 72 hours.
 If HIV positive links to appropriate HIV treatment and care services, If HIV negative provide HIV
prevention information and services and referrals to additional services as per the need.

PMTCT SECTION

 Screening PAGE 54 TO 55 of the Desk Job Aide

 Triple Elimination of HIV, Syphillis and Hepatitis B. Roll out focus on.
 Continue screening for HIV, Syphillis and Strengthen Hepatitis and Management of Positive
Cases
 Review the Hepatitis B Treatment a logarithm!
 Focus on Documentation and Reporting of Hepatis B Screening on Page HMIS 105
 Maternal Re-testing with Emphasis on the Re-Testing Schedule, PAGE 25 of Desk Job Aide
ART Treatment PAGE 56 of Desk Job Aide
TDF/3TC+DTG remain the preferred 1st Line for PMTCT mothers.
Viral Load Monitoring , PAGE, 181 of Desk Job Aide
 Focus on the 3 months Viral Load monitoring schedule with Emphasis on the new cut off for
Suppression according to the Sample type.
Management of Non-Suppressed Viral load clients ; PAGE 181 of Desk Job Aide
 No. of samples to be collected.
 Expected Sample Type and
 Testing Laboratory, CPHL
EID/EPI Integration
Focus on documentation of PMTCT status in the Child Health Register in Column 14
PREP Services
 Screening
 Eligibility
 Documentation, Primary Tools, Reporting Lines
Inclusion of TRK and TRRK in Maternity Register , Refer to Maternity Register
 Care and Treatment
1. 2-year transition plan for adolescents (Pg 79 and 80)
2. Screening for and Management of Advanced HIV Disease in Children, Adolescents and Adults
(introduction of malnutrition) pg 82
3. STOP AIDS package Pg 83
4. Eligibility for CTX pg 85
5. Criteria for rapid ART initiation Pg 93
6. ART Regimen for TB/HIV co-infected patients initiating 1st line ART pg 94
7. Management of Cryptococcal Meningitis pg 103
8. Screening and Management of histoplasmosis and aspergillosis pg 107-109
9. Recommended first-line ARV regimens in Children, adolescents, adults and pregnant or
breastfeeding women pg 175
10. MONITORING RESPONSE TO ART Pg 179-183
11. Substitution and switching pg 184-186
12. DSDM 202-218
NCD Integration into HIV Care
1- Screening and management protocol for Diabetes Mellitus (pg 113-114)
2- Screening and management of Hypertension (pg 115-116)
Note page 115 contains screening algorithm for DM instead of Hypertension hence need to
correct before printing final copies!
3- Lifestyle management of DM and Hypertension in PLHIV (pg 117)
4- Screening for Mental Health using SRQ 20, suicide risk using SADS PERSON score, screening
for substance use disorder using Audit C tool (pg 118-122)
TB
Area Revised/New Guidance Reference

1 Systematic
screening for TB
among PLHIV Chapter 5: CARE
Use of C-Reactive Protein (CRP) and or CXR AND SUPPORT FOR
In addition to the ICF guide PLHIV- TB
SCREENING AND
DIAGNOSIS (Page 89)

2 TB screening, Chapter 5: CARE

testing and TB testing options (TB LAM. mWRDs0 AND SUPPORT FOR
management (as Eligibility for TB LAM PLHIV- TB
part of AHD SCREENING AND
management) DIAGNOSIS (Page 82)

3 ART for TB/HIV co- ART Regimen for TB/HIV co-infected patients initiating 1st line Chapter 5:
infected patients ART. Page 94

ART Regimen for TB/HIV co-infected patients initiating 2nd-line Chapter 5: page 95
ART
4 Treatment of people
with drug-resistant
 TB All people with HIV and drug-resistant TB, requiring second-line Chapter 5:
anti-TB drugs irrespective of CD4 cell count, should start ART as INITIATING ART
early as possible (within the first eight weeks) following initiation AMONG PLHIV
of anti-TB treatment. WITH TB
5 TB Preventive
Treatment Options Screening and management Algorithm for TPT Chapter 5: Page 99

Use of 3HP (RPT + INH) Chapter 5 TPT

6H also in practice REGIMEN
(page 101)
5- *All other guidelines remain as were in previous guidelines.

Laboratory
SN Take home Job aide page no.
1 HIV testing algorithm using HIV/syphilis duo in MCH Page 23
emphasizing the need to retest immediately using the adult national
testing algorithm for discordant results (SD Duo –reactive and
statpak –Non reactive)
2 Handling of inconclusive results when following the HIV testing Page 22
algorithm ( 18 months and above)
3 Laboratory monitoring under monitoring response to treatment Page 180
with revised suppression cutoff (Plasma of 200copies/ml and DBS
of 400copies/ml respectively)
4 Using TB LAM for TB diagnosis in AHD highlighting that TB Page 128 ( power point presentation)
LAM MUST NOT be used for HIV NEGATIVE patients
5 POC tests for diagnosis of others OIs ( Aspergillosis and Page 146-147( power point presentation)
histoplasmosis)
6 ANC & eMTCT services for pregnant women under laboratory Page 83
services bringing out the triple elimination concept ; Have the
following tests performed for mothers ; HIV , syphilis and
Hepatitis B as bear minimum.
SN Take home Job aide page no.
1 HIV testing algorithm using HIV/syphilis duo in MCH Page 23
emphasizing the need to retest immediately using the adult
national testing algorithm for discordant results (SD Duo –
reactive and statpak –Non reactive)
2 Handling of inconclusive results when following the HIV Page 22
testing algorithm ( 18 months and above)
3 Laboratory monitoring under monitoring response to Page 180
treatment with revised suppression cutoff (Plasma of
200copies/ml and DBS of 400copies/ml respectively)
4 Using TB LAM for TB diagnosis in AHD highlighting that Page 128 ( power point presentation)
TB LAM MUST NOT be used for HIV NEGATIVE
patients
5 POC tests for diagnosis of others OIs ( Aspergillosis and Page 146-147( power point
histoplasmosis) presentation)
6 ANC & eMTCT services for pregnant women under Page 83
 laboratory services bringing out the triple elimination
concept ; Have the following tests performed for mothers ;
HIV , syphilis and Hepatitis B as bear minimum.

COMMODITY MANAGEMENT AND PHARMACOVIGILANCE

Areas of Emphasis
1. Ordering for commodities, (1st line and 2nd line ARVs, Lab and TB management commodities,
and 3rd line commodities.
Ordering platforms (CSSP NMS+, DHIS2)
Accountability and Traceability of commodities JA pg 231

2. New formulations to be introduced (TAF/FTC/DTG 25/200/50mg, and LPV/r pellets 40/10mg

pack of 120 Tablets JA Pg147
3. Updates on Pharmacovigilance (Guidance on improved reporting of Adverse drug reactions
JA Pg 210
4. Community Retail Pharmacy Distribution Point (CRPDDP)
JA pg 236

Integrating CQI into HIV services (all on the same page-229)

 Establish health facility QI team
 Set up HIV work improvement teams (WIT)
 Identify gaps
 Gap analysis to get root causes
 Develop possible solutions
 Prioritizing solutions to address performance gaps
Developing improvement projects using the documentation journal

SOP for the implementation of the Intergrated Community Service Delivery Approach
Overview The Intergrated community based service delivery model
The intergrated community based service delivery model is a family centered approach based on the 4 building
blocks of DSD: (1) What, (2) Where, (3) Who and (4) When. It focuses on having a community led Integrated
client centered service delivery which is appropriate and cost-effective to responding to the challenges of HIV
prevention, treatment and care.
This approach ensures that all sub populations (children, adolescents, pregnant and breast feeding women and all
PLHIVs) are mapped and grouped according to villages they come from. Two or three villages together to form a
safe space and it is this space where both client led and health worker led clinical and social services are provided.
This approach focuses on providing a standard package of community based services to address vulnerability and
disease burden in the household. The approach targets PLHIV non suppressing and they are provided a
comprehensive package of services to;
 Identify the undiagnosed PLHIV
 Address poor adherence
 Strengthen social – economic service support to the household
Under this approach, vulnerable households have an opportunity of accessing integrated clinical services at
household level such DOTS, HIV testing for partners, children and siblings of Index clients, TB contact tracing,
treatment literacy, nutrition support intergrated with socio-economic services such as backyard gardening and
linkage to other support services to ultimately improve the quality of clinical care and social wellbeing.

How do you operationalize the model at health facility?

Step 1: Health education and orientation
 The health facility creates awareness to the clients about the continuity of services at community level using an
integrated community appraoch and its benefits during the facility health education sessions.
Step 2: Mapping of the non-suppressed clients
 The health facility maps the non-suppressed clients >200 copies/ml by village, parish and sub county of their
residence to understand preference of care.
Step 3: Mapping and training of Community Health Workers (CHWs)
 The health facility then maps and trains community health workers (CHW) by village, parish and sub county.
These may include VHT, Para social workers, Peer Educators, Peer Mothers, YAPS, Linkage Facilitators etc
that are within the proximity of the non-suppressed clients.
Step 4: Attachment of CHWs to clients
 Conduct a meeting at facility to attach the Community Health Worker (CHW) with the non-suppressed
client/household for support and seek client’s consent.
 Attach upto 5 non suppressed clients to one CHW being in mindful of the distance.
 During the meeting, the client and community health worker agree on where to meet in the community, time
and whether other family members require to be part of the meeting.
Note; In cases where there is already an attachment, assess if the attachment is working/ functional before re-
assignment of a new CHW.
Step 5: Conducting household visit
 During the home visit, conduct the 5A assessment (Assess, Assist, Advise, Agree, Arrange) to understand the
cause of non-suppression and agree on steps to support the client and the household members to access
services.
Provide services to the household members including;
 DOTs of upto 30 days to non-suppressed based on eligibility alternating at household and at community
 HIV screening and testing of eligible family members
 Treatment literacy sessions
 Linkage to socio-economic services to address vulnerability
 Psychosocial support
 Screening household members for any diseases and referral for services
 TB screening and contact tracing. Provide education and information to household members on the
importance of early screening and starting TB treatment.
Note: After the daily 30 days of DOTS, the CHW will continue with weekly visits until client is bled for a repeat
VL.
The CHW reports to counsellor or any designated supervisor on a weekly basis using the community client
encounter form
Roles of a caregiver/family members at home
 Provide basic essential needs to the PLHIV (clothing, food, mosquito net etc)
 Escort the PLHIV to the agreed point with CHW for DOTS
 Identify a committed treatment supporter

Step 7: In the community (safe space/integrated outreach space)

A safe space is a point where the PLHIV with their family members come and access intergrated clinical
and social services on a quarterly basis. This point provides a wide range of integrated services to all
community members i.e;
 ART, HIV testing, immunization, VL bleeding and other clinical services.
 Socio – economic services i.e VSLA, PDM (engage the community development officers to support these
sessions)
 HIV prevention and SRH services
Pre safe space meeting preparations
 CHW communicates to the health facility, CDO and PDM supervisors about the planned quarterly safe
space/outreach meeting.
 The health worker uses a tool (service gap audit tool) to lists the services (ART medicines, VL) required.
 Health worker pre-packs the required items/commodities.
 CHW conducts mobilization and pre appointment reminders to clients on the agreed location and date
At the quarterly intergrated safe space/outreach meeting.
 Health worker or CHW gives health information/education
 CDO registers all clients who require follow up for services
 Health worker provides services i.e VL bleeding, IAC and ART refill, immunization, EID services, NCD
screening, PreP etc.
 The health worker updates client information on services provided using EMR mobile or the facility registers.
 CDO/PDM focal person provides information about the socio-economic services that are available for them as
well as saving schemes.
 CHW working with the Social workers and CDOs link clients to available services in the community (VSLA,
DREAMS safe spaces).
 Integrate OVC case conferencing during the safe space outreaches to discuss patients with unresolved issues.
Reporting 0-9 10-19 20+ Pregnant &
indicators Services Received
years yrs years Lactating
M F M F M F
Number of non-suppressed clients
Total
enrolled on the Community approach
Started
Completed
DOTs Bled for repeat VL
Suppressed
Non suppressed
Tested
Number tested for HIV at household Positive
Linked to care
Total linked
Socio-economic services
Received services
Screened
Sputum collected
TB
Positive
Linked to care

Other clinical services provided

SOCIAL BEHAVIOR CHANGE COMMUNICATION

1. What is SBCC 2. Why SBCC - 3. Who does SBCC focus Who conducts SBCC
Focuses on on

Social and behavior change I. Increasing demand for Primary audience – Clients – Inter Personal
communication (SBCC) is the integrated health Sexually active adolescent youth, Communication (IPC)
strategic use of services and products Teenage mothers, pregnant Agents, Volunteers,
communication to change II. Increasing their timely women/ teens and their spouses, VHTs, Peers, Positive
behaviors, including service and appropriate use KPPPs, Men, persons living risky deviants, Satisfied
utilization, by positively III. Improving health lifestyles. users.
influencing key determinants provider-client Secondary audience – Health
of behavior change as access, interactions workers Facility based providers,
perceptions, cultural beliefs IV. Changing or community health workers,
and social norms. positively influencing Teachers, different types of peers,
Connects the interplay social norms to Parents of adolescent youths,
between individual, support sustainable community leaders, religious,
interpersonal, community, and behavior change at the cultural, traditional leaders, media
societal factors that affect community level. owners and managers.
health behaviors. (Socio
ecological Model)
 CIRCLE OF CARE MODEL
BEFORE SERVICE DURING SERVICE AFTER SERVICE
SBCC improves healthy behaviors and SBCC improves access to care and SBCC boosts adherence and sustained
motivates care seeking user satisfaction behavior change
Addresses socio-economic and cultural Improves provider behavior Improves norms that support healthy
barriers to service utilization Improves client-provider interaction; behaviors
Creates enabling environment and builds trust Reinforces community linkages
supportive norms Reduces provider biases and stigma Enhances follow-up/referral
Generates demand; increases referral through respectful client-provider
interaction; empowers clients
METHODOLOGIES & WHY
Methodology Channels Target population Why/ Xtics of target population
Mass 1. TV Adolescents/ youth, sexually i. Speak Lusoga and Luganda
communication 2. Radio – radio talk shows, radio active adolescents, youth, ii. Don’t discuss sex with
media announcements, DJ Mentions, teenage mothers, KPPPs parents
Spot messages iii. Don’t like getting services
3. Mobile phone with adult people
iv. Peer groupings
Community Political, religious, cultural Positive deviants Welcome different interventions in
Dialogues leaders the community
Inter Personal Individual & Group Men, Don’t feel responsible to protect
Communication Home visits by IPC Agents, VHTs Women partners
PP Feel urge for casual sex because of
idleness
Targeted Community media KPs Don’t test together and don’t share
Community Mobile Phone results
Outreaches Peer groups Live discreet lifestyles
Male Alone Hard headed men in TB Most of the men believe that their
sessions hotspots results are similar to their partners,
so don’t go for health services.
CLIENT LITERACY DISAGGREGATED BY TECHNICAL AREA
Cross cutting Messages by Inter Personal Communication Tools to utilize Mode of mobilization
Technical Area (IPC) Agents
HIV/AIDS i. Reduce number of sexual partners Integrated Community Mass media,
Prevention ii. Demand and seek HCT Mobilization Registers Peers/Champions in male
iii. PLHIV follow treatment, VL testing, dominated spaces
PMTCT
VMMC i. Demand/ seek VMMC services Line lists of eligible Radio talk shows
ii. Make a choice on the preferred method men for for VMMC HH mobilization
of circumcision
KPPP i. Utilize all available prevention Hotspot owners IPC by peers in all hotspots
services namely, condoms, lubricants,
PrEP services, STI screening
TB i. Go for TB screening if cough for 2 Line lists of hard to Male Alone sessions in male
weeks or more especially 15-24 years reach individuals dominated hotspots
ii. Take children for TB screening if especially men
cough for 2 weeks or more
Cervical cancer i. Test for cervical cancer to detect and ART Registers ART clinic days through
screening treat it early Counsellors
ii. Consult with a peer mother who has
already the test
Youth & Gender i. Both male and female avoid unplanned Y&G registers Phones
– AGYW/ pregnancies, abstain or use condoms, Peers (YAPS)
AYPLHIV go to health facilities for information
and care seeking
Family Planning i. Couple plan for birth together, father FP services registers Radio talk shows,
accompanies wife to HF for delivery Health Workers
and after seeking/ using FP method to
delay next pregnancy
GBV i. Solve family problems by talking not GBV registers GBV survivors
fighting
OTHER TAILORED SBC SUPPORT TO THEMATIC AREAS - Mobilization, awareness creation,
Health Education for integrated services
Cross cutting SBCC Unique approaches MATERIALS USED
Technical Area
VMMC i. Mobilization with male champions in identified places like Posters, Booklets and
garages, betting houses, education institutions – (Men Star audio radio spots
Strategy)
ii. Microplanning with facility mobilization teams
iii. Mobilization drives, home to home mobilization with
megaphone,
KPPP i. Integrated community dialogues in identified hotspots, KPPP Counselling
ii. PrEP Initiation & CT Dialogues (distribution of 11,252 Guidelines, Booklets
condoms, 2,171 lubricants) and Factsheets
iii. Mapping of new hotspots
TB i. Men Alone sessions - These are focused community outreach Audio radio spots
activities held to provide safe spaces for men to improve their
health seeking behaviors and adoption of positive health
practices.
Cervical cancer i. Health Education at ART clinic Posters, fliers,
screening ii. Deployment of positive deviant peers to mobilize fellow
women
GBV - Youth & i. Peer mobilization (YAPs to be incorporated among activity Posters, Assessment
Gender – AGYW/ mobilization teams) cards,
AYPLHIV
PMTCT i. ANC Trigger events (Baby showers) – These are mother Posters and radio spots
targeted (pregnant & breastfeeding) focus group dialogues to
discuss the importance of Pre & Ante Natal Care and its
relevance to PMTCT.
VLS i. Procurement of B OK bottles for client literacy by counsellors B: OK Bottles, Posters,
ii. Integration of routine h/h livelihood education into HE Radio spots
HIV/AIDS Prevention i. Distribution of HIVST kits during VMMC camps, (2,691 kits) Posters, Audio visual
ii. Ensuring HTS at all our outreach activities clips