diff --git "a/arv_summary/docstore.json" "b/arv_summary/docstore.json"
new file mode 100644--- /dev/null
+++ "b/arv_summary/docstore.json"
@@ -0,0 +1 @@
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"text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6462048f-47f3-416f-959d-d2f53b007856": {"__data__": {"id_": "6462048f-47f3-416f-959d-d2f53b007856", "embedding": null, "metadata": {"page_label": "4", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a03c440b-e1ff-4848-9cf7-0e6c45556f71", "node_type": "4", "metadata": {"page_label": "4", "file_name": 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"8da10ed2ce7b19429f6ca2474bd899426eca72ffcef6f61e2e5862a1ca3c05bc", "class_name": "RelatedNodeInfo"}}, "hash": "ca4cedb66d0dc1cdf25e7adca935dcb2d72a8c5be7567435a54192c66cb99154", "text": "\u00a9 National AIDS & STI Control Program 2022  \n \nThis guideline document is a publication of the National AIDS & STI Control Program, Ministry of Health \nKenya. No part of this publication may be reproduced, distributed, or transmitted in any form or by any \nmeans, including photocopying or recording, without the prior written permission of the National AIDS and \nSTI Contro l Program (NASCOP), Ministry of Health Kenya, except for non -commercial uses permitted by \ncopyright law.  \n \nKenya HIV Prevention and Treatment Guidelines, 2022  edition contain relevant information required by \nhealthcare providers in the use of ARVs as of the date of issue. All reasonable precautions have been taken \nby NASCOP to verify the information contained in this guideline document.   \n \nFor clarifications contact National AIDS and STI Control Program (NASCOP) at P. O. Box 19361 - 00202, \nNairobi Kenya, T el: +254 (020) 2630867, Email: info@nascop.or.ke, Website: www.nascop.or.ke  \nThe recommended citation for this document is:  \nMinistry of Health, National AIDS & STI Control Program. Kenya HIV Prevention and Treatment Guidelines, \n2022  Edition. Nairobi, Kenya: NASCOP, Aug  2022. Print.  \n \n \n \nDesign and Layout: Collins Etemesi - NASCOP  \nISBN: 13 -978 -9966 -038 -31-9", "start_char_idx": 23, "end_char_idx": 1293, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "976b89b4-0900-4a15-be4a-1c1c4a5b94ce": {"__data__": {"id_": "976b89b4-0900-4a15-be4a-1c1c4a5b94ce", "embedding": null, "metadata": {"page_label": "5", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "4e63b2ac-be58-4d12-b790-b0d0f90f070f", "node_type": "4", "metadata": {"page_label": "5", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fdc164685f4190cc04ef99b1b2df03e279538f92321cda055368953f0986b2da", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6462048f-47f3-416f-959d-d2f53b007856", "node_type": "1", "metadata": {"page_label": "4", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ca4cedb66d0dc1cdf25e7adca935dcb2d72a8c5be7567435a54192c66cb99154", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "03da8c21-fc2c-4ccf-99b5-9beb3feb68f2", "node_type": "1", "metadata": {}, "hash": "ebbeca3161937e543cd025981dd029ea04f5641a37b73ce14d9cf9df30bfffa9", "class_name": "RelatedNodeInfo"}}, "hash": "8da10ed2ce7b19429f6ca2474bd899426eca72ffcef6f61e2e5862a1ca3c05bc", "text": "i Foreword  \nKenya is committed to achieving the UNAIDS 95 \u201395\u201395 testing and treatment targets among \npeople living with HIV within all sub -populations and age groups.  \nThe 2022 edition of the \u2018Guidelines on Use of Antiretroviral Drugs for Treating and Pr eventing \nHIV Infection in Kenya\u2019 is an update of the comprehensive HIV prevention, Care and treatment \nguidelines released in 2018. These guidelines are aligned with the Ministry of Health\u2019s mission of \nproviding the highest standard of health for all Kenyan s and one of the Government of Kenya\u2019s Big \nFour Agenda on Universal Health Coverage .  \nThe theme of the 2022 guidelines is refocusing efforts in the management of Advanced HIV \nDisease to reduce HIV/AIDS related morbidity and mortality. While Kenya has made tremendous \nprogress in HIV Prevention, Care and Treatment through introduction of better medicines, \ndiagnostics and patient centered approaches in service delivery, Advanced HIV Disease continues \nto be a challenge. These guidelines intend to widen access t o key diagnostics and medicines to \nmanage the most common causes of illness and death. Further, emphasis on integrated delivery \nof patient -centered HIV, TB, NCDs, mental health and sexual and reproductive health services has \nbeen included.  \nThese guidelines  provide key recommendations on  HIV testing services and linkage to prevention \nand treatment; initial evaluation and follow up of PLHIV; standard package of care for PLHIV; \nadherence preparation monitoring and support; antiretroviral therapy in infants, c hildren, \nadolescents and adults; prevention of mother to child transmission of HIV, Syphilis and Viral \nHepatitis; TB/HIV coinfection; Hepatitis B & C/HIV co -infection; use of ARVs for post and pre -\nexposure prophylaxis for HIV uninfected populations; and HI V services for people who inject \ndrugs.  \nThe guidelines are an important tool meant to be used by service providers at all levels of the \nhealth sector in Kenya. They are presented in a simplified manner using a public health approach \nto HIV prevention and treatment.  \nIt is my hope that this guidance document provides the much -needed framework and impetus to \nmove towards universal access for HIV services and the agenda of ending AIDS by 2030 as a key \nnational health strategic objective.  \n \n \nDr. Patrick Amoth , EBS  \nAg. Director General for Health , \nMinistry of Health .", "start_char_idx": 4, "end_char_idx": 2413, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "03da8c21-fc2c-4ccf-99b5-9beb3feb68f2": {"__data__": {"id_": "03da8c21-fc2c-4ccf-99b5-9beb3feb68f2", "embedding": null, "metadata": {"page_label": "6", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ecfe7835-b61a-42aa-8b1a-19cc968b028e", "node_type": "4", "metadata": {"page_label": "6", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "564943a33620ed18dd5d8410e8828370eabd66f3f6c208323846bc6c3d7846f4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "976b89b4-0900-4a15-be4a-1c1c4a5b94ce", "node_type": "1", "metadata": {"page_label": "5", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8da10ed2ce7b19429f6ca2474bd899426eca72ffcef6f61e2e5862a1ca3c05bc", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2a7b31f7-59ea-425d-8338-12dc700c0250", "node_type": "1", "metadata": {}, "hash": "31f377d30aaed85f691afeb19e50abd56ea2bfea5055b298782e9733b65039f7", "class_name": "RelatedNodeInfo"}}, "hash": "ebbeca3161937e543cd025981dd029ea04f5641a37b73ce14d9cf9df30bfffa9", "text": "ii Acknowledgement s \n \nThe 2022 Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in \nKenya has been a long -awaited document as the revision was greatly affected by the COVID -19 \npandemic. The document has been updated through the collaborative effort of multiple \nstakeholders, both individuals and institutions, that contributed to the extensive consultations \nled by NASCOP HIV Care and Treatment Program.  \n \nWith much appreciation, I acknowledge all the institutions, both local and international, \ngovernment ministries and departments whose staff spent long hours, both virtually and in \nperson, in the review, writing and finalization of this document.  \n \nI take th is opportunity to appreciate the efforts of the Ministry of Health officers at NASCOP and \nother institutions who coordinated and provided leadership during the review process. \nCompliments to the guidelines review secretariat and the special task force who worked tirelessly \nto ensure that the team produced a great quality document. Particular appreciation to the \nNASCOP team and numerous TA\u2019s who were instrumental in compiling the evidence review and \ndeveloping the guidelines. Special thanks to the consultant s; Jeremy Penner, Irene Mukui, and \nHerb Harwell for their dedication to this process.  \n \nFinancial support for the review process, printing and launch of this document was provided by \nthe Global Fund, UNITAID through CHAI, the US government through the Cent ers for Disease \nControl and Prevention and ICAP at Columbia University through the USAID -funded RISE -Kenya \nProject, WHO and UNICEF - Kenya.  \n \n \n \nDr. Rose Wafula  \nHead, National AIDS & STI Control Program  \nMinistry of Health", "start_char_idx": 4, "end_char_idx": 1727, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2a7b31f7-59ea-425d-8338-12dc700c0250": {"__data__": {"id_": "2a7b31f7-59ea-425d-8338-12dc700c0250", "embedding": null, "metadata": {"page_label": "7", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c3859fdd-8fc5-4d2c-a65f-85d39eb53909", "node_type": "4", "metadata": {"page_label": "7", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b00be6d88241bea1f1706e3852e24b257b21dc09408d48e3580e17ff5997d1cb", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "03da8c21-fc2c-4ccf-99b5-9beb3feb68f2", "node_type": "1", "metadata": {"page_label": "6", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ebbeca3161937e543cd025981dd029ea04f5641a37b73ce14d9cf9df30bfffa9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "177de512-b11e-4cb0-b46e-a75db72e112f", "node_type": "1", "metadata": {}, "hash": "d32dabe5ca87a5be744a5fd9946b920d93260f431e8655e018f24e48b48ea590", "class_name": "RelatedNodeInfo"}}, "hash": "31f377d30aaed85f691afeb19e50abd56ea2bfea5055b298782e9733b65039f7", "text": "iii Table of Contents  \nForeword  ................................ ................................ ................................ ................................ ................................ .......... i \nAcknowledgements  ................................ ................................ ................................ ................................ ....................  ii \nTable of Contents  ................................ ................................ ................................ ................................ ........................  iii \nList of Figures  ................................ ................................ ................................ ................................ ...............................  ix \nList of Tables  ................................ ................................ ................................ ................................ ................................ ..x \nAcronyms and Abbreviations  ................................ ................................ ................................ ............................  xiii \n1. Summary of Key Recommendations  ................................ ................................ ..................  1 \n1.1 HIV Testing Services (HTS) and Linkage to Treatment and Prevention  ................................ ..... 1 \n1.2 Initial Evaluation and Follow -up for PLHIV  ................................ ................................ .............................  1 \n1.3 Standard Package of Care for PLHIV  ................................ ................................ ................................ ...........  2 \n1.4 Adherence Preparation, Monitoring and Support  ................................ ................................ ................  4 \n1.5 Antiretroviral Therapy for Infants, Children, Adolescents, and Adults  ................................ ....... 4 \n1.6 Prevention of Mother to Child Transmission of HIV/Syphilis/HBV  ................................ .............  5 \n1.7 TB/HIV Co -infection Prevention and Management  ................................ ................................ .............  6 \n1.8 HBV/HIV and HCV/HIV Co -infection Prevention and Management  ................................ .............  7 \n1.9 ARVs for Post -exposure Prophylaxis (PEP)  ................................ ................................ .............................  7 \n1.10 Pre -Exposure Prophylaxis (PrEP)  ................................ ................................ ................................ .............  7 \n1.11 People Who Inject Drugs (PWID) and HIV  ................................ ................................ ............................  8 \n2. HIV Testing Services and Linkage to Treatment and Prevention  ...........................  1 \n2.1 Settings for HIV Testing  ................................ ................................ ................................ ................................ .... 1 \n2.1.1 Facility -based testing  ................................ ................................ ................................ ................................ ..........................  1 \n2.1.2 Community \u2013based testing  ................................ ................................ ................................ ................................ ................  2 \n2.2 HTS strategies  ................................ ................................ ................................ ................................ .......................  2 \n2.2.1 HIV Self -Testing (HIVST)  ................................ ................................ ................................ ................................ ...................  2 \n2.2.2 Index Testing  ................................ ................................ ................................ ................................ ................................ ...........  2 \n2.2.3 Voluntary Counselling and Testing (VCT):  ................................ ................................ ................................ ...............  2 \n2.2.4 Social Network Strategy (SNS) - ................................ ................................ ................................ ................................ ...... 2 \n2.3 Package of HI V Testing Services  ................................ ................................ ................................ ...................  5 \n2.4 Age -Specific HIV Testing Algorithms  ................................ ................................ ................................ ..........  8 \n2.4.1 Early Infant Diagnosis  ................................ ................................ ................................ ................................ .................  8 \n2.4.2 Diagnosis of HIV Infection in the Older Child (\u2265 18 months), Adolescents and Adults  ............  12 \n2.4.3 HIV testing for Pregnant Women  ................................ ................................ ................................ .......................  14 \n2.5 Retesting recommendations for HIV negative pe rsons  ................................ ................................ ... 17 \n2.6 Inconclusive HIV status  ................................ ................................ ................................ ................................ .. 18 \n2.7 Approach to Patients on ART with a Discrepant HIV Test Result  ................................ ...............  19", "start_char_idx": 4, "end_char_idx": 5485, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "177de512-b11e-4cb0-b46e-a75db72e112f": {"__data__": {"id_": "177de512-b11e-4cb0-b46e-a75db72e112f", "embedding": null, "metadata": {"page_label": "8", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "166829dd-4ad3-4f0d-b5c7-a4b69e826daf", "node_type": "4", "metadata": {"page_label": "8", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "16b3c8fc086667f5b172469d3e6c255807483491a54309241716ebd390e90c70", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2a7b31f7-59ea-425d-8338-12dc700c0250", "node_type": "1", "metadata": {"page_label": "7", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "31f377d30aaed85f691afeb19e50abd56ea2bfea5055b298782e9733b65039f7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8cd99bd1-eb61-4e5b-8e74-8bc605f6c7fb", "node_type": "1", "metadata": {}, "hash": "ba29669314c8401f8f13cb0ad039b073e8554b70fc97250d46db4d00696961a1", "class_name": "RelatedNodeInfo"}}, "hash": "d32dabe5ca87a5be744a5fd9946b920d93260f431e8655e018f24e48b48ea590", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n \niv 3. Initial Evaluation and Follow up  ................................ ................................ .........................  1 \n3.1 Introduction  ................................ ................................ ................................ ................................ ...........................  1 \n3.2 Initial Clinical Evaluation of PLHIV  ................................ ................................ ................................ ..............  1 \n3.3 Initial Laboratory Evaluation of PLHIV  ................................ ................................ ................................ ...... 4 \n3.4 Managem ent of Patients Who Present with Advanced HIV Disease  ................................ .............  6 \n3.5 Follow -up of PLHIV after ART initiation  ................................ ................................ ................................ ... 8 \n3.5.1 First 6 months after ART initiation  ................................ ................................ ................................ ..............................  9 \n3.5.2 Differentiated Service Delivery for Patients beyond the 1st 6 months of ART  ................................ ....... 9 \n3.6 Summary of clinical and laboratory monitoring of PLHIV on ART ................................ .............  11 \n3.7 Differentiated Care for Chi ldren, Adolescents and Pregnant/ breastfeeding Women  ...... 13 \n3.8 ART Prescription, Dispensing, and Distribution for clients establishe d on ART  .................  14 \n4. Standard Package of Care for PLHIV ................................ ................................ ..................  1 \n4.1 Antiretrovir al Therapy  ................................ ................................ ................................ ................................ ...... 4 \n4.2 PHDP, GBV/IPV & HIV Education/Counselling  ................................ ................................ ......................  5 \n4.2.1 Screening for Gender -Based Violence (GBV)/Intimate -Partner Violence (IPV)  ................................ .... 6 \n4.2.2 HIV Education/Counselling  ................................ ................................ ................................ ................................ ..............  7 \n4.3 Specific Opportun istic Infection Screening and Prevention  ................................ .............................  8 \n4.3.1 Cotrimoxazole Preventive Therapy (CPT)  ................................ ................................ ................................ ................  8 \n4.3.2 Tuberculosis (TB) Prevention and Management for PLHIV  ................................ ................................ ..........  11 \n4.3.3 Cryptococcal Meningitis (CM) Screening and Treatment  ................................ ................................ ...............  11 \n4.4 Reproductive Health Services  ................................ ................................ ................................ .....................  15 \n4.4.1 Sexually Transmitted Infections  ................................ ................................ ................................ ................................ . 15 \n4.4.2 Family Planning and Pre -Conception Counselling  ................................ ................................ .............................  15 \n4.4.3 Maternal Healthcare  ................................ ................................ ................................ ................................ .........................  18 \n4.5 Non -communicable Diseas es Screening and Management  ................................ ............................  18 \n4.5.1 Metabolic Disorders  ................................ ................................ ................................ ................................ ..........................  18 \n4.5.2 Cancer Prevention, Early Detection and Management among PLHIV  ................................ ......................  23 \n4.6 Mental Health Screening and Management  ................................ ................................ ..........................  25 \n4.6.1 Depre ssion  ................................ ................................ ................................ ................................ ................................ .............  25 \n4.6.2 Alcohol and Drug Use/Addiction  ................................ ................................ ................................ ................................  28 \n4.6.3 Anxiety ................................ ................................ ................................ ................................ ................................ .....................  31 \n4.6.4 Stress and stress management  ................................ ................................ ................................ ................................ .... 32 \n4.6.5 experiences o f Trauma  ................................ ................................ ................................ ................................ ....................  33 \n4.6.6 Psychosis  ................................ ................................ ................................ ................................ ................................ ................  34 \n4.6.7 Self -Care  ................................ ................................ ................................ ................................ ................................ ..................  34 \n4.6.8 Wellbeing  ................................ ................................ ................................ ................................ ................................ ...............  35", "start_char_idx": 0, "end_char_idx": 5750, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8cd99bd1-eb61-4e5b-8e74-8bc605f6c7fb": {"__data__": {"id_": "8cd99bd1-eb61-4e5b-8e74-8bc605f6c7fb", "embedding": null, "metadata": {"page_label": "9", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2e0b97f0-f810-42b3-ba01-5f051bc57cc0", "node_type": "4", "metadata": {"page_label": "9", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "289e2cb6528c3f7432249246727c89a894ffcccd3a6747884fa5c6dfbe063b10", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "177de512-b11e-4cb0-b46e-a75db72e112f", "node_type": "1", "metadata": {"page_label": "8", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d32dabe5ca87a5be744a5fd9946b920d93260f431e8655e018f24e48b48ea590", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "987c7577-780d-4ac5-92c7-dbd6dc76012f", "node_type": "1", "metadata": {}, "hash": "f3bd53aceee0fb22e9a42753c49e20201d912ecbc2137eed6de87aa2f14e4229", "class_name": "RelatedNodeInfo"}}, "hash": "ba29669314c8401f8f13cb0ad039b073e8554b70fc97250d46db4d00696961a1", "text": "v 4.7 Nutritional Services  ................................ ................................ ................................ ................................ .........  36 \n4.7.1 Nutritional Assessment, Counselling and Support (NACS)  ................................ ................................ ............  36 \n4.8 Prevention of Other Infections  ................................ ................................ ................................ ...................  40 \n4.8.1 Immunizations  ................................ ................................ ................................ ................................ ................................ ..... 40 \n4.8.2 Malaria  ................................ ................................ ................................ ................................ ................................ .....................  42 \n4.8.3 Safe Water, Sanitation and Hygien e ................................ ................................ ................................ ..........................  42 \n5. Adherence Preparation, Monitoring and Support  ................................ ........................  1 \n5.1 Undetectable = Untransmittable (U=U)  ................................ ................................ ................................ ..... 5 \n5.1.1 Benefits of U=U  ................................ ................................ ................................ ................................ ................................ ....... 5 \n5.1.2 Considerations for implem entation of U=U within clinical settings  ................................ ............................  5 \n5.1.3 Messaging to Patients on U=U  ................................ ................................ ................................ ................................ .........  5 \n5.1.4 How patients can discuss U=U with others  ................................ ................................ ................................ ..............  6 \n5.1.5 Counselling patients about other prevention combination interventions  ................................ ................  6 \n5.1.6 Application of U=U in o ther settings  ................................ ................................ ................................ ............................  6 \n5.2 ART Adherence Preparation and Support  ................................ ................................ ................................  7 \n5.2.1 Treatment Preparation as Part of HIV Testing Services  ................................ ................................ ....................  7 \n5.2.2 ART Treatment Preparation  ................................ ................................ ................................ ................................ ............  7 \n5.2.3 Age -Specific Tr eatment Preparation and Support  ................................ ................................ .............................  13 \n5.3 Adherence Monitoring, Counselling and Support During the First 3 Months of ART  ........ 20 \n5.3.1 Adherence Monitoring  ................................ ................................ ................................ ................................ .....................  20 \n5.3.2 Adherence Counselling and Support During the First 3 Months of ART  ................................ .................  25 \n5.4 Adherence Monitoring, Counselling and Support for Patients with Suppressed Viral Load \n< 200 copies/ml  ................................ ................................ ................................ ................................ ...... 29 \n5.5 Adherence Monitoring, Counselling and Support for Patients with Unsuppressed Viral \nLoad \u2265 200 copies/ml  ................................ ................................ ................................ ...........................  30 \n5.5.1 Enhanced Adherence Assessments  ................................ ................................ ................................ ...........................  31 \n5.5.2 Enhanced Adherence Counselling  ................................ ................................ ................................ ..............................  31 \n5.6 Treatment Preparation for 2nd Line or 3rd Line ART  ................................ ................................ ..... 34 \n5.7 Identifying, Tracing, and Supporting Patients who Default from Care  ................................ ..... 35 \n6. Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  .................  1 \n6.1 Eligibility for ART  ................................ ................................ ................................ ................................ ................  1 \n6.2 Timing of ART Initiation  ................................ ................................ ................................ ................................ ... 1 \n6.3 First -Line ART for Infants, Children, Adolescents and Adults (including Pregnant and \nBreastfeeding Women)  ................................ ................................ ................................ ...........................  3 \n6.4 Dosing and Administration of Dolutegravir (DTG) ................................ ................................ ...............  5 \n6.5 Monitoring and Changing ART  ................................ ................................ ................................ .......................  7 \n6.5.1 Optimizing Therapy for Patients who have suppressed viral load on First Line ART .........................  7", "start_char_idx": 4, "end_char_idx": 5552, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "987c7577-780d-4ac5-92c7-dbd6dc76012f": {"__data__": {"id_": "987c7577-780d-4ac5-92c7-dbd6dc76012f", "embedding": null, "metadata": {"page_label": "10", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "535ec5da-4814-4ce5-9256-9c61109670a2", "node_type": "4", "metadata": {"page_label": "10", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b38e2e870fdb8f5f86ac5b1660fdcc2e52a994f1017faac47faa15161ecee2bf", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8cd99bd1-eb61-4e5b-8e74-8bc605f6c7fb", "node_type": "1", "metadata": {"page_label": "9", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ba29669314c8401f8f13cb0ad039b073e8554b70fc97250d46db4d00696961a1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "26de771d-fec6-49fb-919d-0e8fa9a4746b", "node_type": "1", "metadata": {}, "hash": "2d1c6cf6b27cbe79e80931cc777f00a2adf8e17c06f4f417291876749001c661", "class_name": "RelatedNodeInfo"}}, "hash": "f3bd53aceee0fb22e9a42753c49e20201d912ecbc2137eed6de87aa2f14e4229", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n \nvi 6.5.2 Changing ARVs Due to Adverse Drug Reactions  ................................ ................................ ................................ .... 9 \n6.5.3 Changing ARVs Due to Drug -Drug Interactions  ................................ ................................ ................................ .. 16 \n6.5.4 Changing ARVs Due to Treatment Failure  ................................ ................................ ................................ .............  17 \n7. Prevention of Mother to Child Transmission of HIV/Syphilis/Hepatitis B  .........  1 \n7.1 Antiretroviral Therapy for HIV -positive Pregnant and Breastfeeding Women and Infant \nProphylaxis  ................................ ................................ ................................ ................................ ...................  3 \n7.2. Syphilis elimination for Pregnant and Breastfeeding Women and Infant Treatment  .........  5 \n7.3. Hepatitis B elimination for Pregnant and Breastfeeding Women and Infant Prophylaxis  5 \n7.4 Infant and Young Child Nutrition in the Context of HIV  ................................ ................................ ..... 7 \n8. TB/HIV Co -infection, Prevention  and Management  ................................ ....................  1 \n8.1 TB Screening for PLHIV: Intensified Case Finding (ICF)  ................................ ................................ .... 1 \n8.2. TB Preventive Therapy (TPT)  ................................ ................................ ................................ .......................  9 \n8.2.1. Indications for TPT  ................................ ................................ ................................ ................................ ..............................  9 \n8.2.2. Contraindications to TPT  ................................ ................................ ................................ ................................ ..............  10 \n8.2.3. Dose and Duration of TPT  ................................ ................................ ................................ ................................ .............  10 \n8.2.4. Follow -up of Patients on TPT  ................................ ................................ ................................ ................................ ...... 11 \n8.3. Identifying and Managing Drug Toxicities from TPT  ................................ ................................ ...... 11 \n8.3.1 Peripheral Neuropathy - Suspected drug: INH  ................................ ................................ ................................ ..... 11 \n8.3.2 Drug -Induced Liver Injury (DILI) -Suspected drugs include Isoniazid (H), Rifapentine (P), \nRifampicin (R)  ................................ ................................ ................................ ................................ ................................ .................  12 \n8.3.3 Managemen t of TPT -associated Rash - Suspected Drugs include Isoniazid (H), Rifapentine (P), \nRifampicin (R)  ................................ ................................ ................................ ................................ ................................ .................  13 \n8.4. ART for TB/HIV Co -infect ion ................................ ................................ ................................ ......................  13 \n9. HBV/HIV and HCV/HIV Co -infection Prevention and Management  .......................  1 \n9.1 Hepatitis B/HIV Co -infection  ................................ ................................ ................................ ..........................  1 \n9.1.1 Screening  ................................ ................................ ................................ ................................ ................................ ...................  1 \n9.1.2 Prevention  ................................ ................................ ................................ ................................ ................................ ................  1 \n9.1.3 Treatment  ................................ ................................ ................................ ................................ ................................ .................  2 \n9.2 Hepatitis C/HIV Co -infection  ................................ ................................ ................................ ..........................  5 \n9.2.1 Screening  ................................ ................................ ................................ ................................ ................................ ...................  5 \n9.2.2 Prevention  ................................ ................................ ................................ ................................ ................................ ................  6 \n9.2.3 Treatment of HIV/HCV Co -infection  ................................ ................................ ................................ ............................  6 \n10. ARVs for Post -exposure Prophylaxis  ................................ ................................ .................  1 \n10.1 What is P EP? ................................ ................................ ................................ ................................ ........................  1 \n10.2 Recommended ARVs for PEP  ................................ ................................ ................................ .......................  1 \n10.3 Eligibility For PEP  ................................ ................................ ................................ ................................ .............  2 \n10.4 Management and Follow Up ................................ ................................ ................................ .........................  2", "start_char_idx": 0, "end_char_idx": 5849, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "26de771d-fec6-49fb-919d-0e8fa9a4746b": {"__data__": {"id_": "26de771d-fec6-49fb-919d-0e8fa9a4746b", "embedding": null, "metadata": {"page_label": "11", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "22bcb137-1ad7-4298-84ce-6c1a55233a33", "node_type": "4", "metadata": {"page_label": "11", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4786241e72d08442c782b556f359ccc1e2f4da8ccb1a7d696538234e0dca297a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "987c7577-780d-4ac5-92c7-dbd6dc76012f", "node_type": "1", "metadata": {"page_label": "10", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f3bd53aceee0fb22e9a42753c49e20201d912ecbc2137eed6de87aa2f14e4229", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4764693e-7a8c-427e-b355-edefb7a7b9fc", "node_type": "1", "metadata": {}, "hash": "0e25dab17ee1365d8fcd01a149ec4fc3aa532d440690d457177a8ed3984229ba", "class_name": "RelatedNodeInfo"}}, "hash": "2d1c6cf6b27cbe79e80931cc777f00a2adf8e17c06f4f417291876749001c661", "text": "vii 10.5 Risk reduction cou nselling ................................ ................................ ................................ ............................  4 \n10.6 Preventing HIV exposure  ................................ ................................ ................................ ...............................  4 \n11. Pre-Exposure Prophylaxis (PrEP)  ................................ ................................ ......................  1 \n11.1 Indications for PrEP and Criteria for Eligibility  ................................ ................................ ..................  1 \n11.1.1 Indications for PrEP  ................................ ................................ ................................ ................................ ..........................  1 \n11.1.2 HIV Risk Assessment  ................................ ................................ ................................ ................................ ........................  1 \n11.1.3 Criteria for PrEP Eligibility  ................................ ................................ ................................ ................................ ............  2 \n11.2 Package of PrEP Service  ................................ ................................ ................................ ................................ . 3 \n11.2.1 Pre -Initiation Che cklist  ................................ ................................ ................................ ................................ ....................  4 \n11.2.2 Pre -initiation client education  ................................ ................................ ................................ ................................ ..... 5 \n11.3 Recommended ARVs for PrEP  ................................ ................................ ................................ .....................  5 \n11.3.1 Schema for follow up for daily oral PrEP  ................................ ................................ ................................ ................  7 \n11.3. 2 EVENT DRIVEN PrEP (ON DEMAND PrEP or 2+1+1 PrEP)  ................................ ................................ ...........  7 \n11.4 Managing Clinical and Laboratory Results on Initial and Follow -up Asse ssment  ...............  9 \n11.5 Contra -indications to Oral PrEP (daily or ED PrEP)  ................................ ................................ ....... 12 \n11.6 Criteria for Discontinuing Oral PrEP  ................................ ................................ ................................ ..... 12 \n11.7 Restarting PrEP  ................................ ................................ ................................ ................................ ...............  12 \n11.8 Improving adherence to PrEP  ................................ ................................ ................................ ..................  13 \n11.9 Monitoring Sero -conversion among PrEP users  ................................ ................................ ..............  13 \n12. People Who Inject Drugs (PWID) and HIV ................................ ................................ ....... 1 \n12.1 Intro duction  ................................ ................................ ................................ ................................ ........................  1 \n12.3 ART in HIV positive PWID  ................................ ................................ ................................ .............................  4 \n13. Annexes  ................................ ................................ ................................ ................................ ........  1 \nAnnex 1: WHO Clinical Staging of HIV Infection in Infants and Children  ................................ ...........  1 \nAnnex 2: WHO Clinical Staging of HIV Infection in Adolescents and Adults  ................................ ..... 2 \nAnnex 3: Normal Developmental Miles tones in Children  ................................ ................................ .........  3 \nAnnex 4: Tanner Staging of Sexual Maturity in Adolescents  ................................ ................................ ... 4 \nAnnex 4 A: Tanner Staging of Sexual Maturity in Girls ................................ ................................ ................................ ... 4 \nAnnex 4 B: Tanner Staging of Sexual Maturity in Boys  ................................ ................................ ................................ .. 4 \nAnnex 5: Age -Appropriate Disclosure for Child ren and Adolescents  ................................ ..................  5 \nAnnex 6: Transitioning from Adolescent to Adult HIV Services  ................................ .............................  6 \nAnnex 7: 2018 HIV Testing Services Algorithm ................................ ................................ .............................  7 \nAnnex 8: HIV Education and Adherence Counselling Content Guide  ................................ ...................  8 \nAnnex 9 A: Enhanced Adherence Counselling Content Guide  ................................ ..............................  16 \nAnnex 9 B: Case Summary Form  ................................ ................................ ................................ .......................  22 \nAnnex 9 C: Enhanced Adherence Counselling Form  ................................ ................................ .................  24 \nAnnex 9 D: Home Visit Checklist  ................................ ................................ ................................ .......................  25", "start_char_idx": 4, "end_char_idx": 5595, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "4764693e-7a8c-427e-b355-edefb7a7b9fc": {"__data__": {"id_": "4764693e-7a8c-427e-b355-edefb7a7b9fc", "embedding": null, "metadata": {"page_label": "12", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c0bea67b-e552-4000-84ad-31ceee51a4cc", "node_type": "4", "metadata": {"page_label": "12", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1fe0cbbbcfd84c079142bf3b3853857240e74a8fc7a4f46d41e1273a8899eb6f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "26de771d-fec6-49fb-919d-0e8fa9a4746b", "node_type": "1", "metadata": {"page_label": "11", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2d1c6cf6b27cbe79e80931cc777f00a2adf8e17c06f4f417291876749001c661", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "90f01af3-8aba-4613-9cb5-24f06a78f8bd", "node_type": "1", "metadata": {}, "hash": "27478cee62860625a943f3daae65194902f7e52aa8582508c29795468af50391", "class_name": "RelatedNodeInfo"}}, "hash": "0e25dab17ee1365d8fcd01a149ec4fc3aa532d440690d457177a8ed3984229ba", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n \nviii Annex 9 E: Management Protocol for Patients Switc hing to 3rd Line ART  ................................ .... 26 \nAnnex 10 A: Dosing of Solid and Liquid Formulations for Twice -Daily Dosing in Infants and \nChildren 4 Week s of Age and Older  1 ................................ ................................ .............................  28 \nAnnex 10 B: Simplified Dosing of Child -Friendly Solid and Oral Liquid Formulations for Once -\nDaily Dosing in Infants and Children 4 Weeks of Age and Older1 ................................ ..... 29 \nAnnex 10 C: Drug Dosing of Liquid Formulations for Twice -Daily Dosing in Infants Less than \n4 Weeks of Age  ................................ ................................ ................................ ................................ .........  30 \nAnnex 10 D: Simplified Dosing of INH and CTX Prophylaxis for Infants and Children Who Are \nat Least 4 Weeks of Age  ................................ ................................ ................................ .......................  30 \nAnn ex 10 E: TB Preventive Therapy dosing  ................................ ................................ ................................ . 31 \nAnnex 10 F: Ritonavir Dosing for Super -Boosting LPV/r in Children Taking Rifampicin  ....... 34 \nAnnex 11: Overlapping toxicities between AR Vs ................................ ................................ .......................  35 \nAnnex 12 A: Use of Nucleoside & Nucleotide Reverse Transcriptase Inhibitors in Adults  ..... 36 \nAnnex 12 B: Use of Non -Nucleoside Reverse Transcriptase Inhibitors for Adults  .....................  38 \nAnnex 12 C: Use of Protease Inhibitors in Adults  ................................ ................................ ......................  39 \nAnnex 12 D: Integrase Strand Transfer Inhibitors - INSTIs  ................................ ................................ .. 40 \nAnnex 13 A: Drug -Drug Interactions - NNRTIs  ................................ ................................ ...........................  41 \nAnnex 13 B: Drug -Drug Interactions \u2013 PIs ................................ ................................ ................................ .... 45 \nAnnex 13 C: Drug -Drug Interactions \u2013 INSTIs  ................................ ................................ .............................  52 \nAnnex 14: Health Facility Assessment to Provide Community ART Distribution  .......................  54 \nAnnex 15: Creatinine Clearance  ................................ ................................ ................................ .........................  55 \nAnnex 16: Immune Reconstitution Inflammatory Syndrome  ................................ ..............................  56 \nAnnex 17: HTS Adult Screening Tool Enhancement  ................................ ................................ .................  59 \nAnnex 18: List of Contributors and Affiliation  ................................ ................................ ............................  60 \nAnnex 19: List of Participating Organizations and Agencies  ................................ ................................  62", "start_char_idx": 0, "end_char_idx": 3224, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "90f01af3-8aba-4613-9cb5-24f06a78f8bd": {"__data__": {"id_": "90f01af3-8aba-4613-9cb5-24f06a78f8bd", "embedding": null, "metadata": {"page_label": "13", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": 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"4764693e-7a8c-427e-b355-edefb7a7b9fc", "node_type": "1", "metadata": {"page_label": "12", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0e25dab17ee1365d8fcd01a149ec4fc3aa532d440690d457177a8ed3984229ba", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ef88ffb0-5f21-4f72-9e78-2ff8ba724253", "node_type": "1", "metadata": {}, "hash": "617c5d7906e1c6a8bd9659a6fc629c417d0f4a2f0cc0a076b89223d79aa3667e", "class_name": "RelatedNodeInfo"}}, "hash": "27478cee62860625a943f3daae65194902f7e52aa8582508c29795468af50391", "text": "ix List of Figures  \nFigure 2.1 Algorithm for Early Infant Diagnosis in Infants and Children < 18 months of age  ................................ .. 9 \nFigure 2.2: Birth Testing Algor ithm  ................................ ................................ ................................ ................................ ....................  11 \nFigure 2.3: HIV Testing Services Algorithm  ................................ ................................ ................................ ................................ .... 13 \nFigure 2.4 Dual HIV/syphilis Testing Algorithm  ................................ ................................ ................................ ..........................  15 \nFigure 2.5: Managing Patients on ART Who Present with a New Negative HIV Antibody Test  ............................  20 \nFigure 4.1: Routine Screening for Cryptococcal Meningitis for HIV -infected Adults and Adolescents  .............  14 \nFigure 4.2: Generalized Anxiety Disorder Assessment (GAD -7) ................................ ................................ ..........................  32 \nFigure 4.3: Management of Severe Acute Malnutrition in Children  ................................ ................................ ....................  38 \nFigure 4.4: Management of Malnutrition in Adults with HIV  ................................ ................................ ................................ . 39 \nFigure 5.1: Adherence Preparation, Monitoring and Support  until Viral Load after 3 Months on ART  ...............  2 \nFigure 5.2: Adherence Counselling and Education for Patients Preparing to Initiate 2nd Line or 3rd Line \nART  ................................ ................................ ................................ ................................ ................................ ................................ .....................  34 \nFigure 5.3: Ident ifying, Tracing and Supporting Patients who Default from Care  ................................ .......................  35 \nFigure 6.1: Optimizing ART Regimens for Children and adolescents <15 years Weighing < 30 kg on First \nLine ART  ................................ ................................ ................................ ................................ ................................ ................................ ..............  8 \nFigure 6.2: Optimizing ART Regimens for Children and Adolescents Weighing \u2265 30 kg  or \u2265 15 years old on \nFirst Line ART  ................................ ................................ ................................ ................................ ................................ ................................ ... 9 \nFigure 6.3: General Principles for Managing Adverse Drug Reactions  ................................ ................................ ..............  11 \nFigure 6.4: Managing Single Drug Substitutions for ART  ................................ ................................ ................................ .........  12 \nFigure 6.5: Managing TDF -Associated Kidney Toxicity  ................................ ................................ ................................ ............  13 \nFigure 6.6: Viral Load Monitoring of Patients on ART (1st Line or 2nd Line)  ................................ ...............................  18 \nFigure 8.1: TB diagnosis - GeneXpert Ultra algorithm  ................................ ................................ ................................ ...................  5 \nFigure 8.2: Use of TB -LAM for Diagnosis of TB among PLHIV  ................................ ................................ ................................ .. 8 \nFigure 11.1 : Package of Service for PrEP  ................................ ................................ ................................ ................................ ............  3 \nFigure 11.2: Schema for Follow -up for Daily Oral PrEP  ................................ ................................ ................................ ...............  7 \nFigure 11.3 Schema for Event -Driven PrEP  ................................ ................................ ................................ ................................ ....... 8 \nFigure 11.4 Schema for Initiation and Follow -up for Event -driven PrEP  ................................ ................................ ...........  8", "start_char_idx": 4, "end_char_idx": 4379, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ef88ffb0-5f21-4f72-9e78-2ff8ba724253": {"__data__": {"id_": "ef88ffb0-5f21-4f72-9e78-2ff8ba724253", "embedding": null, "metadata": {"page_label": "14", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", 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"last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "27478cee62860625a943f3daae65194902f7e52aa8582508c29795468af50391", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "abecce2a-989e-4a1c-bead-b50aab1f2035", "node_type": "1", "metadata": {}, "hash": "cca7ad61d9126afc7b12b407142aeb45dd285f26e62000c69974cf027f14dd4c", "class_name": "RelatedNodeInfo"}}, "hash": "617c5d7906e1c6a8bd9659a6fc629c417d0f4a2f0cc0a076b89223d79aa3667e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n \nx List of Tables  \nTable 2.1: HTS Recommendations for Different Populations and Settings  ................................ ................................ ........ 3 \nTable 2.2: Summary of HIV Testing Services Package  ................................ ................................ ................................ ..................  6 \nTable 2.3: Presumptive Diagnosis of HIV in children <18 months while awaiting DNA PCR Results  ................  10 \nTable 2 .4: Approaches to Improve Linkage to Treatment and Prevention Services  ................................ ..................  16 \nTable 2.5: Recommendations for Retesting HIV Negative C lients  ................................ ................................ .......................  18 \nTable 3.1: Initial Clinical Evaluation for PLHIV (History and Physical Examination)  ................................ ...................  2 \nTable 3.2: Baseline Laboratory Investigatio ns for PLHIV  ................................ ................................ ................................ ...........  4 \nTable 3.3: Differentiated Care Based on Initial Patient Presentation  ................................ ................................ ...................  7 \nTable 3.4: Management of patients who are presenting well: WHO Stage 1 or 2, and CD4 count > 200 \ncell/mm3  ................................ ................................ ................................ ................................ ................................ ................................ ............  8 \nTable 3.5: Differentiated Follow -up of Patients Beyond the First 6 Months of ART  ................................ ......................  9 \nTable 3.6: Summary of Clinical and Laboratory Monitoring for PLHIV1 ................................ ................................ ..........  11 \nTable 4.1: Components of the Standard Package of Care for PLHIV  ................................ ................................ ......................  2 \nTable 4.2: Domains and Components for PHDP Serv ices ................................ ................................ ................................ ............  5 \nTable 4.2a: Components of screening for GBV/IPV (LIVES)  ................................ ................................ ................................ ...... 7 \nTable 4.3: Co -trimoxazole Preventive therapy  ................................ ................................ ................................ ................................ . 8 \nTable 4.4: Daily Dose of Cotrimoxazole Preventive Therapy  ................................ ................................ ................................ .... 9 \nTable 4.5: Management of Drug -Associated Skin Rash  ................................ ................................ ................................ ................  9 \nTable 4.6a: Standard Cotrimoxazole Desensitization Regimen (8 days)  ................................ ................................ ..........  10 \nTable 4.6b: Rapid Cotrimoxazole Desensitization Regimen (6 hours)  ................................ ................................ ..............  10 \nTable 4.7: Treatment of Cryptococcal Meningitis  ................................ ................................ ................................ ........................  12 \nTable 4.8: Contraceptive Methods for PLHIV Based on WHO 2018 Medical Eligibility Criteria  ...........................  16 \nTable 4.9: Pr e-Conception Counselling Messages and Services for PLHIV  ................................ ................................ ...... 17 \nTable 4.10: Lifestyle Modifications to Prevent and Manage Cardiovascu lar Disease in PLHIV  ............................  19 \nTable 4.11 : Hypertension Screening, Diagnosis, and Initial Management for Adult PLHIV  ................................ .... 20 \nTable 4.12: Type 2 Diabetes Mellitus Screening, Dia gnosis, and Initial Management for PLHIV  .........................  21 \nTable 4.12: Dyslipidemia Screening, Diagnosis, and Initial Management for PLHIV  ................................ ..................  22 \nTable 4.13: Chronic Kidney Disease Screening, Diagnosis, and Initial Management for PLHIV  ...........................  23 \nTable 4.15: Patient Health Questionnaire -9 (PHQ -9) for Depression Screening  ................................ ..........................  26 \nTable 4.16: CRAFFT Screening Interview for Adolescents  ................................ ................................ ................................ ...... 28 \nTable 4.17: CAGE -AID Screening Questions for Adults  ................................ ................................ ................................ .............  29 \nTable 4.18: Addiction Support Based on Stages of Change  ................................ ................................ ................................ ..... 30 \nTable 4.19: Interpretation of MUAC Results for Children and Pregnant/Lactating Women  ................................ .. 37 \nTable 4.20: Interpretation of Z -scores for Children  ................................ ................................ ................................ ....................  37 \nTable 4.21: Interpretation of BMI Results for Adults  ................................ ................................ ................................ .................  40 \nTable 4.22: Kenya Expanded Program on Immunizations 2016 Schedule  ................................ ................................ ...... 40", "start_char_idx": 0, "end_char_idx": 5589, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "abecce2a-989e-4a1c-bead-b50aab1f2035": {"__data__": {"id_": "abecce2a-989e-4a1c-bead-b50aab1f2035", "embedding": null, "metadata": {"page_label": "15", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d78b15d3-ab1b-457d-94fa-c51d83d49104", "node_type": "4", "metadata": {"page_label": "15", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8ad63bac32e11d95597a904702e8ac8a23f1aaddf798af61331869b42c35091b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ef88ffb0-5f21-4f72-9e78-2ff8ba724253", "node_type": "1", "metadata": {"page_label": "14", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "617c5d7906e1c6a8bd9659a6fc629c417d0f4a2f0cc0a076b89223d79aa3667e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f004daf7-8058-4cd7-975e-406746102049", "node_type": "1", "metadata": {}, "hash": "a0b69214032f9fecd8530a5293f01a379ea81e9de9b71661cabf836912c3645a", "class_name": "RelatedNodeInfo"}}, "hash": "cca7ad61d9126afc7b12b407142aeb45dd285f26e62000c69974cf027f14dd4c", "text": "xi Table 4.23: Vaccinations in Adolescents and Adults Living wit h HIV  ................................ ................................ ................  41 \nTable 5.1: Treatment Preparation and Adherence Counselling Guide  ................................ ................................ .................  7 \nTable 5.2: Components of HIV Education (see Annex 8 for detai led content guide)  ................................ ..................  10 \nTable 5.3: Adherence Support and Retention Interventions  ................................ ................................ ................................ .. 11 \nTable 5.4: ART Readiness Assessment Form  ................................ ................................ ................................ ................................ .", "start_char_idx": 4, "end_char_idx": 796, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f004daf7-8058-4cd7-975e-406746102049": {"__data__": {"id_": "f004daf7-8058-4cd7-975e-406746102049", "embedding": null, "metadata": {"page_label": "15", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], 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"last_accessed_date": "2024-01-25"}, "hash": "cca7ad61d9126afc7b12b407142aeb45dd285f26e62000c69974cf027f14dd4c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6fe83d1b-2b11-44e7-8c3f-6a22e22cb396", "node_type": "1", "metadata": {}, "hash": "e8eea75187cfae529a23ebda0b1330b5af15be8c31b35f00e7eae9f216238e6b", "class_name": "RelatedNodeInfo"}}, "hash": "a0b69214032f9fecd8530a5293f01a379ea81e9de9b71661cabf836912c3645a", "text": "xi Table 4.23: Vaccinations in Adolescents and Adults Living wit h HIV  ................................ ................................ ................  41 \nTable 5.1: Treatment Preparation and Adherence Counselling Guide  ................................ ................................ .................  7 \nTable 5.2: Components of HIV Education (see Annex 8 for detai led content guide)  ................................ ..................  10 \nTable 5.3: Adherence Support and Retention Interventions  ................................ ................................ ................................ .. 11 \nTable 5.4: ART Readiness Assessment Form  ................................ ................................ ................................ ................................ . 13 \nTable 5 .5: Age -appropriate Involvement of Child/Adolescent in HIV Education and Adherence Counselling\n ................................ ................................ ................................ ................................ ................................ ................................ ..............................  15 \nTable 5.6: Unique Considerations for Caregivers, Children and Adolescents  ................................ ................................  16 \nTable 5.7: Treatment Preparation and Support for Chil dren (\u2264 9 years) and Caregivers  ................................ ....... 17 \nTable 5.8: Treatment Preparation and Support for Adolescents (10 -19 years)  ................................ ...........................  18 \nTable 5.9: Treatment Preparation and Support for Adults  ................................ ................................ ................................ ..... 19 \nTable 5.10: Adherence Monitoring Strategies  ................................ ................................ ................................ ...............................  21 \nTable 5.11: Morisky Medication Adherence Scale (MMAS -4) ................................ ................................ ................................  23 \nTable 5.12: Morisky Medication Adherence Scale (MMAS -8) ................................ ................................ ................................  24 \nTable 5.13: Adherence Rate Based on Pill Counts  ................................ ................................ ................................ .......................  25 \nTable 5.14: Adherence Counselling and Support During the First 3 Months of ART  ................................ .................  26 \nTable 5.15: Assessment for Barriers to Adherence  ................................ ................................ ................................ .....................  27 \nTable 5.16: Adherence Counselling and Support for Patients with Viral Load < 50 copies/ml  ............................  29 \nTable 5.17 Viral Load Monitoring Cut -Offs  ................................ ................................ ................................ ................................ ..... 30 \nTable 5.18: Components of Enhanced Adherence Co unselling Sessions (Annex 9A for detailed content \nguide)  ................................ ................................ ................................ ................................ ................................ ................................ .................  32 \nTable 6.1: Special Considerat ions for Timing of ART Initiation  ................................ ................................ ...............................  2 \nTable 6.2: Preferred First -line ART Regimens and Dosing for Children, Adolescents and Adults 1 .......................  3 \nTable 6.3: Use of Alternative ARVs in First -Line Regimens 1 ................................ ................................ ................................ .... 4 \nTable 6.4: Dosing and Administration of Dolutegravir  ................................ ................................ ................................ ................  5 \nTable 6.5: Common Significant Adverse Drug Reactions  ................................ ................................ ................................ .........  10 \nTable 6.6: ARV, CTX and Fluconazole Adjustments in Renal and Hepatic Impairment1 ................................ ...........  14 \nTable 6.7: Management of AZT -Associated Bone Marrow Suppression  ................................ ................................ ...........  15 \nTable 6.8: Management of Drug -Related Hepatotoxicity  ................................ ................................ ................................ .........  15 \nTable 6.9: Diagnosis and Management of Abacavir Hypersensitivity Reaction  ................................ ............................  16 \nTable 6.10: Recommended Second -line ART Regimens in Infants, Children, Adolescents and Adults, \nexcluding TB/HIV co -infection 1 ................................ ................................ ................................ ................................ ...........................  19 \nTable 6.11: Possible Third -line ART in Children, Adolescents and Adults  ................................ ................................ ...... 21 \nTable 7.1: Essential Package of Antenatal Care  ................................ ................................ ................................ ...............................  1 \nTable 7.2: Summary of Use of ART for HIV Positive Pregnant and Breastfeeding Women  ................................ ........ 3 \nTable 7.3: ARV Prophylaxis for HIV -Exposed Infants  ................................ ................................ ................................ ...................  6 \nTable 7.4: Dosing of ARVs for Infant Prophylaxis from Birth to 12 Weeks of Age  ................................ ..........................  7 \nTable 7.5: NVP Dosing for Infant Prophylaxi s beyond 12 Weeks of Age *  ................................ ................................ ..........  7 \nTable 7.6: AZT Dosing for Infant Prophylaxis beyond 12 Weeks of Age *  ................................ ................................ ..........  7", "start_char_idx": 4, "end_char_idx": 6131, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6fe83d1b-2b11-44e7-8c3f-6a22e22cb396": {"__data__": {"id_": "6fe83d1b-2b11-44e7-8c3f-6a22e22cb396", "embedding": null, "metadata": {"page_label": "16", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3ea28eca-0768-43fc-b620-0a62a4d352cb", "node_type": "4", "metadata": {"page_label": "16", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a4fe948c62aac73aa8130837b012426b977745f019bb9f2be4cd8bf18611405d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f004daf7-8058-4cd7-975e-406746102049", "node_type": "1", "metadata": {"page_label": "15", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a0b69214032f9fecd8530a5293f01a379ea81e9de9b71661cabf836912c3645a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "485a6ead-d9cd-4c50-95ef-970dd6f7aeeb", "node_type": "1", "metadata": {}, "hash": "568ab92f99121ee0092631fe526196bae2d838e7164718d55bc64928435a1abe", "class_name": "RelatedNodeInfo"}}, "hash": "e8eea75187cfae529a23ebda0b1330b5af15be8c31b35f00e7eae9f216238e6b", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n \nxii Table 7.7: Complementary Foods for Children 6 -24 Months Old  ................................ ................................ ...........................  9 \nTable 8.1: TB Diagnosis in Children <10 Years Old  ................................ ................................ ................................ ........................  6 \nTable 8.2: Drug Susceptible TB Treatment Regimen for Children, Adolescents and Adults  ................................ ...... 7 \nTable 8.3: Recommended TPT Regimens for PLHIV  ................................ ................................ ................................ ..................  10 \nTable 8.4: Grading and Management of DILI  ................................ ................................ ................................ ................................ .. 12 \nTable 8.5: Management of TPT -Associated Skin Rash  ................................ ................................ ................................ ...............  13 \nTable 8.6: Preferred ART Regimens for TB/HIV Co -infection for Patients Newly Initiating 1st Line ART 1 ... 14 \nTable 8.7: Preferred ART Regimens for Patients who Develop TB while Virally Suppressed on 1st Line ART \n1,2 ................................ ................................ ................................ ................................ ................................ ................................ ..........................  15 \nTable 8.8: Recommended ART Regimens for Patients who Develop TB while Failing 1st Line ART 1 ..............  16 \nTable 9.1: Hepatitis B Vaccination Schedule for HIV -positive Adolescents and Adults  ................................ ...............  2 \nTable 9.2: Summary of Initial Clinical and Laboratory Evaluation in HIV/HBV Co -infection  ................................ ... 3 \nTable 9.3: Dose Adjustment of TDF and  3TC in Patients with Impaired Renal Function 1 ................................ .........  4 \nTable 9.4: Summary of Initial Clinical and Laboratory Evaluation in HIV/HCV Co -infection  ................................ ... 6 \nTable 9.5: Recommended DAA for the Treatment of HCV among PLHIV  ................................ ................................ ............  7 \nTable 10.1: Recommended ARVs for PEP  ................................ ................................ ................................ ................................ ...........  1 \nTable 10.2: Recommendations for PEP Management and Follow -up ................................ ................................ ...................  3 \nTable 10.3 Considerations for special circumstances  ................................ ................................ ................................ ...................  4 \nTable 11:1 HIV Screening questions  ................................ ................................ ................................ ................................ .....................  2 \nTable 11.2: Pre -Initiation Assessment Checklist  ................................ ................................ ................................ .............................  4 \nTable 11.3: Client Education Checklist  ................................ ................................ ................................ ................................ .................  5 \nTable 11.4: Antiretrovirals for Use in PrEP  ................................ ................................ ................................ ................................ ....... 6 \nTable 11. 5 Initial & follow up laboratory test  ................................ ................................ ................................ ................................ ... 9 \nTable 11.6: Managing Clinical and Laboratory Results on Initial and Follow -up Assessment  ..............................  10 \nTable 11.7: Summary of PrEP Initial and Follow -up Assessment  ................................ ................................ ........................  11 \nTable 11.7 Cont: Summary of PrEP Initial and Follow -up Assessment  ................................ ................................ .............  12 \nTable 12.1: Comprehensive Package of Harm Reduction for PWID  ................................ ................................ ......................  2 \nTable 12.2: Summary of ART Recommendations for PWID  ................................ ................................ ................................ ....... 5", "start_char_idx": 0, "end_char_idx": 4516, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "485a6ead-d9cd-4c50-95ef-970dd6f7aeeb": {"__data__": {"id_": "485a6ead-d9cd-4c50-95ef-970dd6f7aeeb", "embedding": null, "metadata": {"page_label": "17", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b1bdb1fc-8ed6-40e8-8e14-d1a047e0c163", "node_type": "4", "metadata": {"page_label": "17", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "723cf18047ad88ce9c68296d5b08fb590d3c16d9c859e1bb3adae8dc6e482873", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6fe83d1b-2b11-44e7-8c3f-6a22e22cb396", "node_type": "1", "metadata": {"page_label": "16", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e8eea75187cfae529a23ebda0b1330b5af15be8c31b35f00e7eae9f216238e6b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6c86064a-0505-4784-b297-bed05720c41f", "node_type": "1", "metadata": {}, "hash": "4e93ccc53a484d3bb537abcb8a70717c4b3c9e1faea25f30542f3962eeb5b36c", "class_name": "RelatedNodeInfo"}}, "hash": "568ab92f99121ee0092631fe526196bae2d838e7164718d55bc64928435a1abe", "text": "xiii Acronyms and Abbreviations  \nAbbreviations and Names of Antiretroviral Drugs  Other Acronyms and Abbreviations  \n3TC  Lamivudine  HTS  HIV Testing Services  \nABC  Abacavir  ICF  Intensified Case Finding  \nATV  Atazanavir  IEC  Information, Education and Communication  \nATV/r  Atazanavir/ritonavir  INH  Isoniazid  \nAZT  Zidovudine  INSTI  Integrase Strand Transfer Inhibitor  \nDRV  Darunavir  IPD  In-Patient Department  \nDRV/r  Darunavir/ritonavir  IPT  Isoniazid Preventive Therapy  \nDTG  Dolutegravir  IPV Intimate Partner Violence  \nEFV  Efavirenz  IRIS  Immune Reconstitution Inflammatory \nSyndrome  \nETR  Etravirine  ITN  Insecticide Treated Mosquito Nets  \nFTC  Emtricitabine  IUD  Intrauterine Device  \nLPV  Lopinavir  KEPI  Kenya Expanded Program of Immunization  \nLPV/r  Lopinavir/ritonavir  KS  Kaposi\u2019s Sarcoma  \nNVP        Nevirapine  LEEP  Loop Electrosurgical Excision Procedure  \nRAL                                Raltegravir  L&D  Labor And Delivery  \nRTV  Ritonavir  LIVES  Listen, Inquiry, Validate, Enhance Safety and \nSupport  \nTDF  Tenofovir Disoproxil Fumarate  LLV  Low Level Viremia  \nOther Acronyms and Abbreviations  LRF  Laboratory Requisition Form  \nACE -I Angiotensin -Converting Enzyme Inhibitor  LP Lumbar Puncture  \nADR  Adverse Drug Reaction  MAC  Mycobacterium Avium Complex  \nAIDS  Acquired Immunodeficiency Syndrome  MAT  Medically Assisted Therapy  \nALT  Alanine Transaminase  MCH  Maternal Child Health  \nALP  Alkaline Phosphatase  MNCH/FP  Maternal, Neonatal and Child Health/Family \nPlanning  \nAHI Acute Hiv Infection  MDT  Multi -Disciplinary Team  \nANC  Antenatal Care  MEC  Medical Eligibility Criteria  \nA&E  Accident And Emergency  MOH  Ministry of Health  \nARB  Angiotensin -Receptor Blocker  MSM  Men Who Have Sex with Men  \nART  Antiretroviral Therapy  MUAC  Mid -Upper Arm Circumference  \nARV  Antiretroviral Drug(S)  NACS  Nutritional Assessment, Counselling and \nSupport  \nAST  Aspartate Transaminase  NASCOP  National AIDS And STI Control Program  \nBD Twice Daily  NCD  Non -Communicable Diseases  \nBF Breastfeeding  NHRL  National H IV Reference Laboratory  \nBMI  Body Mass Index  NNRTI  Non -Nucleoside Reverse Transcriptase \nInhibitor  \nBP Blood Pressure  NRTI  Nucleoside Reverse Transcriptase Inhibitor  \nCAG  Community Art Groups  NSP  Needle and Syringe Programmes  \nCCC  Comprehensive Care Centre  NRTI  Nucleotide Reverse Transcriptase Inhibitor  \nCrCl  Creatinine Clearance  OD  Once Daily", "start_char_idx": 4, "end_char_idx": 2463, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6c86064a-0505-4784-b297-bed05720c41f": {"__data__": {"id_": "6c86064a-0505-4784-b297-bed05720c41f", "embedding": null, "metadata": {"page_label": "18", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "39150fdd-5bb8-4d5c-abf2-b31dbd9896ca", "node_type": "4", "metadata": {"page_label": "18", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "dfd1d58754edd4425d22d2570dbced7c183621646f2431add029a1b5b4d91e60", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "485a6ead-d9cd-4c50-95ef-970dd6f7aeeb", "node_type": "1", "metadata": {"page_label": "17", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "568ab92f99121ee0092631fe526196bae2d838e7164718d55bc64928435a1abe", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "132b6dfa-fdbd-4e46-9855-62ef734ba024", "node_type": "1", "metadata": {}, "hash": "07d484087a668f86e8353d58462297f786250ac172d0974546ddaa6c003e734d", "class_name": "RelatedNodeInfo"}}, "hash": "4e93ccc53a484d3bb537abcb8a70717c4b3c9e1faea25f30542f3962eeb5b36c", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n \nxiv CHV  Community Health Volunteer  OI  Opportunistic Infection  \nCITC  Client -Initiated HIV Testing and Counselling  OPD  Outpatient Department  \nCM Cryptococcal Meningitis  OST  Opioid Substitution Therapy  \nCMV  Cytomegalovirus  OVC  Orphans And Vulnerable Children  \nCNS  Central Nervous System  PCP  Pneumocystis Jirovecii Pneumonia  \nCPT  Cotrimoxazole Preventive Therapy  PCR  Polymerase Chain Reaction  \nCrCl  Creatinine Clearance  PEP  Post -Exposure Prophylaxis  \nCTX  Cotrimoxazole  PrEP  Pre-Exposure Prophylaxis  \nCYP450  Cytochrome P450  PGL  Persistent Generalized Lymphadenopathy  \nDAAs  Direct Acting Antiviral Therapies  PHQ -9  Patient Health Questionnaire -9 \nDBS  Dried Blood Spot  PHDP  Positive Health, Dignity, and Prevention  \nDICEs  Drop -In-Centres  PI  Protease Inhibitor  \nDMS  Director of Medical Services  PITC  Provider Initiated HIV Testing and Counselling  \nDNA  Deoxyribonucleic acid  PLHIV  People Living With HIV  \nDOT  Directly observed therapy  PLLV  Persistent Low-level Viremia  \nDS Double strength  PML                                 Progressive Multifocal Leukoencephalopathy  \nDRT  Drug Resistance Testing  PMTCT                           Prevention of mother -to-child transmission  \nED - PrEP  Event Driven PrEP  PPE                                  Papular Pruritic Eruptions  \nEDTA  Ethylenediaminetetraacetic acid  PrEP  Pre-exposure Prophylaxis  \nECP  Emergency contraceptive pill  PTB  Pulmonary Tuberculosis  \nEID  Early Infant Diagnosis  PWID  People Who Inject Drugs  \neMTCT  Elimination of Mother to Child Transmission  NHCSC  National HIV Clinical Support Centre  \nEPTB  Extra -pulmonary Tuberculosis  RAST  Rapid Assessment Tool  \nFDA  Food and Drug Administration  RNA  Ribonucleic Acid \nFBC  Full Blood Count  RPR  Rapid Plasma Reagin  \nFBS Fasting Blood Sugar  sCrAg  Serum Cryptococcal Antigen  \nFDC  Fixed Dose Combination  SRH  Sexual and Reproductive Health  \nFLP  Fasting Lipid Profile  SS  Single Strength  \nFP  Family Planning  STI  Sexually Transmitted Infection  \nFTC  Emtriciatabine  TB  Tuberculosis  \nGIT  Gastro -intestinal tract  TB LAM  Tuberculosis Lipoarabinomannan  \nGOK  Government of Kenya  TDF  Tenofovir  \nGBV  Gender -Based Violence  TT Tetanus Toxoid  \nHb  Hemoglobin  TWG  Technical Working Group  \nHBV  Hepatitis B virus  ULN  Upper Limit of Normal  \nHBsAg  Hepatitis B Surface Antigen  UTI Urinary Tract Infection  \nHCV  Hepatitis C Virus  VIA  Visual Inspection with Acetic Acid  \nHCW  Health Care Worker  VILI  Visual Inspection with Lugol\u2019s Iodine  \nHEI  HIV Exposed Infant  VL  Viral Load  \nHIV  Human immunodeficiency Virus  VMMC  Voluntary Medical Male Circumcision  \nHIVST  HIV Self-testing  WHO  World Health Organization", "start_char_idx": 0, "end_char_idx": 2777, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "132b6dfa-fdbd-4e46-9855-62ef734ba024": {"__data__": {"id_": "132b6dfa-fdbd-4e46-9855-62ef734ba024", "embedding": null, "metadata": {"page_label": "19", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f73fc514-129e-411d-abfb-fd3325e7d08f", "node_type": "4", "metadata": {"page_label": "19", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b657f47c64be37af8c3cf97a24366470c05dd527fed9dc7dea82083957a3d851", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6c86064a-0505-4784-b297-bed05720c41f", "node_type": "1", "metadata": {"page_label": "18", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4e93ccc53a484d3bb537abcb8a70717c4b3c9e1faea25f30542f3962eeb5b36c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5a853088-17a0-4c66-b782-ef594f027603", "node_type": "1", "metadata": {}, "hash": "aa429e65de1479b33aab1a57ddcb5dbf9abff28a1ca97b35f5fdbd579a3d8900", "class_name": "RelatedNodeInfo"}}, "hash": "07d484087a668f86e8353d58462297f786250ac172d0974546ddaa6c003e734d", "text": "Summary of Key Recommendations  \n1 - 1   \n1. Summary of Key Recommendations  \n \n1.1 HIV Testing Services (HTS) and Linkage to Treatment and Prevention  \n\u2022 HIV testing should be voluntary and conducted ethically in an environment where \nConsent, Confidentiality, Counselling, Correct results, Connection (linkage) and Creating \nan enabling environment can be assured  \n\u2022 To optimize access to testing services, HIV testing can be conducted in 2 different settings:  \n\u25aa Facility -based  \n\u25aa Community -based  \n\u2022 Targeted HIV testing is recommended which involves index client listing of contacts, HIV \nself-testing and use of HTS screening tool to identify people at risk of HIV infection as \neligible for testing  \n\u2022 Serial testing, using ap proved rapid HIV antibody testing kits, is used to diagnose HIV \ninfection in children older than 18 months, adolescents, and adults. An HIV -positive \ndiagnosis will be made using three consecutive reactive assays  \n \n1.2 Initial Evaluation and Follow -up for PLHIV  \n\u25cf Initial clinical evaluation of PLHIV entails CD4 monitoring, which is recommended for:  \n\u25aa Baseline investigation for all PLHIV  \n\u25aa Any patient with suspected treatment failure  \n\u25aa Any patient returning to care after interrupting treatment for > 3 months  \n\u25aa Any patient on fluconazole maintenance therapy or on dapsone as prophylaxis, to \ndetermine when prophylaxis can be discontinued  \n\u25cf Advanced HIV Disease is defined as:  \n\u25aa Adults, adolescents, and children five years and older as having a CD4 cell count of \nless than 200 cells/mm3 or \n\u25aa WHO clinical stage 3 or 4 disease  \n\u25aa All children younger than five years  \n\u25cf All PLHIV presenting with Advanced HIV Disease (AHD) should be offered a package of \ncare that includes timely initiation of ART, screening, diagnosis, prophyl axis, and \nmanagement  of opportunistic infections.  \n\u25cf Frequency of routine VL monitoring:  \n\u25aa For PCR positive HEIs: at baseline (at the time of ART initiation)  \n\u25aa Age 0 -24 years old: 3 months after ART initiation, and then every 6 months  \n\u25aa Age \u2265 25 years old: 3 months after ART initiation, then at month 12, and then annually", "start_char_idx": 3, "end_char_idx": 2133, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5a853088-17a0-4c66-b782-ef594f027603": {"__data__": {"id_": "5a853088-17a0-4c66-b782-ef594f027603", "embedding": null, "metadata": {"page_label": "20", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "147c869a-d57e-436a-b40b-118e58e2f1f6", "node_type": "4", "metadata": {"page_label": "20", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4be807733f9ee9a63fcec7e6b2f1cb7bd4036271dc8f7f34560e936f5cc915d2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "132b6dfa-fdbd-4e46-9855-62ef734ba024", "node_type": "1", "metadata": {"page_label": "19", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "07d484087a668f86e8353d58462297f786250ac172d0974546ddaa6c003e734d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4d41cb52-b901-43f0-9842-4e0bef3c9c1e", "node_type": "1", "metadata": {}, "hash": "e7af99f72d1eedf803ba759b9262b2e37f55a3d4322badce7ee6607365dd2ef6", "class_name": "RelatedNodeInfo"}}, "hash": "aa429e65de1479b33aab1a57ddcb5dbf9abff28a1ca97b35f5fdbd579a3d8900", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n1 - 2  \u25aa Pregnant or breastfeeding: at confirmation of pregnancy (if already on ART) or 3 \nmonths after ART initiation (if ART initiated during pregnancy/breastfeeding), and \nthen every 6 months until c omplete cessation of breastfeeding  \n\u25aa Before any drug substitution (if no VL result available from the prior 6 months)  \n\u25aa Three months after any regimen modification (including single -drug substitution)  \n\u25cf PLHIV should receive differentiated care based on initial e valuation (advanced vs. well) \nand follow up (established vs not established on ART)  \n \n1.3 Standard Package of Care for PLHIV  \nConsists of 8 components:  \n1. Antiretroviral Therapy  \n\u25aa All PLHIV are eligible for ART irrespective of CD4 cell count or percentage, WHO \nclinical stage, age, pregnancy status, or comorbidities  \n\u25aa ART should be initiated as soon as the patient is ready to start, preferably within \ntwo weeks from time of HIV diagnosis (except for patients with cryptococcal \nmeningitis or TB meningi tis) \n2. Positive Health, Dignity, and Prevention, GBV/IPV & HIV Education and Counselling  \n\u25aa All patients should be counselled and supported for disclosure of HIV status; \npartner/ family testing and engagement; condom use; family planning; sexually \ntransmitted infections screening; treatment adherence; and pre -exposure \nprophylaxis for HIV -negative sexual partners  \n\u25aa All females aged 15 -49 years and emancipated minors accessing HIV care services \nshould be screened for Intimate Partner Violence (IPV) as p art of the standard \npackage of care  \n\u25aa All PLHIV should be provided with HIV education and counselling  \n3. Screening for and Prevention of Specific Opportunistic Infections  \nCotrimoxazole Preventive Therapy (CPT) is no longer recommended as life -long \nprophylaxis, and is only recommended in the following sub populations, unless they \nhave an allergy to sulfur drugs or develop toxicity from CPT  \n\u25cf All HIV Exposed Infants  \n\u25cf HIV infected children < 15 years of age  \n\u25cf All PLHIV > 15 years of age:  \no Living in malaria -endemic zones  (Refer to the National Guidelines for the \nDiagnosis, Treatment and Prevention of Malaria in Kenya for the current Kenya \nMalaria endemicity map)  \no Presenting with WHO stage 3 or 4 event, or meeting the AHD criteria  \no Suspected treatment fa ilure  \n\u25cf All Pregnant and Breast -feeding women", "start_char_idx": 3, "end_char_idx": 2404, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "4d41cb52-b901-43f0-9842-4e0bef3c9c1e": {"__data__": {"id_": "4d41cb52-b901-43f0-9842-4e0bef3c9c1e", "embedding": null, "metadata": {"page_label": "21", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d2373f3f-3b6a-4e5c-b72e-f944e551ba3a", "node_type": "4", "metadata": {"page_label": "21", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6b6c0cba34c4b71772914da4563b09cb827da55588125196b0ffb3f9641931d0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5a853088-17a0-4c66-b782-ef594f027603", "node_type": "1", "metadata": {"page_label": "20", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "aa429e65de1479b33aab1a57ddcb5dbf9abff28a1ca97b35f5fdbd579a3d8900", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "16091ed1-021c-4338-96f3-e69b73754e91", "node_type": "1", "metadata": {}, "hash": "50fdca657b5cc419973a6e93b6c053d515528cd74253336725bf3c779a26c0ba", "class_name": "RelatedNodeInfo"}}, "hash": "e7af99f72d1eedf803ba759b9262b2e37f55a3d4322badce7ee6607365dd2ef6", "text": "Summary of Key Recommendations  \n1 - 3  \u25aa When dapsone (as a substitute for CPT) is being used as PCP prophylaxis, it is only \nrecommended for patients in WHO Stage 4 and/or absolute CD4 count \u2264 200 \ncells/mm3 (or CD4% \u2264 25% for children \u2264 5 years old), and should be discontinued \nonce a patient achieves viral suppression and a sustained CD4 count of > 200 \ncell/mm3 (or > 25% for children \u2264 5 years old) for at least 6 months  \n\u25aa All PLHIV should be screened for TB at  every visit using the Intensified Case Finding \n(ICF) tool and assessed for TB Preventive Therapy (TPT) if screened negative for TB  \n\u25aa All adolescent and adult PLHIV with a baseline CD4 count of \u2264 200 cells/mm3 should \nbe screened for cryptococcal infection us ing the serum CrAg test  \n4. Reproductive Health Services  \n\u25aa All PLHIV should be screened for STI at every clinic visit  \n\u25aa Pregnancy status should be determined for all women of reproductive age at every \nvisit and their contraception need determined and met  \n\u25aa All HIV p ositive women between the ages of 18 - 65 years should be screened for \ncervical cancer (HPV testing conducted every 2 years or Annually if using VIA -VILI)  \n5. Screening for and Management of Non -Communicable Diseases  \n\u25aa All PLHIV should be screened for hypertension, diabetes mellitus, dyslipidaemia, \nand renal disease annually.  \n\u25aa Routine screening should be provided for early detection of cervical cancer, breast \ncancer, bowel cancer, and prostate cancer  \n6. Mental Health Screening and Management  \n\u25aa All PLHIV should receive basic screening for depression  and anxiety  before initiating \nART, and annually thereafter, and whenever there is a clinical suspicion  \n\u25aa All PLHIV should be provided for and linked with support structures to maintain \ngeneral well -being  addressi ng issues that could affect their mental health  \n\u25aa All adults and adolescents should be screened for alcohol and drug use before \ninitiating ART and regularly during follow -up \n\u25aa All caregivers should also receive baseline and follow -up screening for depression \nand alcohol/drug use  \n7. Nutrition Services  \n\u25aa All PLHIV should receive nutritional assessment, counselling, and support tailored \nto the individual needs of the patients  \n\u25aa All infants irrespective of HIV status should be exclusively breastfed for the first 6 \nmonths  of life, with timely introduction of appropriate complementary foods after \n6 months, and continued breastfeeding up to 24 months or beyond  \n8. Prevention of Other Infections  \n\u25aa PLHIV (including children) should receive vaccinations as recommended by the \nNational  Vaccines and Immunization Program  \n\u25aa All PLHIV should receive vaccination for COVID -19 following national guidelines for \nage and dosing", "start_char_idx": 3, "end_char_idx": 2749, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "16091ed1-021c-4338-96f3-e69b73754e91": {"__data__": {"id_": "16091ed1-021c-4338-96f3-e69b73754e91", "embedding": null, "metadata": {"page_label": "22", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e73d7427-2dd4-490d-90d4-715311ba8a26", "node_type": "4", "metadata": {"page_label": "22", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "db28b9f06e3f95adc4be0ed42092eeaab554fd0292089d9a70ccad61e3b2ebd2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "4d41cb52-b901-43f0-9842-4e0bef3c9c1e", "node_type": "1", "metadata": {"page_label": "21", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e7af99f72d1eedf803ba759b9262b2e37f55a3d4322badce7ee6607365dd2ef6", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "98e61a24-aee6-4654-9473-27175c5d2754", "node_type": "1", "metadata": {}, "hash": "25d8d9066ae2ce6adcddfcc5f00c177aecc9ceb084f1b7a31242964057288c0c", "class_name": "RelatedNodeInfo"}}, "hash": "50fdca657b5cc419973a6e93b6c053d515528cd74253336725bf3c779a26c0ba", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n1 - 4  1.4 Adherence Preparation, Monitoring and Support  \n\u2022 The adherence preparation, monitoring, and support that a patient requires should be \ntailored to their level of adherence and the stage of ART initiation and follow -up \n\u2022 All patients with durable viral suppression (2 consecutive viral load results with < 50 \ncopies) should be offered messaging on Undetectable=Untrans mittable (U=U).  \n\u2022 Whenever possible, follow -up should be provided by the same care provider or team of \ncare providers (e.g., same clinician and counsellor) at every visit. This is particularly \nimportant during the first 3 months in care  \n\u2022 For all children/adol escents, the level of disclosure should be assessed at the first visit. \nOngoing care should include a plan for age -appropriate disclosure  \n\u2022 All patients are at risk of new or worsening barriers to adherence, so adherence \nmonitoring, counselling and support s hould continue despite viral suppression  \n\u2022 Every service delivery point that is providing ARVs for patients (whether ART, PEP, or \nPrEP) must have a functional system for identifying patients who miss appointments and \nfor taking action within 24 hours of a mi ssed appointment  \n\u2022 In patients failing ART, do not change regimens until the reason/s for treatment failure \nhave been identified and addressed (which should be done urgently using a case -\nmanagement approach)  \n1.5 Antiretroviral Therapy for Infants, Children, Adolescents, and Adults  \n\u2022 The goal of ART is to suppress viral replication with the aim of reducing the patient\u2019s VL \nto undetectable levels (Viral Load <50 copies/LD L) \n\u2022 All individuals with confirmed HIV infection are eligible for ART, irrespective of CD4 \ncount/%, WHO clinical stage, age, pregnancy or breastfeeding status, co -infection status, \nrisk group, or any other criteria, provided that the individual is willing and ready to start \nART  \n\u2022 ART should be started in all patients as soon as possible, even on the  same day as \nconfirming their HIV diagnosis (and preferably within 2 weeks)  \n\u2022 Preferred first -line ART for infants, children, adolescents and adults  \n\u25aa Birth to 4 weeks: AZT + 3TC + NVP  \n\u25aa > 4 weeks to < 15 years old  \n\u25aa < 30 kg: ABC + 3TC + DTG  \n\u25aa \u2265 30 kg: TDF + 3TC + DTG  \n\u25aa \u2265 15 years old: TDF + 3TC + DTG  \n\u2022 Children and adolescents who are virally suppressed but are NOT on the preferred first -\nline ART regimen should be assessed for transition and transitioned to the preferred \nregimen  \n\u2022 Treatment failure is suspected when a pa tient has a VL \u2265 100 0 copies/ml after at least 3 \nmonths of using ART. Treatment failure is only confirmed when VL is \u2265 1,000 copies/ml \nafter assessing for and addressing poor adherence or other reasons for high VL, and then \nrepeating VL after at least 3 mo nths of excellent adherence to allow for viral re -\nsuppression", "start_char_idx": 3, "end_char_idx": 2902, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "98e61a24-aee6-4654-9473-27175c5d2754": {"__data__": {"id_": "98e61a24-aee6-4654-9473-27175c5d2754", "embedding": null, "metadata": {"page_label": "23", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "fac5cfec-8e70-443a-9c9a-1aa079dd975d", "node_type": "4", "metadata": {"page_label": "23", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "423b5d22ab30d22d0864989037f44d0284ef87818bb8ca93157077da6d3013e8", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "16091ed1-021c-4338-96f3-e69b73754e91", "node_type": "1", "metadata": {"page_label": "22", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "50fdca657b5cc419973a6e93b6c053d515528cd74253336725bf3c779a26c0ba", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6413c2d1-98a1-45e3-951e-4396aeabbd6a", "node_type": "1", "metadata": {}, "hash": "0a622b473f3498fe949f7ed3e3f0cfd437b151e4b237f5348a376a3c22e40069", "class_name": "RelatedNodeInfo"}}, "hash": "25d8d9066ae2ce6adcddfcc5f00c177aecc9ceb084f1b7a31242964057288c0c", "text": "Summary of Key Recommendations  \n1 - 5  \u2022 Persistent low -level viremia ( pLLV) is defined as having VL 200 - 999 copies/ml on two \nor more consecutive measures. These patients are at increased risk of progression to \ntreatment failure, dev elopment of ARV resistance and death and therefore require a \nsimilar case management approach as patients with an initial VL \u2265 1,000 copies/ml  \n\u2022 All PLHIV with a detectable VL \u2265 200 copies/ ml (unsuppressed) : assess for and address \npotential reasons for virem ia, including intensifying adherence support, and repeat the \nVL after 3 months of excellent adherence  \n\u25aa If the repeat VL is < 200  copies/ml ( suppres sed) then continue routine \nmonitoring  \n\u25aa If the repeat VL is \u2265 1,000 copies/ml (suspected treatment failure), prepare for \nchange to an effective regimen (Figure 5.2 and Table 6.10)  \n\u25aa If the repeat VL is 200 - 999 copies/ml (low level viremia),  reassess adherence \nand other causes of viremia and repeat VL after another 3 months of excellent \nadherence  \n1.6 Pre vention of Mother to Child Transmission of HIV/Syphilis/HBV  \n\u2022 Prevention of mother -to-child transmission (PMTCT) of HIV,  Syphilis and Hepatitis B  \n(triple elimination ) should be offered as part of a comprehensive package of fully \nintegrated, routine antenatal  care interventions  \n\u2022 All pregnant women, unless known positive, should be counseled and tested for HIV, \nSyphilis (using the HIV -Syphilis dual test) and HBV during their first ANC visit, and if \nnegative a repeat HIV -Syphilis dual test should be performed in the 3rd trimester.  \n\u2022 Lifelong ART should be initiated in all pregnant and breastfeeding women living \nwith HIV, regardless of gestational age, WHO clinical stage or CD4 count  \n\u2022 ART should be started as soon as possible, ideally on the same day HIV diagnosis is  made, \nwith ongoing enhanced adherence support  \n\u2022 The preferred first line ART regimen for pregnant and breastfeeding women is TDF + 3TC \n+ DTG  \n\u2022 For pregnant and breastfeeding women newly initiated on ART, obtain VL 3 months after \ninitiation, and then every 6 m onths until complete cessation of breastfeeding  \n\u2022 For HIV positive women already on ART at the time of confirming pregnancy or \nbreastfeeding, obtain a VL irrespective of when prior VL was done, and then every 6 \nmonths until complete cessation of breastfeeding  \n\u2022 For pregnant or breastfeeding women with a VL \u2265 200 copies/m l (unsuppressed ): assess \nfor and address potential reasons for viremia, including intensifying adherence support, \nand repeat the VL after 3 months of excellent adherence  \n\u25aa If the repea t VL is < 200  copies/ml (suppressed) then continue routine \nmonitoring  \n\u25aa If the repeat VL is \u2265 1,000 copies/ml (treatment failure), prepare for change to \nan effective regimen  \n\u25aa If the repeat VL is 200  - 999 copies/ml ( low level viremia ), reassess adherence \nand other causes of viremia and consult the Regional or National TWG", "start_char_idx": 3, "end_char_idx": 2950, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6413c2d1-98a1-45e3-951e-4396aeabbd6a": {"__data__": {"id_": "6413c2d1-98a1-45e3-951e-4396aeabbd6a", "embedding": null, "metadata": {"page_label": "24", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "aa6d0815-bf4a-4ff8-95ec-db2f74d50287", "node_type": "4", "metadata": {"page_label": "24", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "47596dc2373ed13ce0cc034d53733a2adbabeb70b73822cd23cd6d7c4766d8da", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "98e61a24-aee6-4654-9473-27175c5d2754", "node_type": "1", "metadata": {"page_label": "23", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "25d8d9066ae2ce6adcddfcc5f00c177aecc9ceb084f1b7a31242964057288c0c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f093d403-c424-4237-a9ee-6df79286ab97", "node_type": "1", "metadata": {}, "hash": "0660ff86e4c777af2990c1d60846c45269d4133d42b667c30d682b2f3b03fc62", "class_name": "RelatedNodeInfo"}}, "hash": "0a622b473f3498fe949f7ed3e3f0cfd437b151e4b237f5348a376a3c22e40069", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n1 - 6  \u2022 All HIV exposed infants (HEI) should be tested with DNA PCR within 6 weeks of age or \nfirst contact thereafter; if negative then another DNA PCR at 6 months, and if negative \nthen  repeat DNA PCR at 12 months.  \n\u2022 All HEI should receive infant ARV prophylaxis consisting of 6 weeks of AZT + NVP and \nthereafter NVP should be continued until 6 weeks after complete cessation of \nbreastfeeding  \n\u2022 All infants irrespective of HIV status should be exclusively breastfed for the first 6 months \nof life, with timely introduction of appropriate complementary foods after 6 months, and \ncontinued breastfeeding up to 24 months or beyond  \n \n1.7 TB/HIV Co -infection Prevention and Management  \n\u2022 All healthcare settings should implement TB infection control recommendations to \nreduce the risk of transmission of TB among patients, visitors and staff  \n\u2022 Symptom -based TB screening using the ICF tool MUST be performed for all PLHIV at \nevery clinic visit  \n\u25aa Patien ts who screen negative should be assessed for and provided with TB \npreventive therapy (TPT)  \n\u25aa Patients who screen positive (presumptive TB) must complete definitive diagnostic \npathways  \n\u2022 The GeneXpert Ultra MTB/Rif test is the preferred test for diagnosis of T B and \nrifampicin resistance in all presumptive TB cases  \n\u2022 TB-LAM can be used as an adjunct rapid point -of-care diagnostic test for PLHIV: with \nadvanced HIV disease (WHO stage 3 or 4 or CD4 count \u2264 200 cells/mm3 (or CD4% \u2264 25% \nfor children \u2264 5 years)) with presumptive TB, or; any danger signs of severe illness, or; \ncurrently admitted to hospital  \n\u2022 Patients diagnosed with TB/HIV co -infection should start anti -TB treatment immediately \nand initiate ART as soon as anti -TB medications are tolerated, preferably within 2 weeks \n(unless they have TB meningitis, in which case ART should be deferred for 4 to 8 weeks)  \n\u2022 Patients with TB/HIV co -infection who are already on ART should start anti -TB treatment \nimmediately and continu e ART, making any required adjustments to the ART regimen \nbased on known drug -drug interactions and monitoring toxicity  \n\u2022 Always assess for ART failure in patients who develop TB after being on ART for \u2265 6 \nmonths", "start_char_idx": 3, "end_char_idx": 2258, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f093d403-c424-4237-a9ee-6df79286ab97": {"__data__": {"id_": "f093d403-c424-4237-a9ee-6df79286ab97", "embedding": null, "metadata": {"page_label": "25", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f7ca1157-77d0-4d8a-972c-e90c4be389a1", "node_type": "4", "metadata": {"page_label": "25", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1504d78005af8e99365ca6031f21568d90bb2fdc13563568c862e971b7d883c0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6413c2d1-98a1-45e3-951e-4396aeabbd6a", "node_type": "1", "metadata": {"page_label": "24", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0a622b473f3498fe949f7ed3e3f0cfd437b151e4b237f5348a376a3c22e40069", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "36d133d1-4330-4290-8f81-ea93099f7b7d", "node_type": "1", "metadata": {}, "hash": "4431625168e0ce61d2899d1f51c9969193ff3b2de762b1d9858a26999290bbea", "class_name": "RelatedNodeInfo"}}, "hash": "0660ff86e4c777af2990c1d60846c45269d4133d42b667c30d682b2f3b03fc62", "text": "Summary of Key Recommendations  \n1 - 7  1.8 HBV/HIV and HCV/HIV Co -infection Preve ntion and Management  \n\u2022 All HIV positive adolescents and adults should be screened for HBV infection, using serum \nHBsAg, as part of initial evaluation; children who did not complete routine childhood \nimmunizations should also be screened for HBV and vaccinat ed if negative.  \n\u2022 PLHIV without evidence of hepatitis B infection (HBsAg negative) should be vaccinated \nagainst hepatitis B  \n\u2022 The recommended first -line ART for adults with HIV/HBV co -infection is TDF+ 3TC + DTG  \n\u2022 HCV serology should be offered to individuals at  risk of HCV infection  \n\u2022 Direct acting antiviral therapies (DAAs) for treatment of HCV have simplified the \nmanagement of HIV/HCV co -infection  \n \n1.9 ARVs for Post -exposure Prophylaxis (PEP)  \n\u2022 PEP should be offered as soon as possible (< 72 hours) after high -risk exposure  \n\u2022 The recommended ARV agents for PEP are  \n\u25aa  <15 years old  \n\u25aa < 30 kg: ABC + 3TC + DTG  \n\u25aa \u2265 30 kg: TDF + 3TC + DTG  \n\u25aa \u2265 15 years old  \n\u25aa TDF + 3TC + DTG  \n \n1.10 Pre -Exposure Prophylaxis (PrEP)  \n\u2022 PrEP should be offered to HIV negative individuals at substantial ongoing risk of HIV \ninfection (including the seronegative partner in a discordant relationship)  \n\u2022  PrEP works if taken as prescribed . However, it does not prevent other STIs or unintended \npregnancies, therefore, additional protection should be of fered.  \n\u2022 PrEP should only be offered to clients  \u226515 years of age who are sexually active after \neligibility assessment using  the following parameters:  \n\u25aa Laboratory: HIV negative  \n\u25aa Medical (for oral PrEP): no contraindication to TDF; no severe renal diseases; wei ght \n\u2265 30 kg  \n\u25aa Client readiness: client must be willing to take PrEP as prescribed, and adhere to \nassociated follow up and HIV testing (at enrollment, at month 1 and thereafter every \n3 months)  \n\u2022 The recommended ARV regimen for Oral PrEP is TDF/FTC (alternative  TDF/3TC), \navailable in two dosing strategies:  \n\u25aa Daily oral PrEP: TDF (300 mg) + FTC (200 mg) once daily  \n\u25aa Event -driven PrEP : Event driven PrEP is where oral PrEP is used in men having sex \nwith men when an isolated sexual act is anticipated. The dose is two pills of TDF/FTC \ntaken between 2 and 24 hours (preferably closer to 24h) before the anticipated \nsexual act; then, a third pill taken 24 hours after the first two pills; and then a fourth \npill taken 24 hours after the third pill (\u201c2+1+1\u201d).", "start_char_idx": 3, "end_char_idx": 2470, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "36d133d1-4330-4290-8f81-ea93099f7b7d": {"__data__": {"id_": "36d133d1-4330-4290-8f81-ea93099f7b7d", "embedding": null, "metadata": {"page_label": "26", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ac48d349-540d-437e-b917-fb9a06560000", "node_type": "4", "metadata": {"page_label": "26", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d1c010e76d5892a9ba7593d1500a994d380ae6347b28f51d5fd6ceac020d0d60", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f093d403-c424-4237-a9ee-6df79286ab97", "node_type": "1", "metadata": {"page_label": "25", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0660ff86e4c777af2990c1d60846c45269d4133d42b667c30d682b2f3b03fc62", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8fb1d10a-2738-4b2f-933e-f1e911a9339a", "node_type": "1", "metadata": {}, "hash": "e83003f99c3ad8417fc6cac5b0c7ca021015bff0e72418b14e958a6af1c4e034", "class_name": "RelatedNodeInfo"}}, "hash": "4431625168e0ce61d2899d1f51c9969193ff3b2de762b1d9858a26999290bbea", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n1 - 8  1.11 People Who I nject Drugs (PWID) and HIV  \n\u2022 PWID should be offered regular HIV testing and counselling and be linked to   \ncomprehensive HIV treatment and prevention services including harm reduction \ncounselling and support  \n\u2022 The recommended first -line ART for adult PWID is T DF + 3TC + DTG  \n\u2022 PWID should be offered screening, diagnosis, treatment and prevention of STIs as part of \ncomprehensive HIV prevention and care  \n\u2022 PWID should have the same access to TB prevention, screening and treatment services as \nother populations at risk o f or living with HIV  \n\u2022 PWID should be screened for HBV (by HBsAg) and HCV (by HCV serology) at first contact  \n\u2022 All PWID should be linked to Needle and Syringe Programs (NSP) to access sterile \ninjecting equipment  \n\u2022 All PWID should be linked to Medically Assisted Therapy (MAT)", "start_char_idx": 3, "end_char_idx": 899, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8fb1d10a-2738-4b2f-933e-f1e911a9339a": {"__data__": {"id_": "8fb1d10a-2738-4b2f-933e-f1e911a9339a", "embedding": null, "metadata": {"page_label": "27", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "860be34f-546d-4c39-8aa6-6c6c690e1caf", "node_type": "4", "metadata": {"page_label": "27", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c2fb285ee4a7e5e2cfa57dc88a86d8aefffc7f1347e27fe95f7d4bbe6ada7467", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "36d133d1-4330-4290-8f81-ea93099f7b7d", "node_type": "1", "metadata": {"page_label": "26", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4431625168e0ce61d2899d1f51c9969193ff3b2de762b1d9858a26999290bbea", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "47072249-207e-4136-a776-3b7c2f5b9de4", "node_type": "1", "metadata": {}, "hash": "23269979cc1c070bafa3327f1caf38341f9e39be5816c291f54a302bb9524db8", "class_name": "RelatedNodeInfo"}}, "hash": "e83003f99c3ad8417fc6cac5b0c7ca021015bff0e72418b14e958a6af1c4e034", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 1   \n2. HIV Testing Services and Linkage to Treatment \nand Prevention  \nHIV testing services (HTS) provide the first critical link to comprehensive HIV treatment and \nprevention services such as voluntary medical male circumcision (VMMC), pre -exposure \nprophylaxis (PrEP), post -exposure prophylaxis (P EP) and other combination HIV prevention \nservices. In addition, this initial step also provides opportunities to offer other interventions such \nas sexual and reproductive health services (SRH), TB screening and referral, and substance abuse \nscreening and r eferral.  \nHIV testing should be voluntary and conducted ethically in an environment where the six Cs \nprinciples of Consent, Confidentiality, Counselling, Correct results, Connection (linkage) to care and \nother appropriate post -test services and creating an  enabling environment are adhered to . \nTargeted HIV testing  is the major strategic shift, involving index client listing of contacts, HIV self -\ntesting and use of HIV screening tools to identify people at risk of HIV infection as eligible for \ntesting, except in the case of PMTCT and key populations.  \n2.1 Settings fo r HIV Testing  \nIn Kenya, HTS is delivered in two broad settings: facility -based and community -based settings  \n2.1.1 Facility -based testing  \n\u25cf The HTS screening tool should be used to facilitate prioritization of testing for persons at risk \nof HIV infection; those diagnosed with sexually transmitted infections, with multiple sexual \npartners, key populations, and those with possible or known HIV exposures, such as sexual or \nneedle sharing partner of a person living with HIV or of a person of unknown HIV status  \n\u25cf Providers should undertake a thorough risk assessment using the validated NASCOP screening \ntools (Annex 17) to identify clients at risk and those eligible for a HIV test.  \n\u25cf HTS should be offered only to clients who consent  \n\u25cf Clients who are not eli gible for testing should receive HIV prevention messages and be offered \nservices as appropriate  \n\u25cf Clients who test HIV positive should be linked to care while those who test negative should be \nlinked to HIV prevention services  \n\u25cf Patients starting HIV care shou ld receive disclosure counselling and support, and be offered \nfamily, sexual and needle -sharing partner testing  \nAs much as possible, HIV testing services should be integrated into care pathways at all service \ndelivery points including adult and pediatric i npatient units, outpatient units, maternal and child \nhealth clinics, SRH/family planning clinics, TB clinics, specialty clinics, gender -based violence \n(GBV) care units and service delivery points for key and priority populations.", "start_char_idx": 3, "end_char_idx": 2760, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "47072249-207e-4136-a776-3b7c2f5b9de4": {"__data__": {"id_": "47072249-207e-4136-a776-3b7c2f5b9de4", "embedding": null, "metadata": {"page_label": "28", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e2f30e16-7d8a-4b6e-874b-bb8b23d60ec5", "node_type": "4", "metadata": {"page_label": "28", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b68d06cd57e74eab047e2f1d3738205f33fde7fd87bc443f8ff5864d8b4f1a4b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8fb1d10a-2738-4b2f-933e-f1e911a9339a", "node_type": "1", "metadata": {"page_label": "27", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e83003f99c3ad8417fc6cac5b0c7ca021015bff0e72418b14e958a6af1c4e034", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "910e1ec9-a96c-4d56-b4ac-f51132ae3667", "node_type": "1", "metadata": {}, "hash": "01ff83ca929bdd287e8cc86051375dcecfa7deb3402db4d6b5fc0607b17cf8e9", "class_name": "RelatedNodeInfo"}}, "hash": "23269979cc1c070bafa3327f1caf38341f9e39be5816c291f54a302bb9524db8", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 2  2.1.2 Community \u2013based t esting  \nTargeted community based HTS offers additional opportunities to identify and link people to HIV \ntreatment and prevention. This setting is especially important for testing children and partners of \nindex clients through index testing , as well as  outreach to key and priority populations, orphans, \nand vulnerable children (OVCs), adolescents, youth and targeted testing in workplaces.  \n2.2 HTS strategies  \nThe major HTS strategies to identify people living with HIV but unaware of their status are:  \n2.2.1 HIV Self -Testing (HIVST)  \n\u25cf HIVST allows individuals to collect their own specimen, perform the test, and interpret the \nresults on their own, conducted either within a health facility, at home or in any other \nconvenient place.  \nHIVST can be  conducted with o r without direct assistance by a trained person.  \n\u25cf HIVST is a screening test and is not sufficient to make an HIV -positive diagnosis. A reactive \n(positive) self -test result should therefore be confirmed using the validated national testing \nalgorithm by an H TS-trained service provider.  \n\u25cf HIVST should be performed using MoH approved HIV rapid diagnostic test kits that are either \nblood -based or oral fluid based.  \n\u25cf HIVST may have the greatest benefit in reaching specific populations such as partners of newly \ndiagnosed PLHIV; partners of pregnant women attending antenatal care (ANC); contacts of \npatients treated for STIs; hard -to-reach populations such as men, adolescents, and young \npeople, as well as key populations, such as MSM and sex workers.  \nHIVST is a scr eening test and does not provide a diagnosis.  \nAll reactive (positive) self -test results must be confirmed in a health facility according to \nnationally set standards  \n2.2.2 Index Testing  referred to as partner testing/partner notification services, is an approach \nwhereby the exposed contacts (i.e., sexual partners, biological children and anyone with whom a \nneedle was shared) of an HIV -positive person (i.e., index client), are elicited and offered HIV testing \nservices  \n2.2.3 Voluntary Counselling and Testin g (VCT):  This involves provision of targeted HIV \ntesting to clients who willingly present to HTS facilities for testing for diverse reasons, including \nself-assessed risk.  \n2.2.4 Social Network Strategy (SNS) - this involves offering to index clients self -guided options \nto informally extend links to HIV testing and other services to a broader set of social -, sexual -, \nand injecting -network members who have an elevated risk of HIV infection. The index client for \nSNS can either be PLHIV or HIV negative persons wi th increased risk for HIV infection . \nProviding targeted HTS for different populations and in different settings increases opportunities \nfor access to knowledge of HIV status and to a range of HIV treatment and prevention services. \nTable 2.1 summarizes key recommendations for HTS for different sub -populations.", "start_char_idx": 3, "end_char_idx": 3023, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "910e1ec9-a96c-4d56-b4ac-f51132ae3667": {"__data__": {"id_": "910e1ec9-a96c-4d56-b4ac-f51132ae3667", "embedding": null, "metadata": {"page_label": "29", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "9043492f-6019-4487-9e6a-77d3a260487f", "node_type": "4", "metadata": {"page_label": "29", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "71f94bd8cd7dc483bc4351e561a11bd95f38579b2706889093a25c2f6710c176", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "47072249-207e-4136-a776-3b7c2f5b9de4", "node_type": "1", "metadata": {"page_label": "28", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "23269979cc1c070bafa3327f1caf38341f9e39be5816c291f54a302bb9524db8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "49e509a7-4087-4928-ac2b-40df372584ed", "node_type": "1", "metadata": {}, "hash": "1cd24b80935dc9a63990efde5b006380ab13624dc557be8e016f6cdc11ac6827", "class_name": "RelatedNodeInfo"}}, "hash": "01ff83ca929bdd287e8cc86051375dcecfa7deb3402db4d6b5fc0607b17cf8e9", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 3  Table 2.1: HTS R ecommendations for Different Populations and Settings  \nPopulation  Recommendation  \nBirth testing of \ninfants born to \nknown HIV - \npositive mothers \n(Figure 2.2)  \u25cf Birth testing (HIV testing of infants at birth or at first contact within 2 weeks after \nbirth) can be conducted where feasible and in settings wher e return of results is \nfeasible within 24 hours and ART  can be initiated immediately*). Infants tested at \nbirth must be tested at the 6 weeks immunization visit regardless of the results of \nthe initial test at birth.  \n\u25cf Infants with an initial positive HIV D NA PCR result should be presumed to be HIV \ninfected and started on ART in line with national guidelines, with a new sample for \nconfirmatory HIV DNA PCR and baseline viral load taken at the time of ART \ninitiation (ART initiation is based on the initial HIV DNA PCR result)  \nInfants and \nchildren aged less \nthan 18 months \n(Figure 2.1)  \u25cf HIV exposure status of all infants should be established at first contact.  \n\u25cf To establish HIV exposure status of a child less than 18 months of age, conduct HIV \nantibody testing for mothers with unknown status or who previously tested \nnegative during antenatal care at the 6 -week immunization visit or first contact. If \nthe mother declines to be tested or is not available for testing, then conduct a rapid \nHIV antibo dy test for the child to determine exposure (if antibody test is positive \nthis confirms HIV exposure)  \n\u25cf When HIV exposure is confirmed, ARV prophylaxis should be started immediately.  \n\u25cf All HEIs should have DNA PCR testing at the 6 -week immunization visit or fi rst \ncontact thereafter.  \n\u25cf Infants with an initial positive HIV DNA PCR result should be presumed to be HIV \ninfected and started on ART in line with national guidelines, with a new sample for \nconfirmatory HIV DNA PCR and baseline viral load taken at the time of ART \ninitiation (ART initiation is based on the initial HIV DNA PCR result)  \n\u25cf All HEI with initial HIV negative results should continue infant ARV prophylaxis \nand be followed as HEIs, including additional PCR testing at 6 months and 12 \nmonths, and antibody  testing at 18 months and every 6 months during \nbreastfeeding, and at 6 weeks after complete cessation of breastfeeding  \nChildren older \nthan 18 months \ntill age 9 years \n(Figure 2.3)  \u25cf Conduct HIV testing and counselling for all children of adults living with HIV as \nsoon as possible after confirming the HIV positive status of the adult. Within health \nfacilities, testing should be conducted at in -patient wards, nutrition clinics, and all \nhigh HIV burden settings.  \nAdolescents and \nyoung people  \n(10 - 24 years) \n(Figure 2.3)  \u25cf Targeted HIV testing services should be offered to adolescents and young people \nwho are screened and found eligible for HIV test. HIV prevention services should \nbe offered to clients who test negative while those who test positive should be \nlinked to HIV care.  \n\u25cf Adolescents aged above 10 years, should be tested with the written consent of a \nparent or guardian, and are also required to give assent.  \n\u25cf Adolescents who are e mancipated minors irrespective of age, can give their own \nconsent.  \n\u25cf All adolescents should be counselled on the potential benefits and risks of \ndisclosure of their HIV status and empowered and supported to determine if, \nwhen, how and to whom to disclose.  \n\u25cf For sexually active adolescents, HIV testing and counselling should be offered to \ntheir partners and children where appropriate.  \n\u25cf All uncircumcised adolescent males who test HIV negative should be counselled \nabout the prevention benefits of VMMC and linked t o VMMC services if they agree", "start_char_idx": 3, "end_char_idx": 3764, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "49e509a7-4087-4928-ac2b-40df372584ed": {"__data__": {"id_": "49e509a7-4087-4928-ac2b-40df372584ed", "embedding": null, "metadata": {"page_label": "30", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c3b64f78-a75d-463e-9373-eb59b6658351", "node_type": "4", "metadata": {"page_label": "30", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3fe782ed46633992fb07dc83d1e510e1d925b5368bdbf006bd4f06389350e8fd", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "910e1ec9-a96c-4d56-b4ac-f51132ae3667", "node_type": "1", "metadata": {"page_label": "29", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "01ff83ca929bdd287e8cc86051375dcecfa7deb3402db4d6b5fc0607b17cf8e9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "c373593e-4319-4586-ac21-0893aaae7db1", "node_type": "1", "metadata": {}, "hash": "87356d944c8701ef51f047b6f0f5155c8eb32f2d4dee7b71b3059e489068e24b", "class_name": "RelatedNodeInfo"}}, "hash": "1cd24b80935dc9a63990efde5b006380ab13624dc557be8e016f6cdc11ac6827", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 4  Table 2.1 Cont.  \nPregnant and \nbreastfeeding \nwomen  \u25cf During the first ANC visit, HIV testing of pregnant women should be done \nusing a dual test for HIV and syphilis, unless the woman is known to be living \nwith HIV.  \n\u25cf Women who test negative for both HIV and Syphilis should be offered a repeat \nHIV-Syphilis dua l test in the third trimester.  \n\u25cf Prevention services should be offered to all pregnant and breastfeeding \nwomen who test HIV negative. They should be screened for eligibility and \nwillingness for PrEP.  \n\u25cf At labor and delivery, HIV testing should be done for all women with \nunknown HIV status and those who previously tested negative (even if tested \nnegative in the third trimester).  \n\u25cf All breastfeeding mothers (unless known HIV positive) should be counselled \nand tested at the 6 -week infant immunization visit. The HIV  test (if negative) \nshould be repeated every 6 months until complete cessation of breastfeeding.  \n\u25cf For mothers considered to be at high risk of HIV infection, retesting \npostnatally should be done every 3 months; these include mothers \ncategorized as key popul ation; in a HIV discordant relationship, or having \nongoing sexual or injecting behavior that places her at risk, including new or \nmultiple sexual partners.  \n\u25cf Mothers should be counselled on the schedule for repeat HIV testing in \npregnancy and postnatal as p art of routine ANC and postnatal education.  \n\u25cf All pregnant and breastfeeding women who are not tested, opt -out or decline \nHIV testing during the first contact should be offered HIV counselling and \ntesting in subsequent visits with appropriate referral and li nkage for \nprevention, care, and support services.  \n\u25cf All HIV positive pregnant and breastfeeding women enrolled into care should \nreceive counselling and support (assisted disclosure), case management and \nfollow -up. It should also include linkage to general ca re for ANC, delivery and \npost -natal care  \n\u25cf All spouses/partners as well as children of pregnant and breastfeeding \nwomen testing HIV positive should be offered HIV testing and counselling.  \nSexual partners & \nchildren of index \nclients (HIV positive \nperson who is newly \ndiagnosed or already \nin HIV care)  \u25cf All PLHIV enrolled into HIV care should receive disclosure counselling and \nbe supported to disclose their HIV status (assisted disclosure)  \n\u25cf HIV testing and counselling (facility -based or community -based) should be \nencouraged for all partners including  sexual partners, needle sharing \npartners, and children of index clients, with appropriate linkage to \ntreatment and prevention services.", "start_char_idx": 3, "end_char_idx": 2681, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "c373593e-4319-4586-ac21-0893aaae7db1": {"__data__": {"id_": "c373593e-4319-4586-ac21-0893aaae7db1", "embedding": null, "metadata": {"page_label": "31", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e1b9b241-5272-494d-8179-360166cfca1c", "node_type": "4", "metadata": {"page_label": "31", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4610e082f82babfaff0c60c23e2864358c8d6620af366f6d268ea8082ede6282", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "49e509a7-4087-4928-ac2b-40df372584ed", "node_type": "1", "metadata": {"page_label": "30", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1cd24b80935dc9a63990efde5b006380ab13624dc557be8e016f6cdc11ac6827", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5d676676-531f-4592-ab7c-bfe07469832e", "node_type": "1", "metadata": {}, "hash": "9c21c9780cc538498bcab194289920caf1851c76376349c9830edc5c8a924012", "class_name": "RelatedNodeInfo"}}, "hash": "87356d944c8701ef51f047b6f0f5155c8eb32f2d4dee7b71b3059e489068e24b", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 5  Table 2.1 Cont.  \nKey and vulnerable \npopulations  \u25cf Conduct HIV testing and counselling for all clients from key and vulnerable \npopulations presenting to the health facility irrespective of the reason for \ntheir visit, or through targeted outreach and testing at key and vulnerable \npopulation service delivery points (e.g., drop -in centers).  \n\u25cf Key populations that test negati ve should be retested quarterly.  \n\u25cf Link all who test HIV positive to treatment and prevention services.  \n\u25cf Prevention services should be recommended, including consistent and \ncorrect use of condoms and use of sterile needles and syringes.  They should \nbe scree ned for eligibility and willingness for PrEP.  \n\u25cf All uncircumcised males who test HIV negative should be counselled on the \nprevention benefits of VMMC and linked to VMMC services if they consent  \nTargeted HIV testing \nand counselling of \nadults  \u25cf All adults eligible for testing should be offered HTS and encouraged to know \ntheir HIV status and the status of their partners.  \n\u25cf For those that test negative, re -testing is recommended if there is a new risk \nexposure.  \n\u25cf HIV positive adults should be counseled for  immediate ART initiation.  \n\u25cf Link all adults identified as HIV positive to treatment and prevention services.  \n\u25cf Clients who are not eligible for testing should receive HIV prevention \nmessages and be offered services, as appropriate.  \n\u25cf All males who test HIV nega tive should be counselled on the prevention \nbenefits of VMMC and linked to VMMC services if they consent  \n \n2.3 Package of HIV Testing Services  \nAn HIV testing and counselling session consists of:  \n\u25cf A pre -test session  \n\u25cf HIV testing  \n\u25cf Assessment for other health -related conditions or needs (while HIV tests are running)  \n\u25cf A post -test session (including index testing)  \n\u25cf Referral and linkage to other appropriate health services (as part of the post -test session)  \nThe HIV testing service package is summarized in Tab le 2.2.", "start_char_idx": 3, "end_char_idx": 2057, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5d676676-531f-4592-ab7c-bfe07469832e": {"__data__": {"id_": "5d676676-531f-4592-ab7c-bfe07469832e", "embedding": null, "metadata": {"page_label": "32", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "785c472b-98b3-4405-a024-ef5a7d4bdf1c", "node_type": "4", "metadata": {"page_label": "32", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "111809f4a842044367ffd515f4b2fbb5f206e1589ab8f6e911f9bbfcf45c6b0c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "c373593e-4319-4586-ac21-0893aaae7db1", "node_type": "1", "metadata": {"page_label": "31", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "87356d944c8701ef51f047b6f0f5155c8eb32f2d4dee7b71b3059e489068e24b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "07cbf3ca-365c-43d2-a232-7d915ec2338a", "node_type": "1", "metadata": {}, "hash": "cf8587bed3e6e07484197489cc0cc7765abf01ecc68e53890dc63ca3d947b8c1", "class_name": "RelatedNodeInfo"}}, "hash": "9c21c9780cc538498bcab194289920caf1851c76376349c9830edc5c8a924012", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 6  Table 2.2: Summary of HIV Testing Services Package  \nPre- Test Counselling  \nPre-test counselling may be provided to an individual or a couple presenting for HTS.  Group information \ncan also be offered during pre -test.  \nThe objectives of the pre -test counselling session are to:  \n\u2212 Provide information on the benefits of knowing one\u2019s H IV status, including outcomes for people \non ART and undetectable = Untransmittable  (U=U).  \n\u2212 Provide an explanation for the HIV testing process including time the session will take, \nconfidentiality, and interpretation of test results  \n\u2212 Obtain informed consent for HIV testing.  \n\u2212 Explore the client\u2019s risk of HIV infection.  \n\u2212 Discuss the importance of disclosure to partners and other family members.  \n\u2212 Explain the benefits of couple testing and partner services/index testing.  \nProvide information on available post -test se rvices, including referrals for prevention or HIV care services  \nPerform test.  \nThe goal of HIV testing is to:  \n\u2022 Provide accurate HIV diagnosis as per the nationally approved testing algorithm  \n\u2022 Provide same day HIV test results  \nDuring the 15 minutes as you wait for the test results:  \n\u2212 Discuss Combination Prevention e.g., PrEP, PEP, Risk Reduction, STI treatment, condom \ninformation and demonstration, VMMC, Elimination of Mother to Child Transmission of HIV \n(eMTCT)  \n\u2212 Screen, provide information and referrals for; Intimate Partner Violence (IPV), STI and cancer \nscreening, Tuberculosis (TB), Family planning/c ontraceptive needs, etc.  \n\u2212 Establishing number of sexual contacts and biological children for the purpose of index testing.  \n\u2212 Document in the HTS, Lab, referral and linkage register (MOH 362).  \nDiscuss further on index testing and HIVST as you perform the secon d and the third test, as per the national \nalgorithm, for the clients who test positive with the screening test  \nPost -test counselling  \n\u2212 Check if the client is ready for results and help them to interpret.  \n\u2212 Check what the client understands by the results.  \n\u2212 Allow the client to share his/her initial reactions and verbalize their initial feelings.  \n\u2212 Explore and acknowledge client\u2019s immediate feelings and concerns.  \nOffer necessary support", "start_char_idx": 3, "end_char_idx": 2293, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "07cbf3ca-365c-43d2-a232-7d915ec2338a": {"__data__": {"id_": "07cbf3ca-365c-43d2-a232-7d915ec2338a", "embedding": null, "metadata": {"page_label": "33", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e228615f-57ad-4283-a789-a1b2ebfe9f36", "node_type": "4", "metadata": {"page_label": "33", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4ca917c187c98dfe6c6bea7afef0231ea0db5bb8be2104a43366c0bd5fd16c0f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5d676676-531f-4592-ab7c-bfe07469832e", "node_type": "1", "metadata": {"page_label": "32", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9c21c9780cc538498bcab194289920caf1851c76376349c9830edc5c8a924012", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3b2e3883-3d7a-4e71-b805-303f91628806", "node_type": "1", "metadata": {}, "hash": "bf984ca0ee538ddf23de1e5e04b92733f570bf4ed725de808e8b48d5f753be38", "class_name": "RelatedNodeInfo"}}, "hash": "cf8587bed3e6e07484197489cc0cc7765abf01ecc68e53890dc63ca3d947b8c1", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 7  Table 2.2 Cont.  \nNEGATIVE RESULT  \n\u2212 Explain test results.  \n\u2212 Review implications of being HIV negative.  \n\u2212 Support clients to develop a risk reduction \nplan (see HTS operational manual)  \n\u2212 Provide information on methods to prevent \nHIV acquisition.  \n\u2212 Provide male and/or female condoms, \nlubricant, and guidance on their use.  \n\u2212 Emphasize on importance of knowing the \nstatus of sexual partners and information \nabout the availability of partner and couples \ntesting services.  \n\u2212 Referral and linkage to relevant HIV \nprevention services  \nExplain the need for repeat testing for people \nwho tes t negative but report risky behavior \nwithin the prior  4 weeks (i.e., unprotected sex \nwith a partner of unknown status or Known HIV \npositive status); if they test HIV negative again \nafter 4 weeks  and are at  ongoing risk of HIV \nacquisition , they should be ad vised to return for \ntesting every 3 months  POSITIVE RESULT  \n\u2212 Review implications of being HIV positive.  \n\u2212 Help the index client to cope with emotions arising \nfrom the diagnosis.  \n\u2212 Discuss immediate concerns and help for the client \nto decide who in his or her social network may be \navailable to provide immediate support.  \n\u2212 Discuss positive living.  \n\u2212 Provide clear information on ART and its benefits \nfor maintaining health and reducing the  risk of HIV \ntransmission, as well as where and how to access \nART  \n\u2212 Refer clients who turn HIV positive to CCC for \nlinkage to treatment.  \n\u2212 Revisit index testing and HIVST to determine \npartner notification plan/approach (refer to HTS \noperational manual and APN S operational Manual).  \n\u2212 Discussion of the risks and benefits of disclosure to \npartners; couples counselling should be offered to \nsupport mutual disclosure.  \nEncourage and offer HIV testing for sexual partners, \ninjecting partners, biological children, and oth er family \nmembers, which can be done through couples testing, \nfamily testing and/or assisted partner notification \nservice.  \nAssessment of other health related conditions  \nAssess risk for sexually transmitted infections (STIs) and opportunistic infections that would also require \nmanagement  \nReferral and linkage to care  \nObtain accurate locator information from the index client (physical location, phone number)  \nPhysically escort the client for re -testing and linkage to ART  \nDocument the outcomes of partner follow up(s)  \nPost -Test Counseling in the Era of Test -and -Treat  \nPost -test counselling should, at a minimum, include three key messages that being the ART treatment \npreparation process for all PLHIV:  \n\u2212 Treatment (called antiretroviral therapy or ART) is available and is recommended for everyone \nwith HIV.  \n\u2212 Starting treatment as soon as possible (preferably within two weeks from testing positive for \nHIV) reduces the chance of your illness getting worse or of passing HIV to others. If  you take your \nART properly and do not miss pills you can expect to live a long and productive life", "start_char_idx": 3, "end_char_idx": 3058, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3b2e3883-3d7a-4e71-b805-303f91628806": {"__data__": {"id_": "3b2e3883-3d7a-4e71-b805-303f91628806", "embedding": null, "metadata": {"page_label": "34", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b7f36a3b-b69c-4269-bc16-ef525e180eb0", "node_type": "4", "metadata": {"page_label": "34", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d32fa52e07d59be861a744843c825a988f2a52e568090f1a2f0cbc3116a5464b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "07cbf3ca-365c-43d2-a232-7d915ec2338a", "node_type": "1", "metadata": {"page_label": "33", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cf8587bed3e6e07484197489cc0cc7765abf01ecc68e53890dc63ca3d947b8c1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "459ae164-c164-4271-8f3c-4445083d9fb1", "node_type": "1", "metadata": {}, "hash": "ffd88b014796b8aa40937c8c8e0d756c9189c84ce6c6f63058b9156a98c7812e", "class_name": "RelatedNodeInfo"}}, "hash": "bf984ca0ee538ddf23de1e5e04b92733f570bf4ed725de808e8b48d5f753be38", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 8  2.4 Age -Specific HIV Testing Algorithms  \n2.4.1  Early Infant Diagnosis  \n2.4.1.1 Confirmation of HIV infection in HIV Exposed Infants and Children < 18 Months Old  \nHIV expo sure  of an infant or child can occur in utero, at labour and delivery and through breast \nmilk. Confirmation of HIV infection should immediately follow.  \nAll HIV exposed infants (HEI) should be tested with DNA PCR within 6 weeks of age or first contact \nthere after; if negative then another DNA PCR at 6 months, and if negative then repeat DNA PCR at \n12 months.  \nIf the HEI develops symptoms suggestive of HIV as per WHO staging criteria, an additional DNA \nPCR test should be conducted immediately.  \nAn antibody test  should be performed for all HEI at 18 months of age and every 6 months thereafter \nduring breastfeeding, and at 6 weeks after complete cessation of breastfeeding (Figure 2.1).", "start_char_idx": 3, "end_char_idx": 940, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "459ae164-c164-4271-8f3c-4445083d9fb1": {"__data__": {"id_": "459ae164-c164-4271-8f3c-4445083d9fb1", "embedding": null, "metadata": {"page_label": "35", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "895c98b4-10f9-4cf0-9b11-b1d222418bfe", "node_type": "4", "metadata": {"page_label": "35", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "884d4b126a41287869ca562267419624bee7b308091f4bcd58d13fec2904051e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3b2e3883-3d7a-4e71-b805-303f91628806", "node_type": "1", "metadata": {"page_label": "34", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "bf984ca0ee538ddf23de1e5e04b92733f570bf4ed725de808e8b48d5f753be38", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "38951bf5-8af5-4f4d-8dbb-0d686486ef36", "node_type": "1", "metadata": {}, "hash": "dcbb14412e8db22acfefeeeb6ced5e0e77680f8528c87c89b90537a2c496e0e7", "class_name": "RelatedNodeInfo"}}, "hash": "ffd88b014796b8aa40937c8c8e0d756c9189c84ce6c6f63058b9156a98c7812e", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 9  \nEstablish  HIV   of Infants  and  Children\n< 18 months\n\u2022  Mother known HIV \n\u2022  HTS  for mothers  with  unkn own HIV \n\u2022  Rapid antibod y test on infant/child  if mother s HIV cannot  be \nEstablish HIV infection for HIV Exposed Child at 6 weeks or at first \ncontact  (includes child with negative DNA PCR result at birth)\n\u2022 Collect a DBS for HIV DNA PCR test 1\n\u2022 Start/continue infant  ARV prophylaxis\n\u2022 Start CPT At L&D, MNCH/F P, \nIPD, A&E,  CCC & \nHIV DNA PCR test NEGATIVE\nChild HIV -exposed\n\u2022 Continue HEI follow -upHIV DNA PCR test POSITIVE\nChild presumed HIV infected\n\u2022 Discontinue infant ARV prophylaxis\n\u2022 Start ART\n\u2022 Offer comprehensive care including \ncontinuation of CPT\n\u2022 Collect new sample for confirmatory HIV DNA \nPCR, baseline viral load and CD4%.  1Conduct DNA PCR  at 6 months of age or soonest contact \nthereafter (or earlier if child develops symptoms \nsuggestive of HIV -as per WHO staging criteria)1\nConfirmatory HIV DNA \nPCR test POSITIVE\nChild confirmed HIV \ninfected\n\u2022 Continue ART and \ncomprehensive care \nand routine under -5 \ncareConfirmatory HIV DNA PCR \ntest NEGATIVE\nChild presumed HIV infected\n\u2022 Continue ART \n\u2022 Collect and send a DBS \nto NHRL and manage \nas per the results from \nNHRLHIV DNA PCR result NEGATIVE\nChild HIV -exposed\n\u2022 Continue HEI follow -up\n\u2022 Conduct DNA PCR at 12 months of age  or \nsoonest contact till 18 months of age (or earlier if \nchild develops symptoms suggestive of HIV -as \nper WHO staging criteria) 1\nHIV DNA PCR result NEGATIVE\nChild HIV -exposed\n\u2022 Continue HEI follow -up\n\u2022 Continue routine under -5 care\n\u2022 Conduct HIV Antibody test at 18 months of age \n\u2022 If breast feeding, do HIV antibody test every 6 months while breast \nfeeding and 6 weeks after complete cessation of breastfeeding \nIf HIV antibody test  is negative\nChild HIV negative \n\u2022 Stop CPT * \n\u2022 Review at age 2 years and document vital status \n\u2022 Continue routine  unde r-5 If HIV antibody test  is positive \nChild confirmed HIV infected\n\u2022 Start  ompre hensive  \n\u2022 Continue CPT\n\u2022 Continue routine  unde r-5 \n1 Where Point of Care DNA PCR is available - EID should be done using the whole blood at the facility. \nFor baseline viral load testing \u2013 If available, use point of care machine for viral load; If there is no point of care \nmachine to do viral load - Take a plasma and send it to the VL testing laboratory\n* Only after final antibody test negativeChild is HIV unexposed\n  \nFigure 2.1 Algorithm for Early Infant Diagnosis in Infants and Children < 18 months of age", "start_char_idx": 3, "end_char_idx": 2568, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "38951bf5-8af5-4f4d-8dbb-0d686486ef36": {"__data__": {"id_": "38951bf5-8af5-4f4d-8dbb-0d686486ef36", "embedding": null, "metadata": {"page_label": "36", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "df120b93-6ea4-4bc9-b401-14c0925d853b", "node_type": "4", "metadata": {"page_label": "36", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "54185402f7858627374b97f53981e7aa7eb6b407d2fdbbce52ff7e2f9b1aeb3b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "459ae164-c164-4271-8f3c-4445083d9fb1", "node_type": "1", "metadata": {"page_label": "35", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ffd88b014796b8aa40937c8c8e0d756c9189c84ce6c6f63058b9156a98c7812e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "95023805-2050-48c4-a227-ad540a3f402a", "node_type": "1", "metadata": {}, "hash": "cd88a8ffbc617c41b139293392d8bdba35b5a7be783af2c8c9409d1d8798c861", "class_name": "RelatedNodeInfo"}}, "hash": "dcbb14412e8db22acfefeeeb6ced5e0e77680f8528c87c89b90537a2c496e0e7", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 10  Presumptive Diagnosis of Severe HIV Disease in Children under 18 Months  \nOccasionally, children less than 18 months of age present to hospital with severe illness; and a rapid \nHIV antibody test confirm s HIV exposure. Lack of immediate availability of HIV DNA PCR results \nfor confirmation of HIV could result in undue delay in starting life -saving ART. In such children, a \npresumptive diagnosis of HIV infection can be made using the criteria in Table 2.3. A RT can be \ninitiated while awaiting HIV DNA PCR results to confirm HIV infection.  \nTable 2.3: Presumptive Diagnosis of HIV in children <18 months while awaiting DNA PCR \nResults  \nHIV antibody test positive AND symptomatic with;  \n 2 or more of the following:  \n\u25cf Oral candidiasis/thrush  \n\u25cf Severe pneumonia  \n\u25cf Severe sepsis  \nOR any of the of following:  \n\u25cf Any WHO Clinical Stage 4 condition  \n\u25cf Recent maternal death (if likely to have been HIV -related) or advanced HIV disease in \nmother  \n\u25cf Child\u2019s CD4% < 2 5% \n \n2.4.1.2  Birth Testing  \nBirth testing is defined as HIV testing (with DNA PCR) at birth or around birth for infants born to \nHIV-positive mothers. Birth testing has the potential to improve survival for infants who are \ninfected during pregnancy, around labour and delivery by ident ifying them early for rapid ART \ninitiation. Do not use cord blood for birth testing as this could result in false positive results.  \nA DNA PCR test can be offered at birth or around birth where feasible.  \nALL children initially tested at birth should be rete sted at 6 weeks of age and the EID \nalgorithm followed (Figure 2.2.)  \nConsiderations for providing birth testing:  \nBirth testing may be prioritized for newborns who are at high risk of HIV acquisition including \nthose born to:  \n\u25cf Mothers who seroconvert during p regnancy.  \n\u25cf Mothers who have unsuppressed or unknown viral loads during delivery.  \n\u25cf Mothers who received a HIV positive diagnosis for the first time at or after 28 weeks \ngestation or during labour and delivery  \n\u25cf Mother on ART for less than 12 weeks prior to delivery  \nBirth testing should be offered where this is feasible:  \n\u25cf DNA PCR results can be returned the same  day e.g., where on site point of care is available.  \n\u25cf ART regimens recommended for neonates as per national guidelines are available and can \nbe initiated immed iately.  \n\u25cf Follow -up of the newborn is done to ensure no lost to follow -up.", "start_char_idx": 3, "end_char_idx": 2483, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "95023805-2050-48c4-a227-ad540a3f402a": {"__data__": {"id_": "95023805-2050-48c4-a227-ad540a3f402a", "embedding": null, "metadata": {"page_label": "37", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2078a97b-2825-4569-8fdb-ab0573457ee2", "node_type": "4", "metadata": {"page_label": "37", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3e935ca1ffb64fa3122c10c8b3c075feffedbfe602c8f797fd4b3eaefe7a369d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "38951bf5-8af5-4f4d-8dbb-0d686486ef36", "node_type": "1", "metadata": {"page_label": "36", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "dcbb14412e8db22acfefeeeb6ced5e0e77680f8528c87c89b90537a2c496e0e7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5205665d-330e-4172-a27b-86bc1be2fef7", "node_type": "1", "metadata": {}, "hash": "6903dfb72c16acbbc0cfd06aef0385b59ab85b26505635b9aae208c03de15681", "class_name": "RelatedNodeInfo"}}, "hash": "cd88a8ffbc617c41b139293392d8bdba35b5a7be783af2c8c9409d1d8798c861", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 11  \nInfant of known HIV positive mothers at birth (or \nwithin 2 weeks of birth)\n\u2022 Collect DBS for DNA PCR\n\u2022 Start infant ARV prophylaxis immediately after \nbirth.  \nHIV DNA PCR positive HIV DNA PCR Negative \n\u2022 Initiate ART immediately\n\u2022 Book for follow up at 2 weeks of age. \n\u2022 Offer comprehensive care for HIV infected child. \n\u2022 Collect new sample for confirmatory HIV DNA \nPCR, baseline viral load and CD4%.\u2022 Continue infant ARV prophylaxis and follow up \nfor HIV exposed infants. \n\u2022 Repeat DNA PCR test at 6 weeks. Follow the EID \nalgorithm. \nConfirmatory DNA PCR positive/ \ndetectable Viral load \n\u2022 Continue ART \n\u2022 Provide comprehensive care. Confirmatory DNA PCR negative \n\u2022 Continue ART \n\u2022 Collect DBS for repeat PCR at 6 weeks of age \nand manage as per EID algorithm \n\u2022 Collect new sample send to NHRL. Manage as \nper NHRL results \nFigure 2.2: Birth Testing Algorithm  \n \n2.4.1.3  Use of Point of Care testing for Children  \nPoint -of-care testing occurs at the health facility where care is being provided, with results being \nreturned to the patient or caregiver on the same day as sample collection. Point of care DNA PCR \ntesting for early infant diagnosis of HIV can reduce the turnaround time for testing and return of \nresults and allow imme diate initiation of ART among infants.  Point of care DNA PCR testing can be \nused to diagnose HIV infection as well as to confirm positive results.", "start_char_idx": 3, "end_char_idx": 1475, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5205665d-330e-4172-a27b-86bc1be2fef7": {"__data__": {"id_": "5205665d-330e-4172-a27b-86bc1be2fef7", "embedding": null, "metadata": {"page_label": "38", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5278fb74-e74a-455a-b486-3eb2abe49e19", "node_type": "4", "metadata": {"page_label": "38", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5d28fd967549166588d3ebb678ccdda1c99a5a02de574c959cd207effc1c933a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "95023805-2050-48c4-a227-ad540a3f402a", "node_type": "1", "metadata": {"page_label": "37", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cd88a8ffbc617c41b139293392d8bdba35b5a7be783af2c8c9409d1d8798c861", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "74fca76f-f1f1-45ac-b7f9-66fc4cb1a4a2", "node_type": "1", "metadata": {}, "hash": "770b830d928d384c9b92f270e240d3e2c521c9807961112076203ebeb009ff53", "class_name": "RelatedNodeInfo"}}, "hash": "6903dfb72c16acbbc0cfd06aef0385b59ab85b26505635b9aae208c03de15681", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 12  2.4.2  Diagnosis of HIV Infection in the Older Child (\u2265 18 months), Adolescents and \nAdults  \n\u25cf Serial testing,  using approved rapid HIV antibody testing kits, is used to diagnose HIV infection \nin children older than 18 months, adolescents, and adults, and (refer to Figure 2.3)  \n\u25cf An HIV -positive diagnosis will be made using three consecutive reactive assays . This thr ee-\ntest strategy as well as retesting aims to ensure that at least a 99% Positive Predictive Value \n(PPV) is maintained, and false positive misdiagnosis is avoided.  \n\u25cf Offer adequate information to all clients and obtain consent prior to the HIV test (verbal \nconsent is adequate but should be documented by the health care worker in client records). \nFor children below the age of 14 year who are not emancipated minors, a written consent from \nthe guardian is recommended.  \n\u25cf Individuals 15 years and older and emancipa ted minors can provide self -consent.  \n\u25cf Clients who test positive should be linked to care and treatment. Counselling support, index \nand family testing should be offered to these clients.  \n\u25cf Clients who test negative should be counselled on HIV risk reduction b ehaviors and linked to \ncombination HIV prevention services (such as VMMC, RH/FP, condoms, PrEP, etc.) depending \non individual risk profile. Table 2.5 provides recommendations for re -testing those who test \nHIV negative.  \nHIV testing algorithm for children >1 8months, adolescents and adults.  \nFigure 2.3 illustrates the serial testing algorithm. An HIV -positive diagnosis will be made using \nthree consecutive reactive assays (Figure 2.3). All individuals are first tested on Assay 1 (A1). \nAnyone with a non -reactive test result (A1\u2212) is reported HIV -negative.  Individuals who are \nreactive on Assay 1 (A1+) will then be tested on a separate and distinct Assay 2 (A2). Individuals \nwho are reactive on both Assay 1 and Assay 2 (A1+; A2+) will then be tested on a separate an d \ndistinct Assay 3 (A3). A positive HIV diagnosis is given when Assay 3 is reactive (A1+; A2+; A3+).  \nIf Assay 3 is nonreactive (A1+; A2+; A3\u2212), the status should be reported as HIV -inconclusive, and \nthe individual should be asked to return in 14 days for retesting.   \nIndividuals who are reactive on Assay 1 but non -reactive on Assay 2 (A1+; A2\u2212) should be repeated \non Assay 1. If repeat Assay 1 is non -reactive (A1+; A2\u2212; repeat A1 \u2013), the status should be reported \nas HIV -negative.  If repeat Assay 1 is reactive (A1+; A2 \u2013; repeat A1+), the status should be reported \nas HIV -inconclusive, and the individual asked  to return in 14 days for retesting.   All clients with \nHIV positive results will be referred to a Comprehensive Care Clinic for retesting prior to \ninitiation of ART  \nNOTE:  The three -test algorithm will be implemented after identification of the specific \nassay. Meanwhile, the current algorithm continues being in use (Annex 7). Guidance will \nbe issued before implementation.", "start_char_idx": 3, "end_char_idx": 3028, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "74fca76f-f1f1-45ac-b7f9-66fc4cb1a4a2": {"__data__": {"id_": "74fca76f-f1f1-45ac-b7f9-66fc4cb1a4a2", "embedding": null, "metadata": {"page_label": "39", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5e027427-9560-42ce-8843-1ec95cd4725f", "node_type": "4", "metadata": {"page_label": "39", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9660958d004d13347a974768f38158300b4292840cafadfab0ab507acd4e7dcc", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5205665d-330e-4172-a27b-86bc1be2fef7", "node_type": "1", "metadata": {"page_label": "38", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6903dfb72c16acbbc0cfd06aef0385b59ab85b26505635b9aae208c03de15681", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8bf181b9-54f6-4036-a4b6-01be2ccece70", "node_type": "1", "metadata": {}, "hash": "f19d805621f53ba8ee0f3463b9b5ea69a8954ee82718ea853ae9438a1181b889", "class_name": "RelatedNodeInfo"}}, "hash": "770b830d928d384c9b92f270e240d3e2c521c9807961112076203ebeb009ff53", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 13  \nHIV TEST A1\nNON -REACTIVE REACTIVE\nREPORT NEGATIVE HIV TEST A2\nNON -REACTIVE REACTIVE\nHIV TEST A1 HIV TEST A3\nNON -REACTIVE REACTIVE NON -REACTIVE REACTIVE\nREPORT NEGATIVE\nREPORT INCONCLUSIVE AND \nRETEST IN 14 DAYS. \nREPORT HIV POSITIVE AND REFER TO THE SECOND TESTER AT CCC/MCH\nHIV TEST A1\nNON -REACTIVE REACTIVE\nREPORT INCONCLUSIVE AND \nRETEST IN 14 DAYSHIV TEST A2\nNON -REACTIVE REACTIVE\nHIV TEST A1 HIV TEST A3\nNON -REACTIVE REACTIVE NON -REACTIVE REACTIVE\nREPORT NEGATIVEREPORT INCONCLUSIVE AND \nRETEST IN 14 DAYSINITIATE ART\nNote: \n\u2022 The use of DNA PCR as a supplemental assay is no longer recommended\n\u2022 For inconclusive HIV status, if reactivity remains the same after 14 days the individual should be \nreported as HIV -negative and advised to retest after 3 months \nFigure 2.3: HIV Testing Services Algorithm", "start_char_idx": 3, "end_char_idx": 891, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8bf181b9-54f6-4036-a4b6-01be2ccece70": {"__data__": {"id_": "8bf181b9-54f6-4036-a4b6-01be2ccece70", "embedding": null, "metadata": {"page_label": "40", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ff9d6f05-aa11-431a-9d95-0959cbf1a0d6", "node_type": "4", "metadata": {"page_label": "40", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1eb846ac311dcbe77d0bba808edc0822626ae2fd118267c0d68b551bebaa9164", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "74fca76f-f1f1-45ac-b7f9-66fc4cb1a4a2", "node_type": "1", "metadata": {"page_label": "39", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "770b830d928d384c9b92f270e240d3e2c521c9807961112076203ebeb009ff53", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1e231584-7885-4823-9212-5e3c4d6a5d46", "node_type": "1", "metadata": {}, "hash": "4f7f6b8eb727c91d8c6e3ae0bb9b001e19d8ac53607d3efaa94a474a6cdf396f", "class_name": "RelatedNodeInfo"}}, "hash": "f19d805621f53ba8ee0f3463b9b5ea69a8954ee82718ea853ae9438a1181b889", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 14  Results interpretation  \nRESULTS  INTERPRETATION  \nA1- HIV-NEGATIVE  \nA1+; A2+; A3+  HIV-POSITIVE  \nA1+; A2 -; Repeat A1+  HIV-INCONCLUSIVE (retest after 14 days). If reactivity \nremains the same after 14 days, the individual should be \nreported as HIV -negative   \nA1+; A2 -; Repeat A1 - HIV-NEGATIVE  \nA1+; A2+; A3 - HIV- INCONCLUSIVE (Retest after 14 days). If reactivity \nremains the same after 14 days, the individual should be \nreported as HIV -negative  \n \n2.4.3  HIV testing for Pregnant Women  \nFor pregnant women, the HIV/syphilis dual test should be used as the A1 test (Figure 2.4). The dual \ntest kit is recommended for:  \n\u25cf Pregnant women during their first ANC, unless the woman is known to be living with HIV.  \n\u25cf For those who test negative for both HIV and Syphilis repeat testing should be conducted \nin the third trimester using the HIV and syphilis dual test.  \n\u25cf Partners accompanying pregnant women for the first -time during ANC  \nHIV/Syphilis dual test should not be used for retesting women on ART or with  known positive HIV \nstatus, or women diagnosed with syphilis during pregnancy.  \nSee Figure 2.4 for the full algorithm when considering HIV and syphilis (TP) results concurrently.", "start_char_idx": 3, "end_char_idx": 1277, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1e231584-7885-4823-9212-5e3c4d6a5d46": {"__data__": {"id_": "1e231584-7885-4823-9212-5e3c4d6a5d46", "embedding": null, "metadata": {"page_label": "41", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "858047f6-5cb2-41e6-97b0-c5a790f0f536", "node_type": "4", "metadata": {"page_label": "41", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e6fdc365e8d2df3dd0d3b4df40c9b447dc57c2f4a87cc74e0a0179eb1ffd7127", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8bf181b9-54f6-4036-a4b6-01be2ccece70", "node_type": "1", "metadata": {"page_label": "40", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f19d805621f53ba8ee0f3463b9b5ea69a8954ee82718ea853ae9438a1181b889", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b65e8381-9737-476a-9ba3-5b1ee4202516", "node_type": "1", "metadata": {}, "hash": "6553ce714e433efe73929ea2042f309db454654aeaead9ebf54a5c836206a7d0", "class_name": "RelatedNodeInfo"}}, "hash": "4f7f6b8eb727c91d8c6e3ae0bb9b001e19d8ac53607d3efaa94a474a6cdf396f", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 15  \nTEST A1 (HIV/Syphillis)\nHIV TEST A1 SYPHILIS TEST A1\nREPORT NEGATIVE HIV TEST A2\nNON -REACTIVE REACTIVE\nHIV TEST A1 HIV TEST A3\nNON -REACTIVE REACTIVE NON -REACTIVE REACTIVE\nREPORT NEGATIVE REPORT INCONCLUSIVE \nRETEST IN 14 DAYS.\nREPORT HIV POSITIVE AND REFER TO THE SECOND TESTER AT CCC/MCH\nHIV TEST A1\nNON -REACTIVE REACTIVE\nREPORT INCONCLUSIVE AND \nRETEST IN 14 DAYSHIV TEST A2\nNON -REACTIVE REACTIVE\nHIV TEST A1 HIV TEST A3\nNON -REACTIVE REACTIVE NON -REACTIVE REACTIVE\nREPORT NEGATIVE REPORT INCONCLUSIVE AND \nRETEST IN 14 DAYSINITIATE ARTNON -REACTIVE REACTIVE NON -REACTIVE REACTIVE\nREPORT NEGATIVEREPORT POSITIVE AND \nTREAT FOR SYPHILLIS\nNote: \n\u2022 The use of DNA PCR as a supplemental assay is no longer recommended\n\u2022 For inconclusive HIV status, if reactivity remains the same after 14 days the individual should be \nreported as HIV -negative and advised to retest after 3 months \nFigure 2.4 Dual HIV/syphilis Testing Algorithm", "start_char_idx": 3, "end_char_idx": 1010, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b65e8381-9737-476a-9ba3-5b1ee4202516": {"__data__": {"id_": "b65e8381-9737-476a-9ba3-5b1ee4202516", "embedding": null, "metadata": {"page_label": "42", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "872cda82-50fb-473c-af82-ac3ec0c780e1", "node_type": "4", "metadata": {"page_label": "42", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "664f2a74baff99795210dd9f2133cbb9d8e0a08ea2a158f5634afcc5c0ca6640", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1e231584-7885-4823-9212-5e3c4d6a5d46", "node_type": "1", "metadata": {"page_label": "41", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4f7f6b8eb727c91d8c6e3ae0bb9b001e19d8ac53607d3efaa94a474a6cdf396f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "25a6937c-41c6-4d74-ba21-812bd3eed8b8", "node_type": "1", "metadata": {}, "hash": "91b60a3d88ea1f069495c37fbcedcce05f7c66c69320a73c50bb3cd631aafdc1", "class_name": "RelatedNodeInfo"}}, "hash": "6553ce714e433efe73929ea2042f309db454654aeaead9ebf54a5c836206a7d0", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 16  RESULTS  INTERPRETATION  \nA1 HIV -, Syphilis Test (TP) - HIV negative, syphilis negative  \nA1 HIV -, Syphilis Test (TP)+  HIV negative, syphilis positive  \nA1 HIV+, Syphilis Test (TP) - Syphilis negative and proceed with A2 for HIV  \nA1 HIV+, Syphilis Test (TP)+  Syphilis positive and proceed with A2 for HIV  \nA1 (HIV+); A2+; A3+  HIV-positive  \nA1(HIV+); A2 -; Repeat A1+  HIV-inconclusive (retest after 14 days). If reactivity remains the same \nafter 14 days, the individual should be reported as HIV -negative  \nA1(HIV+); A2 -; Repeat A1 - HIV-negative  \nA1(HIV+); A2+; A3 - HIV- inconclusive (retest after 14 days). If reactivity remains the same \nafter 14 days, the individual should be reported as HIV -negative  \nTable 2.4: Approaches to Improve Linkage to Treatment and Prevention Services  \nkey area  Action  \nInformation  \u25cf Quality post -test counselling should include information about the nature and \navailability of additional HIV -related services, description of the next steps in \ntreatment and prevention including entire treatment plan and follow -up visits \nand schedule.  \n\u25cf The benefits of immediate assessment and early initiation of ART should be \nemphasized.  \n\u25cf Involve the patient in the decision -making process regarding treatment and \nprevention (espe cially where and when to start ART)  \nDisclosure  \u25cf Disclosure to a trusted \u2018significant other\u2019 promotes linkage and adherence to \ntreatment.  \n\u25cf Encourage and help the patient to discuss HIV status with a trusted friend or close \nrelative.  \n\u25cf Encourage adolescents to identify and invite a supportive adult or friend to \nsupport them.  \n\u25cf For children, HIV status should be disclosed to children by age 12 years and the \nprocess can start when a child is as young as 7 years old.  The health care provider \nor the pa rent/caregiver/guardian can disclose to the child with appropriate \nguidance and training. The aim of disclosure to children is to start to involve them \nin the management of their own health and reduce stigma associated with HIV  \nBarriers to \nLinkage  \u25cf During post -test counselling, identify and address any barriers to linkage", "start_char_idx": 3, "end_char_idx": 2199, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "25a6937c-41c6-4d74-ba21-812bd3eed8b8": {"__data__": {"id_": "25a6937c-41c6-4d74-ba21-812bd3eed8b8", "embedding": null, "metadata": {"page_label": "43", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "761f2193-f1b6-4a94-9216-db6296df98c3", "node_type": "4", "metadata": {"page_label": "43", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "12fc8c53d15e29082321e8d78860e32f5bcd7de877f93e9723ad274269368ac7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b65e8381-9737-476a-9ba3-5b1ee4202516", "node_type": "1", "metadata": {"page_label": "42", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6553ce714e433efe73929ea2042f309db454654aeaead9ebf54a5c836206a7d0", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "97c29e76-ee97-4f67-88cb-423ba7cccae2", "node_type": "1", "metadata": {}, "hash": "3df9a6d044f0aee466e5bedd94d27ac44355cba5a56549e7fd7f2569db07fb0e", "class_name": "RelatedNodeInfo"}}, "hash": "91b60a3d88ea1f069495c37fbcedcce05f7c66c69320a73c50bb3cd631aafdc1", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 17  Table 2.4 Cont.  \nSystems to \nFacilitate \nLinkage  \u25cf The HTS provider is responsible for linkage into care.  \n\u25cf Same day enrolment into care is expected. monitor linkage to treatment initiation \nwithin 14 days of diagnosis, however allow follow up of clients to 90 days of a \nHIV-positive diagnosis  \n\u25cf For HIV negative clients link to HIV prevention services based on assessed risk  \n\u25cf Linkage should be done to on -site treatment and prev ention services through \npatient escorts. Where this is not possible (due to patient preference or the \nservices are not available), the testing facility should book the appointment with \nthe receiving facility and follow -up to ensure the patient registers at  the receiving \nfacility. Provide the patient with referral information, referral form and contact \ndetails of the facility.  \n\u25cf Deploy retention and loss -to-follow up tracking system to ensure linkage is \nsuccessful. These include enlisting the help of peer or b uddy systems, SMS \nreminders, phone calls and community outreach workers to escort HIV positive \nclients to enrolment.  \n\u25cf Early preparation and assessment for ART, with early initiation of ART \nstrengthens engagement in care.  \nCare \nCoordination \nand \nIntegration  \u25cf Coordinate and treat mother -baby pairs, partners, and families together. \nIntegrate common services offered to PLHIV (TB diagnosis and treatment, \nSRH/FP, cervical cancer screening, nutrition etc.)  \n\u25cf Where referrals are necessary, such referrals should be coor dinated \n(communication and documentation between referring and receiving service \ndelivery points)  \nLinkage Register  \u25cf Maintain a linkage register at all testing points in the facility and community.  \n\u25cf Track and report on progress with linkage monthly  \n\u25cf Discuss linkage at MDT meetings.  \n \n2.5 Retesting recommendations for HIV negative persons  \nRetesting in this context refers to testing that occurs later after the initial test is negative.  \nThe purpose of retesting is to:  \n\u25cf Monitor the effectiveness of HIV prevention interventions  \n\u25cf identify and treat new HIV infections as early as possible when prevention efforts fail.  \nThe following are the recommendations for HIV retesting in different populations and settings in \nKenya:", "start_char_idx": 3, "end_char_idx": 2322, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "97c29e76-ee97-4f67-88cb-423ba7cccae2": {"__data__": {"id_": "97c29e76-ee97-4f67-88cb-423ba7cccae2", "embedding": null, "metadata": {"page_label": "44", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ad2c7b74-7acb-47f7-bf90-e779598253b8", "node_type": "4", "metadata": {"page_label": "44", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "81f2460c9b339a13cbd4507bfafd183bb19d23cae3c8d69e9b62910360d33474", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "25a6937c-41c6-4d74-ba21-812bd3eed8b8", "node_type": "1", "metadata": {"page_label": "43", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "91b60a3d88ea1f069495c37fbcedcce05f7c66c69320a73c50bb3cd631aafdc1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "328a2ebe-32bd-4e06-8cc6-1d8b9f57e5a4", "node_type": "1", "metadata": {}, "hash": "eee6913edf4a567d85853dca5ea5a73fdf2d3a7568769a2ab2ab9478f91b959a", "class_name": "RelatedNodeInfo"}}, "hash": "3df9a6d044f0aee466e5bedd94d27ac44355cba5a56549e7fd7f2569db07fb0e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 18  Table 2.5: Recommendations for Retesting HIV Negative Clients  \nScenario/population  Recommendation for retesting  \nGeneral population  All general population to be screened every 2 years \nusing the approved NASCOP HTS screening tool and \nthose eligible get tested  \nKey populations (FSW, MsM, TG, \nPWID)  Re-test every 3 months  \nNegative partner in discordant  \n \n Retest HIV negative partner at the initiation of ART for the \nHIV positive partner, at 6months and 12 months once \nviral suppression is achieved.  \nRetest a nnually if the positive partner remains virally \nsuppressed.  \nPregnant women  Test in first trimester or first contact; Re -test in the third \ntrimester and, during labour and delivery.  \nBreastfeeding mothers  Re-test 6 weeks after delivery, at 6 months then every 6 \nmonths until complete cessation of breast feeding.  \nFor mothers considered to be at high risk of HIV \ninfection, retesting postnatally should be done every 3 \nmonths  \nPersons who had a most recent \n(e.g., less than one month) high \nrisk exposure to  HIV  Test at initial presentation and re -test at 4 weeks, after \nwhich National testing guidelines apply  \nSTI symptomatic patients or \npatients with symptoms \nsuggestive of acute HIV  Test at initial presentation and re -test at 4 weeks, after \nwhich national te sting guidelines apply  \nIndividuals on Pre -exposure \nprophylaxis (PrEP)  Test at initiation of PrEP; Retest at month one, and then \nevery 3 months  \n2.6 Inconclusive HIV status  \nAn HIV -inconclusive test status means that individuals had discrepant results on the test (for \nexample, first test reactive, second test nonreactive, third test reactive) and so could not be given \nan HIV -positive or HIV -negative diagnosis.  \nInconclusive results are rare, but they may occur when  \ni) cross -reactivity exists between kits or patient -related factors,  \nii) the tester or test kit makes an error; and/or  \niii) individuals are seroconverting and in the window period, when infection cannot be \ndeterm ined.", "start_char_idx": 3, "end_char_idx": 2085, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "328a2ebe-32bd-4e06-8cc6-1d8b9f57e5a4": {"__data__": {"id_": "328a2ebe-32bd-4e06-8cc6-1d8b9f57e5a4", "embedding": null, "metadata": {"page_label": "45", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "17049bc9-9b30-4884-8df6-d881951c68aa", "node_type": "4", "metadata": {"page_label": "45", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cf93a115d73dffac680b3d3eec39db4176d3999667fbaafb81694113057aa3aa", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "97c29e76-ee97-4f67-88cb-423ba7cccae2", "node_type": "1", "metadata": {"page_label": "44", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3df9a6d044f0aee466e5bedd94d27ac44355cba5a56549e7fd7f2569db07fb0e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "37d34b50-2cbd-4101-9391-7da2f8a757a1", "node_type": "1", "metadata": {}, "hash": "5c7f15b8854ab86060788d682518ecf9a2ce0bacd1be5a25b0f264b8a2632c0c", "class_name": "RelatedNodeInfo"}}, "hash": "eee6913edf4a567d85853dca5ea5a73fdf2d3a7568769a2ab2ab9478f91b959a", "text": "HIV Testing Services and Linkage to Treatment and Prevention  \n2 - 19  The window period is the time from exposure to HIV infection to when the body produces enough \nHIV antibodies to be detected by an HIV antibody test. This time can vary across different types of \ntests, where some tests may be able to detect antibodies earli er than another test, which can lead \nto discrepant test results.  \nAll people with an inconclusive HIV status should be encouraged to return in 14 days for retesting. \nReceiving inconclusive results could be confusing and stressful for clients and may be dif ficult for \nthe provider to explain. During post -test counselling, the provider needs to take time to explain \ncarefully what an HIV -inconclusive status means, stating that it is neither HIV -positive nor HIV -\nnegative, and that retesting in 14 days is needed to establish the correct diagnosis. Because \ndefinitive diagnosis cannot be made on the day of testing, and immediate referral to HIV care or \nART initiation is not appropriate, providers need to help clients make a clear plan for follow -up and \nschedule an a ppointment for retesting. Also, clients should be informed about prevention options \nand how to stay HIV -negative, as well as about the availability and benefits of ART.  \nThose suspected of having an acute HIV infection1 \u2013 for example, if they report or pre sent with \nsymptoms associated with acute HIV infection \u2013 should be followed up closely. This is a period of \nhigh infectiousness due to high viral load, and clients need to be informed how to protect their \npartners. Individuals at high ongoing risk of HIV c an be informed about PrEP and encouraged to \ndiscuss options depending on their final HIV status when they come back for retesting.  \n \n2.7 Approach to Patients on ART with a Discrepant HIV Test Result  \nHIV testing should not be performed to patients who are al ready enrolled into HIV care and \non ART.  However, some patients self -refer for HIV antibody testing without disclosing that they \nare known HIV positive and on ART. Figure 2.5 provides recommendations on managing patients \nwho have a non -reactive antibody te st while on ART.", "start_char_idx": 3, "end_char_idx": 2179, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "37d34b50-2cbd-4101-9391-7da2f8a757a1": {"__data__": {"id_": "37d34b50-2cbd-4101-9391-7da2f8a757a1", "embedding": null, "metadata": {"page_label": "46", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "29e16d90-8ff1-4cbb-a9e4-81d81b54d8fd", "node_type": "4", "metadata": {"page_label": "46", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "750d53c93f5520ba94776ad12b38dc770e22bb209d5912097c406e70f5a5afe5", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "328a2ebe-32bd-4e06-8cc6-1d8b9f57e5a4", "node_type": "1", "metadata": {"page_label": "45", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "eee6913edf4a567d85853dca5ea5a73fdf2d3a7568769a2ab2ab9478f91b959a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "28733101-925b-4882-bfea-305c9b6d0518", "node_type": "1", "metadata": {}, "hash": "32b7abcbeeb3722a83d31304f0ac6f7edd5bde4b62da469059a129d934c4c5e4", "class_name": "RelatedNodeInfo"}}, "hash": "5c7f15b8854ab86060788d682518ecf9a2ce0bacd1be5a25b0f264b8a2632c0c", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n2 - 20  \nEducation/counselling  for patients who are on ART and present with a new negative HIV antibody test\n\u2022 The new HIV antibody test may be a  false negative    the patient may still be HIV -infected but their antibody \nlevels may be suppressed as a result of effective ART. This is more common for patients who start ART very \nsoon after HIV infection\n\u2022 Those with prior history of detectable viral loads, positive DNA PCR results, or low CD4 counts are almost \nalways truly HIV positive\n\u2022 Continue their ART until a special test is performed (a new sample for DNA PCR) at the National HIV \nReference Laboratory (NHRL)\n\u2022 Stopping ART before HIV status is confirmed could result in a rapid rise in viral load, decline in CD4, and \nincreased risk of developing an opportunistic infection or dying\n\u2022 Draw a sample for DNA PCR  and send to the NHRL  (preferably a whole blood EDTA sample following \ncold -chain protocols within 24 hours of collection; DBS is acceptable if EDTA is not possible)\n\u2022 Specify that this is a sample for confirming HIV status  of a patient who is on ART, and provide the dates \nand results for all prior antibody tests, DNA PCR tests, and RNA viral load tests in the request form\nIf HIV DNA PCR sample is positive\n\u2022 This confirms the patient is HIV positive\n\u2022 Provide additional counseling on the \nreasons why the antibody test may have \nbeen falsely negative and discourage the \npatient from any repeat antibody testing\n\u2022 Emphasize that the patient  s ART is \nworking and the need for continued \nexcellent adherenceIf HIV DNA PCR sample is negative\n\u2022 The patient may be HIV negative, or it could be that the \npatient is  HIV positive but the HIV DNA levels have been \nsuppressed below the testing limit (this is more common if \na DBS sample was used)\n\u2022 Inform the patient that they may still be HIV positive and \nneed to be monitored closely for an additional 6 months \nbefore confirming they are HIV negative\n\u2022 Inform the patient that ART should be stopped immediately\n\u2022 They should return for HIV viral load performed at 1 \nmonth, 3 months, and 6 months after stopping ART \n(samples for HIV viral load should be sent to the designated \nVL/EID network laboratory assigned to the requesting \nfacility with all past details) \nFigure 2.5: Managing Patients on ART Who Present with a New Negative HIV Antibody Test", "start_char_idx": 3, "end_char_idx": 2398, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "28733101-925b-4882-bfea-305c9b6d0518": {"__data__": {"id_": "28733101-925b-4882-bfea-305c9b6d0518", "embedding": null, "metadata": {"page_label": "47", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f2baf9fe-98ec-466f-b240-1a118f2f106d", "node_type": "4", "metadata": {"page_label": "47", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fd9a6b30830f28726aab03e0ca481851cec9613e5cfe56343f8a716d6474b184", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "37d34b50-2cbd-4101-9391-7da2f8a757a1", "node_type": "1", "metadata": {"page_label": "46", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5c7f15b8854ab86060788d682518ecf9a2ce0bacd1be5a25b0f264b8a2632c0c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "63a3004b-bdb9-4a45-87e6-edb6a0037572", "node_type": "1", "metadata": {}, "hash": "ed94d159c45fd560b12444b1d879f3959f848107b0ac4f78077da1bc782dbd78", "class_name": "RelatedNodeInfo"}}, "hash": "32b7abcbeeb3722a83d31304f0ac6f7edd5bde4b62da469059a129d934c4c5e4", "text": "Initial Evaluation and Follow up  \n3 - 1   \n3. Initial Evaluation and Follow up  \n \n3.1 Introduction  \nAll PLHIV are eligible for ART irrespective of CD4 cell count or percentage, WHO clinical  stage, age, \npregnancy status, or comorbidities. ART should be initiated as soon as the patient is ready to start, \npreferably within two weeks from time of HIV diagnosis.  \nIn order to provide targeted services based on clinical presentation, during the init ial evaluation \nall PLHIV should be categorized as presenting with advanced HIV disease (AHD) or as presenting \nwell (Table 3.3). Patients with advanced disease require more intensive evaluation for and \nmanagement of OIs, and once ART is started, they are at  higher risk of developing immune \nreconstitution inflammatory syndrome (IRIS, Annex 16).  \nSimilarly, after at least 6 months on ART, PLHIV should be categorized as being either established \nor not established on ART (clinically, virologically, and psychosoci ally) to best meet the specific \nneeds of each patient for treatment and follow -up and improve patient outcomes through provision \nof targeted differentiated care. Differentiated care minimizes inconvenience and unnecessary \nfrequent follow -up, thus reducing costs and time related to clinic visits. It also allows resources to \nbe focused on those patients who require additional attention.  \n3.2 Initial Clinical Evaluation of PLHIV  \nAll patients enrolling into HIV care should have a complete medical history taken, a thorough \nphysical examination and appropriate laboratory investigations. Findings from this initial \nevaluation should be documented legibly in a retrievable health record management format \n(electronic or paper -based) to facilitate long -term follow -up of the patient. Table 3.1 summarizes \nimportant aspects of the initial medical history and physical examination for PLHIV.  \nThe initial visit provides the opportunity to establish a meaningful patient -provider relationship; \nthe clinician should elicit concerns  and expectations with open, non -judgmental, and clear \ncommunication.", "start_char_idx": 3, "end_char_idx": 2094, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "63a3004b-bdb9-4a45-87e6-edb6a0037572": {"__data__": {"id_": "63a3004b-bdb9-4a45-87e6-edb6a0037572", "embedding": null, "metadata": {"page_label": "48", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ee707112-bcc3-47d8-9a39-3ab055ebbb87", "node_type": "4", "metadata": {"page_label": "48", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2fd0d02178c5716edf8b5a2d0823a49a5f32036f355e9c540e471ca94862151c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "28733101-925b-4882-bfea-305c9b6d0518", "node_type": "1", "metadata": {"page_label": "47", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "32b7abcbeeb3722a83d31304f0ac6f7edd5bde4b62da469059a129d934c4c5e4", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5ae8f2a6-82f0-4450-a2ee-347b6c397702", "node_type": "1", "metadata": {}, "hash": "5a7d140214c8a1f9bde890cc08ac47ca3e6bb91deb8201a6c2e15729738f73f3", "class_name": "RelatedNodeInfo"}}, "hash": "ed94d159c45fd560b12444b1d879f3959f848107b0ac4f78077da1bc782dbd78", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 2  Table 3.1: Initial Clinical Evaluation for PLHIV (History and Physical Examination)  \nHistory  Details for History taking  \nCurrent and past \nmedical history  \u25cf Presenting complaints/current symptoms  \no Also inquire about symptoms due to co -existing HIV -related and non -HIV-\nrelated disease and co -morbidities that will require immediate intervention  \n\u25cf History of TB and TB contacts  \nComplete the Intensified Case Finding (ICF) tool  \n\u25cf Date of first positive HIV test  \n\u25cf Past and current co -morbidities (e.g., TB, cryptococcal meningitis, hypertension, \ndiabetes, kidney, and liver disease)  \no Document history of TB  \n\u25cf Current medications,  \no Establish current medications (prescription, non -prescription, and \nherbal) likely to interact with ARVs  \no Document ARV exposure history including previous or current ARV use \n(including for PMTCT, PEP, PrEP, and ART)  \n\u25cf Drug allergies, especially sulpha allergy  \n\u25cf History of hospitalizations  \no Establish reasons for hospitalizations  \n\u25cf Family history of chronic disease or cancer  \nEstablish nutritional history and adequacy of nutritional intake and household food \nsecurity  \nPsychosocial \nhistory  \u25cf Education, employment, family, marital status  \n\u25cf Establish possible presence of mental health concerns  \no Including past treatment for mental illnesses and any current \nsymptoms of depression  \n\u25cf Assess for disclosure and presence of self -stigma  \no Encourage disclosure to trusted close relations and sexual partners  \n\u25cf Substance use screening including alcohol, tobacco, miraa (khat), marijuana, \nnarcotics, injection drug use (use the CRAFFT screening tool for adolescents and \nthe CAGE -AID screening tool for adults to screen for alcohol and drug use \ndisorders \u2013 see Tables 4.15 and 4.16)  \n\u25cf Establish and document social support structures  \n\u25cf Link to additional facility and community support resources, including \npsychosocial support groups, peer mentors, harm reduction services for PWIDs, \netc. \nElicit and begin to address possible barriers to adherence", "start_char_idx": 3, "end_char_idx": 2106, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5ae8f2a6-82f0-4450-a2ee-347b6c397702": {"__data__": {"id_": "5ae8f2a6-82f0-4450-a2ee-347b6c397702", "embedding": null, "metadata": {"page_label": "49", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a7cdf01a-89c8-49a4-8c74-041c1e961dc3", "node_type": "4", "metadata": {"page_label": "49", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "41b2d56e180415bae502469b4c0477e2decd7c199f798add566b30dd2e802db7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "63a3004b-bdb9-4a45-87e6-edb6a0037572", "node_type": "1", "metadata": {"page_label": "48", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ed94d159c45fd560b12444b1d879f3959f848107b0ac4f78077da1bc782dbd78", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "100a18a4-95fc-4352-bb7a-f602b9101998", "node_type": "1", "metadata": {}, "hash": "ad3e2a3858916bb74338cd22ebb56d6817645c74042d48c2b8eb664f0876d803", "class_name": "RelatedNodeInfo"}}, "hash": "5a7d140214c8a1f9bde890cc08ac47ca3e6bb91deb8201a6c2e15729738f73f3", "text": "Initial Evaluation and Follow up  \n3 - 3  Table 3.1 Cont.  \nSexual and \nreproductive \nhistory  History  \n\u25cf History of STIs  \n\u25cf Current symptoms of STIs  \n\u25cf Sexual practices  \no Determine HIV status and disclosure to sexual partner(s)  \no ART status of sexual partner/s  \n\u25cf Pregnancy history and age of all living children  \n\u25cf Menstrual history, family planning and plans for pregnancy  \n\u25cf History of cervical cancer screening  \n\u25cf Vaccination history (including COVID -19 vaccine)  \nDiscuss:  \n\u25cf Secondary prevention and avoidance of re -infection with STIs  \n\u25cf Pregnancy intention and contraception needs  \nEncourage contact tracing and HIV testing for sexual partners and all children < 15 \nyears of age of HIV -infected women or whose mothers\u2019 HIV status is unknown  \nVital signs, and \nanthropometric \nmeasurements  \u25cf Measure and record weight, height, MUAC (in children and pregnant women), \ntemperature, pulse rate, BP, respiratory rate, and pulse oximetry  \n\u25cf Calculate BMI as: Weight (kg)/ Height2(m); Use z -scores for children  \n\u25cf Monitor growth trends for children  \nGeneral \nexamination  Examine the following:  \n\u25cf Conjunctiva and palms for pallor or jaundice; swollen lymph nodes (cervical, \naxillary, inguinal); mouth for Kaposi\u2019s sarcoma (KS) lesions, oral hairy \nleucoplakia, candidiasis, tooth decay; skin (for drug eruptions, herpes zoster, \ndermatitis, pruritic papular eruptions (PPE), folliculitis, fungal infections, \nmolluscum, and KS)  \n\u25cf Assess developmental milestones for children  \nSystemic \nexamination  \u25cf Central Nervous System  \n\u25cf Mental State Examination (for mental status)  \n\u25cf Abdomen   \n\u25cf Respiratory  \n\u25cf Cardiovascular  \n\u25cf Genitourinary/ anorectal system (for ulcers, discharge, condylomata/warts, \nprostate examination for men \u2265 45 years of age). Speculum examination with \ncervical cancer screening for females", "start_char_idx": 3, "end_char_idx": 1849, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "100a18a4-95fc-4352-bb7a-f602b9101998": {"__data__": {"id_": "100a18a4-95fc-4352-bb7a-f602b9101998", "embedding": null, "metadata": {"page_label": "50", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "af3c4ab7-964a-48e3-afdd-8d5b4393b620", "node_type": "4", "metadata": {"page_label": "50", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "382c121ba1ec4e2fb4b6064de98d57fb7820cd05381cf778e3819d781ac4fda1", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5ae8f2a6-82f0-4450-a2ee-347b6c397702", "node_type": "1", "metadata": {"page_label": "49", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5a7d140214c8a1f9bde890cc08ac47ca3e6bb91deb8201a6c2e15729738f73f3", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "53e8c4be-2e5c-43b9-97d3-b34006c0bc04", "node_type": "1", "metadata": {}, "hash": "929081208cf444cfc14401e8ce77c43fba20066fc09e2a59a4cb9f3b114d34b2", "class_name": "RelatedNodeInfo"}}, "hash": "ad3e2a3858916bb74338cd22ebb56d6817645c74042d48c2b8eb664f0876d803", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 4  Table 3.1 Cont.  \nSummary  List differential diagnosis and management plan for each problem (including \ninvestigations, treatment, referrals, and follow -up) \n\u25cf Assign and document the WHO Clinical Stage and manage presenting \nillnesses  \n\u25cf Growth and developmental milestone must be assessed and used for WHO \nstaging in children  \nDifferentiate between patients with advanced disease versus those who are clinically \nwell, to guide acuity of follow -up \n3.3 Initial Laboratory Evaluation of PLHIV  \nThe comprehensiveness of laboratory tests will depend on presence and/or type of suspected \nconcurrent illness. Table 3.2 summarizes the recommended baseline laboratory investigations for \nall PLHIV. Additional investigations should be based on clinical indicati on. ART should not be \ndelayed if a laboratory test is not available.  \nTable 3.2: Baseline Laboratory Investigations for PLHIV  \nHIV  \nSpecific  Test  Comments  \n\u25cf Confirm and \ndocument positive \nHIV test result  \u25cf Positive status should be reconfirmed prior to ART \ninitiation for all patients  \n\u25cf Refer to current HIV testing algorithm  \nCD4 cell count  \u25cf For all patients  (CD4% for children \u2264 5 years old)  \n\u25cf If CD4 \u2264 200 cells/mm3 in PLHIV >5 years, th en \nlaboratories should automatically perform a serum \ncryptococcal antigen (sCrAg) on the same sample to screen \nfor cryptococcal infection  \n\u25cf TB-LAM should also be conducted   \nViral load (HIV -1 RNA)  \u25cf Baseline viral load (VL) is recommended for infants after \n1st PCR test is positive. Specimen for baseline VL can be \ndrawn at the time of initiating ART; obtaining a VL should \nnot delay ART initiation  \nSerum Cryptococcal  \nAntigen (sCrAg)  \u25cf Obtain serum CrAg If CD4 \u2264 200 cells/mm3 in patients >5 \nyears  as reflex testing by the laboratory  \n\u25cf If positive, manage as per the cryptococcal meningitis \nscreening algorithm (Figure 4.1)", "start_char_idx": 3, "end_char_idx": 1932, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "53e8c4be-2e5c-43b9-97d3-b34006c0bc04": {"__data__": {"id_": "53e8c4be-2e5c-43b9-97d3-b34006c0bc04", "embedding": null, "metadata": {"page_label": "51", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c27823b1-eb17-41b5-84f3-0d1f2ddacab0", "node_type": "4", "metadata": {"page_label": "51", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "bb605e3c0a1bb3c5e05e772aeb549b8ddaf0208c44ab9c9550a0d40897a43b3c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "100a18a4-95fc-4352-bb7a-f602b9101998", "node_type": "1", "metadata": {"page_label": "50", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ad3e2a3858916bb74338cd22ebb56d6817645c74042d48c2b8eb664f0876d803", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3fc6d248-8418-44a5-85a9-e5e07c1888d9", "node_type": "1", "metadata": {}, "hash": "961438a5ab917d259f1b4201feda99cbae11e70c2fa34124a2e09ca933a84d99", "class_name": "RelatedNodeInfo"}}, "hash": "929081208cf444cfc14401e8ce77c43fba20066fc09e2a59a4cb9f3b114d34b2", "text": "Initial Evaluation and Follow up  \n3 - 5  Table 3.2 Cont.  \nOthers  Hb (preferably full  \nblood count if available)  \u25cf All patients especially if on AZT  \n\u25cf  \nPregnancy Test  \u25cf Pregnancy status should be determined for all women of \nreproductive age (based on history of last menstrual period, \nand if uncertain, irregular, or delayed then a urine pregnancy \ntest should be performed)  \nTB- LAM  \u25cf Conduct TB -LAM  on a urine sample if CD4 \u2264 200 cells/mm3 \nin PLHIV >5 years, and if CD4% \u2264 25% in children < 5 years  \n\u25cf Seriously ill patients  \nUrinalysis (for protein  \n& glucose)  \u25cf All patients  \nCreatinine  o All patients, especially those starting TDF. Calculate \nCreatinine Clearance (CrCl), (Annex 15)  \nSyphilis serology \n(VDRL, TPHA, or RPR)  \u25cf All patients with a history of being sexually active  \nGlucose  \u25cf All patients  \nPlasma lipid profile  \u25cf All patients  \nHBsAg  \u25cf All adolescent and adult patients (plus children who did not \ncomplete routine childhood immunizations)  \nHCV antibody  \u25cf PWID or for patients with history of injection drug use  \nALT  \u25cf Not recommended as baseline investigation unless there is a \nspecific clinical reason (e.g., patient with history of hepatitis, \nsigns or symptoms of liver disease, or risk of liver disease - \nalcoholics, HBV or HCV infection, hepatotoxic drugs such as \nfluconazole, etc.)  \nHPV testing  \u25cf For women of reproductive age between 25 -49 years \nconducted at baseline and every two years (refer to cancer \nscreening guidelines)  \n \nIt is not possible for ALL facilities providing ART to offer all the laboratory tests recommended for \nHIV treatment. If a facility does not have on -site capacity to carry out any test, arrangements \nshould be made to transport specimens to a local or regional reference laboratory.", "start_char_idx": 3, "end_char_idx": 1785, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3fc6d248-8418-44a5-85a9-e5e07c1888d9": {"__data__": {"id_": "3fc6d248-8418-44a5-85a9-e5e07c1888d9", "embedding": null, "metadata": {"page_label": "52", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d20b856c-290b-4755-b94f-3466edc7f0df", "node_type": "4", "metadata": {"page_label": "52", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "43ff66d36800dfa193215520a2787068effa9b4d4d469d681f78913faed70ee4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "53e8c4be-2e5c-43b9-97d3-b34006c0bc04", "node_type": "1", "metadata": {"page_label": "51", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "929081208cf444cfc14401e8ce77c43fba20066fc09e2a59a4cb9f3b114d34b2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "73268e57-38db-418f-b57f-6601c3698450", "node_type": "1", "metadata": {}, "hash": "f2a85b775d4cfac17c457e4d9a75be7f334e8efb082fa9e3adabe19c9c2b6558", "class_name": "RelatedNodeInfo"}}, "hash": "961438a5ab917d259f1b4201feda99cbae11e70c2fa34124a2e09ca933a84d99", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 6  3.4 Management of Patients Who Present with Advanced HIV Disease  \nThe World hea lth organization (WHO) defines AHD for adults, adolescents, and children five years \nand older as having a CD4 cell count of less than 200 cells/mm3 or WHO clinical stage III or IV \ndisease. All children younger than five years living with HIV who are not al ready receiving ART and \nnot clinically stable are considered to have AHD.  \nAdvanced HIV Disease can occur in various settings including PLHIV newly presenting to care, \nthose returning to care after treatment interruption and those on ART who have experienc ed \ntreatment failure.  \nPLHIV with AHD have immune suppression with reduced ability to fight opportunistic infections \n(OI), other infectious and non -infectious diseases, and are therefore at increased risk of morbidity \nand mortality. AHD is also associated with increased health -care costs, use of more health -care \nservices and more frequent monitoring needs. Leading causes of mortality among adults with AHD \ninclude immune reconstitution inflammatory syndrome, tuberculosis (TB), severe bacterial \ninfections, cryptococcal disease, histoplasmosis, toxoplasmosis, and Pneumocystis Jirovecii \npneumonia amongst others.  \nCD4 testing criteria to diagnose AHD and determine eligibility for package for care:   \n\u2022 New clients initiating ART:  \no CD4 testing should be c onducted as a baseline test for ALL PLHIV  \n\u2022 Patients who are treatment experienced:  \no PLHIV \u22655 years of age and who had previously initiated ART and are reinitiating after >3 \nmonths).  \no Individuals who have documented persistent unsuppressed viral load (two viral load VL \n>1,000 within 3 -6 months).  \nPackage of Care for AHD  \nAll PLHIV presenting  with Advanced HIV Disease (AHD) should be offered a package of care that \nincludes timely initiation of ART, screening, diagnosis, prophylaxis, and management of \nopportunistic infections.  \nTable 3.3 provides a summary of definitions of well versus advanced disease and package of care \nfor each at enrolment.", "start_char_idx": 3, "end_char_idx": 2107, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "73268e57-38db-418f-b57f-6601c3698450": {"__data__": {"id_": "73268e57-38db-418f-b57f-6601c3698450", "embedding": null, "metadata": {"page_label": "53", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a88534d1-f1cd-4c18-8185-06e8175f24bd", "node_type": "4", "metadata": {"page_label": "53", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "38237a204187a732f08e562c71606a15fbc4d260c14887937a62ca1235329d74", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3fc6d248-8418-44a5-85a9-e5e07c1888d9", "node_type": "1", "metadata": {"page_label": "52", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "961438a5ab917d259f1b4201feda99cbae11e70c2fa34124a2e09ca933a84d99", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ba8c847e-22cd-4e17-83e5-4a5aa37fad9f", "node_type": "1", "metadata": {}, "hash": "f2b50050a8385c05e3010d140d74f5f97fe7187d2e9a1b1116de57f6a845d788", "class_name": "RelatedNodeInfo"}}, "hash": "f2a85b775d4cfac17c457e4d9a75be7f334e8efb082fa9e3adabe19c9c2b6558", "text": "Initial Evaluation and Follow up  \n3 - 7  Table 3.3: Differentiated Care Based on Initial Patient Presentation  \nAdults, adolescents, and children \u2265 5 years who Present with Advanced HIV Disease: WHO Stage \n3 or 4, or CD4 count \u2264 200 cell/mm3  \nAll children younger than five years at enrollment into care  \nPackage of Care  \u25cf Standard Package of Care (Chapter 4)  \n\u25cf Intensive management of presenting illnesses and malnutrition  \n\u25cf Priority for identification, management, and prevention of OIs, \nincluding.  \no GeneXpert ultra for TB diagnosis for all PLHIV with presumptive TB \n(Figure 8.1)  \no TB-LAM (Figure 8.2), in addition to GeneXpert ultra, for PLHIV with \npresumptive TB who  \n\u25aa Have CD4 \u2264 200 cells/mm3 and if CD4% \u2264 25% in children < 5 \nyears  \n\u25aa Have signs of severe illness, or  \n\u25aa Are currently admitted to hospital  \no Cryptococcal antigen screening for adolescents and adults with CD4 \n\u2264 200 cells/mm3 or clinical suspicion of meningitis (any age) (Figure \n4.1)  \no Cotrimoxazole Preventive Therapy (CPT)  \no TB Preventiv e Therapy (TPT)  \n\u25cf Immediate ART initiation unless they are suspected to have TB, TB \nmeningitis, or cryptococcal meningitis;( Table 6.1)  \n\u25cf Close monitoring for development of immune reconstitution \ninflammatory syndrome (Annex 16)  \nFocus of ART Preparation \nCounselling  \u25cf Immediate ART start is required to prevent further damage to the \nimmune system.  \n\u25cf Starting ART soon will decrease risk of disease progression, including \nwasting and other infections  \nFrequency of  \nFollow -up \u25cf Weekly follow -up until ART initiation, and then at week 2 and 4 after \nART initiation, and then monthly until confirmed viral suppression.  \n\u25cf More frequent visits or hospitalization may be required to stabilize \nacute medical conditions and address psychosocial and other concerns  \n\u25cf Referral for management of co -morbidities or concurrent infections \nmay also be needed  \nManagement of Opportunistic Infections in Patients with AHD  \nCryptococcal Disease (CM)  \nCryptococcal disease is one of the most important opportunistic infections among peop le living \nwith AHD and is a major contributor to mortality.  \nEarly diagnosis and treatment of cryptococcal meningitis is key to reducing mortality from \ncryptococcal disease. Health -care professionals should have a low threshold for suspecting \ncryptococcal meningitis among people with advanced HIV disease.  \nScreening, prevention and treatment of  cryptococcal meningitis is described in Section 4.33.", "start_char_idx": 3, "end_char_idx": 2498, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ba8c847e-22cd-4e17-83e5-4a5aa37fad9f": {"__data__": {"id_": "ba8c847e-22cd-4e17-83e5-4a5aa37fad9f", "embedding": null, "metadata": {"page_label": "54", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2dee5b8c-ea0a-497e-9869-cb1dbdb7220a", "node_type": "4", "metadata": {"page_label": "54", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3e07bec061aec966585e445c5f95b53606114049812e167e2dbae871404050bb", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "73268e57-38db-418f-b57f-6601c3698450", "node_type": "1", "metadata": {"page_label": "53", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f2a85b775d4cfac17c457e4d9a75be7f334e8efb082fa9e3adabe19c9c2b6558", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6b057ee7-619f-400b-b359-eb332d325f6e", "node_type": "1", "metadata": {}, "hash": "140c23a7d541020325c59fb9ef4d5dddc2e8544d7655b83766f18c75c57d8624", "class_name": "RelatedNodeInfo"}}, "hash": "f2b50050a8385c05e3010d140d74f5f97fe7187d2e9a1b1116de57f6a845d788", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 8  Tuberculosis (TB)  \nTB is the most frequent life -threatening OI and a leading cause of death among PLHIV. TB remains \nthe leading cause of mortality among PLHIV, despite substantial scale -up of ART, accounting for \n30% of the AIDS -related deaths reported.  \nScreening, prevention  and treatment of TB is described in Chapter 8.  \nTable 3. 4: Management of patients who are presenting well : WHO Stage 1 or 2, and CD4 count \n> 200 cell/mm3  \nAdults, adolescents, and children \u2265 5 years who Present Well: WHO Stage 1 or 2, and CD4 count > \n200 cell/mm3 \nFocus of ART Preparation \nCounselling  \u25cf ART is the most important treatment to maintain good health and an \nactive life  \n\u25cf Starting ART soon will decrease risk of developing wasting and other \ninfections  \n\u25cf ART will reduce the risk of transmitting HIV to others  \nFrequency of  \nFollow -up \u25cf Weekly follow -up until ART initiation, and then at week 2 and 4 after \nART initiation, and then monthly until confirmed viral suppression  \n\u25cf Additional visits as required to address any medical or psychosocial \nconcerns  \nAdults, adolescents, and children \u2265 5 years who Present Well: WHO Stage 1 or 2, and CD4 count > \n200 cell/mm3 \nLocation of Services  \u2022 Management at any ART service delivery point; all facility levels   \n\u2022 Initial management and ART initiation by trained and experienced HCW  \nFocus of Treatment \nPreparation Counselling  \u2022 ART is the most important treatment to maintain good health and an \nactive life  \n\u2022 Starting ART soon will decrease risk of developing wasting and other \ninfections  \n\u2022 ART will reduce the risk of transmitting HIV to others  \n \n3.5 Follow -up of PLHIV after ART initiation   \nFollow -up of patients on ART is determined by the duration the patient has been on treatment, how \nwell they understand the treatment and their response to AR T. Follow -up includes scheduled \nclinical appointments, unscheduled clinical assessments for patients with concerns/complaints, \nroutine and as -needed laboratory monitoring.", "start_char_idx": 3, "end_char_idx": 2073, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6b057ee7-619f-400b-b359-eb332d325f6e": {"__data__": {"id_": "6b057ee7-619f-400b-b359-eb332d325f6e", "embedding": null, "metadata": {"page_label": "55", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5fce181e-49ab-4b12-8c2a-60d9cd3f9eeb", "node_type": "4", "metadata": {"page_label": "55", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "85c443eee6eca3b22115d787e5691fa324f04e6cd797fec8a425d18ac5977f63", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ba8c847e-22cd-4e17-83e5-4a5aa37fad9f", "node_type": "1", "metadata": {"page_label": "54", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f2b50050a8385c05e3010d140d74f5f97fe7187d2e9a1b1116de57f6a845d788", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2226cc97-356a-413b-abc8-85cadc835d51", "node_type": "1", "metadata": {}, "hash": "610673b9053de15a7cf68301df4e0f0c0d842cdec79b1add3a532e03bdca59ab", "class_name": "RelatedNodeInfo"}}, "hash": "140c23a7d541020325c59fb9ef4d5dddc2e8544d7655b83766f18c75c57d8624", "text": "Initial Evaluation and Follow up  \n3 - 9  3.5.1 First 6 months after ART initiation  \nAfter ART initiation, patients need to be monitored closely for development of adverse drug events, \nidentify and address barriers to adherence, and development of IRIS. A reasonable follow -up \nschedule for most patients is 2 weeks and 4 weeks after ART initiation (Table 3. 5 and 3. 6).  \nWhen possi ble, follow -up for a particular patient should be provided by the same care provider or \nteam of care providers (e.g., same clinician and same counsellor) at every visit. This is particularly \nimportant during the first 6 months in care.   \n3.5.2 Differentiat ed Service Delivery for Patients beyond the 1st 6 months of ART  \nFollow up of patients beyond 6 months of ART is described in table 3. 5. It also  provides the criteria \nfor determining if a patient is established on ART.  \nIn summary:  \n\u25cf Patients who are not established on ART require closer follow -up.  \n\u25cf Patients who are established on ART require less frequent facility follow -up, with up \nto six months b etween clinical appointments  \n \nTable 3. 5: Differentiated Follow -up of Patients Beyond the First 6 Months of ART  \nPatients NOT established on ART  \nPatients with any of the following:  \n\u25cf On treatment for < 6 months  \n\u25cf Any active OIs (including TB) in the previous 6 months  \n\u25cf Poor or questionable adherence to scheduled clinic visits in the previous 6 months.  \n\u25cf Most recent VL \u2265 200 copies/ml  \n\u25cf Children < 2 years  \nPackage of \nCare  \u25cf Standard Package of Care  \n\u25cf Case management to address reason/s for not being established on ART  \nFocus of \nCounselling  \u25cf ART is the most important treatment to maintain good health and an active life  \n\u25cf ART will reduce the risk of transmitting HIV to others   \nFrequency of \nFollow -up \u25cf Every 1 -3 months, based on clinical judgment  \n\u25cf Additional visits as required to address any medical or psychosocial concerns  \n\u25cf If VL is detectable at 3 months they will need additional assessments for \nand management of the reason/s for detectable viral load, with close \nfollow -up until viral suppression is achieved (Chapter 5).  \n\u25cf Patients with confirmed viral suppression can be followed up every 3 -6 \nmonths based on patient preference and clinician judgment, with \nadditional unscheduled visits any time the patient has a concern.", "start_char_idx": 3, "end_char_idx": 2352, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2226cc97-356a-413b-abc8-85cadc835d51": {"__data__": {"id_": "2226cc97-356a-413b-abc8-85cadc835d51", "embedding": null, "metadata": {"page_label": "56", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2cf536cc-06c1-432a-9885-e247c37bfee3", "node_type": "4", "metadata": {"page_label": "56", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8394cb386db36bd562058ff1b706da2715d17744d6a5c3a6f399720236202377", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6b057ee7-619f-400b-b359-eb332d325f6e", "node_type": "1", "metadata": {"page_label": "55", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "140c23a7d541020325c59fb9ef4d5dddc2e8544d7655b83766f18c75c57d8624", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9dbae495-0f82-4f2d-96cf-6cce6654964e", "node_type": "1", "metadata": {}, "hash": "5ed0fb0dbc90789fff9f7f02727aad42a7226f28420b73b57f3b4c62b9b70c2e", "class_name": "RelatedNodeInfo"}}, "hash": "610673b9053de15a7cf68301df4e0f0c0d842cdec79b1add3a532e03bdca59ab", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 10  Table 3. 5 Cont.  \nPatients Established on ART  \nPatients established on ART must have achieved ALL the following  \n\u25cf On their current ART regimen for \u2265 6 months  \n\u25cf Currently no active Illness or in the previous 6 months (patients with well controlled chronic \nconditions should not be excluded)  \n\u25cf Adherent to scheduled clinic visits for the previous 6 months  \n\u25cf VL \u2264200 copies/ml (LDL) within the last 6 months  \nNote:  \n\u25cf This definition should be applied to all populations, including those receiving second - \nand third -line regimens, those with controlled comorbidities, children above 2 years *, \nadolescents, pregnant and breastfeeding women, and key populations.  \n\u25cf The client\u2019s category can change at any time so there is a need for a reassessment at each \nvisit. Clients should be categorized at every visit and managed based on their status.  \nPackage of \nCare  \u25cf Standard Package of Care  \n\u25cf Re-assessment of criteria at every clinical visit  \nLocation of  \nServices  \u25cf Clinical review and ART prescription from any ART service delivery point; all \nfacility levels  \n\u25cf Distribution of ART between clinical appointments, which can be facility -based \nor community -based  \nFocus of  \nCounselling  \u25cf Encourage patient to continue with what is working  \n\u25cf Reminders that any significant life event or change in daily routine could \ninterfere with adherence  \nFrequency of  \nFollow -up \u25cf Clinic appointments to be made at 6 months intervals  \n\u25cf ART should be offered as refills lasting 3 months,  (through fast -track pick -up at \nfacility or through community -based distribution). Patients on injectab le \ncontraception should be provided FP through a fast -tracked process between \nclinic follow -up visits; oral contraceptives and condoms should be distributed \nwith ART  \n\u25cf Additional visits as required to address any medical or psychosocial concerns  \n\u25cf Closer follow -up may be arranged based on patient preference  \n*  Children below 2 years are excluded as they require frequent dose adjustment", "start_char_idx": 3, "end_char_idx": 2083, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9dbae495-0f82-4f2d-96cf-6cce6654964e": {"__data__": {"id_": "9dbae495-0f82-4f2d-96cf-6cce6654964e", "embedding": null, "metadata": {"page_label": "57", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "cb4bd890-cde5-4751-9afc-f89e20d07a18", "node_type": "4", "metadata": {"page_label": "57", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2b46e2597c1d4a69fd4e8f40238360d62bae3fd79b27a4c3a3cb8b345b1ea0e6", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2226cc97-356a-413b-abc8-85cadc835d51", "node_type": "1", "metadata": {"page_label": "56", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "610673b9053de15a7cf68301df4e0f0c0d842cdec79b1add3a532e03bdca59ab", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2397e4fc-5100-4d28-bb40-f56de5fe3569", "node_type": "1", "metadata": {}, "hash": "b7d32bced4916c2df757d5cbb73e4dd6c930688ca9b02ef608fb7413090c1c2a", "class_name": "RelatedNodeInfo"}}, "hash": "5ed0fb0dbc90789fff9f7f02727aad42a7226f28420b73b57f3b4c62b9b70c2e", "text": "Initial Evaluation and Follow up  \n3 - 11  3.6 Summary of clinical and laboratory monitoring of PLHIV on ART  \nTable 3. 6 summarizes the recommended minimum routine follow -up schedule for PLHIV.  \nAdditional clinical and laboratory follow -up should be performed whenever clinically indicated  \nTable 3. 6: Summary of Clinical and Laboratory Monitoring for PLHIV1 \n Initial  \nVisit  ART  \npreparation  Week  \n(After \nART)   \nMonths (after ART)   \n\u2265 6 months  \n \nAppointment2,3   \nEvery week4  \n2  \n4  \n2  \n3  \n4  \n5  \n6 Every 1 -6 \nmonths \ndepending \non stability  \nHistory and \nphysical exam5 \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  At each \nclinical visit  \nAdherence \nassessment and \nsupport6 \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  \u2714  At each visit  \nTB Screening  \u2714  Every visit, using ICF screening tool  \nCD4 count  \u2714  \u25cf Baseline, and then only if patient develops treatment failure (to assess \nfor risk of OIs), or if defaults from care (off ART) for at least 6 months  \n\u25cf For patients on prophylaxis using dapsone (documented CTX allergy), \nrepeat CD4 every 6 months until CD4 >200 cells/mm3 for two \nconsecutive measures 6 months apart and VL undetectable, after which \ndapsone and CD4 monitoring can be discontinued  \nHIV Viral Load   \u25cf For PCR positive HEIs: baseline at the time of ART initiation  \n\u25cf Age 0 -24 years: at month 3, then every 6 months  \n\u25cf Age \u2265 25 years: at month 3, then month 12, then annually thereafter if \nsuppressed  \n\u25cf For all: before any drug substitution for patients on ART for a t least 6 \nmonths with no valid VL, at month 3 after regimen modification, and \nthen as per population group  \n\u25cf Any patient with a detectable VL during routine monitoring, follow viral \nload monitoring algorithm (Figure 6.6)  \nHIV Viral Load \n(pregnant/ \nbreastfeeding)   \u25cf If on ART at time of confirming pregnancy: VL done at confirmation of \npregnancy (regardless of when previously done), then every 6 months \nuntil complete cessation of breastfeeding  \n\u25cf If starting ART during pregnancy or breastfeeding, VL at 3 months after \ninitiation, and then every 6 months until complete cessation of \nbreastfeeding", "start_char_idx": 3, "end_char_idx": 2105, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2397e4fc-5100-4d28-bb40-f56de5fe3569": {"__data__": {"id_": "2397e4fc-5100-4d28-bb40-f56de5fe3569", "embedding": null, "metadata": {"page_label": "58", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "46395a8f-e6ca-4011-9906-a77dfb2e1a34", "node_type": "4", "metadata": {"page_label": "58", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0a171404b4b666d408298b4513cf819b517bb63595e2ce39c620e32dc961f769", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9dbae495-0f82-4f2d-96cf-6cce6654964e", "node_type": "1", "metadata": {"page_label": "57", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5ed0fb0dbc90789fff9f7f02727aad42a7226f28420b73b57f3b4c62b9b70c2e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a9eba739-f783-4cc3-8d1f-7293619b6ce0", "node_type": "1", "metadata": {}, "hash": "7fb7aec3793588c5090ae45bcba34fb0eca2d8a43b53f6e85b312ab587dffb5d", "class_name": "RelatedNodeInfo"}}, "hash": "b7d32bced4916c2df757d5cbb73e4dd6c930688ca9b02ef608fb7413090c1c2a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 12  Table 3. 6 Cont.  \nCrAg  \u2714  Baseline for adults and adolescents with CD4 \u2264 200 cells/mm3 (as reflex \ntesting by laboratory), then only if there is clinical suspicion of CM  \nHb \u2714  Baseline, then symptom directed; if on AZT, baseline then weeks 2, 4, and \n12 \nPregnancy \nStatus  \u2714  At every visit for women of reproductive age (by history +/ - urine \npregnancy test)  \nUrinalysis \n(protein & \nglucose)  \u2714  Baseline, then annually if on TDF  \nCreatinine  \u2714  Baseline, then annually if on TDF  \nGlucose  \u2714  Baseline, then annually  \nPlasma lipid \nprofile  \u2714  Baseline, then annually  \nHBsAg  \u2714  Baseline, followed by immunization for all patients who screen \nnegative (after viral suppression is confirmed)  \nSyphilis \nserology \n(VDRL, \nTPHA, or \nRPR)  \u2714  Baseline, then annually in those at risk and as part of routine ANC profile  \nDrug \nResistance  \nTesting   DRT recommended once treatment failure confirmed on a DTG - or PI -based \n1st line regimen, or confirmed treatment failure on 2nd line or subsequent \nregimens  \nALT   Not recommended for routine baseline or follow -up unless specific clinical \nindication  \nCervical \nCancer  All women should be screened for cervical cancer following the national guidelines.  \nUsing HPV screening conducted every 2 years for HIV positive women in their \nreproductive age (or annually if using VIA -VILI)  \nHCV  Baseline for PWIDs or with a history of injection drug use", "start_char_idx": 3, "end_char_idx": 1478, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a9eba739-f783-4cc3-8d1f-7293619b6ce0": {"__data__": {"id_": "a9eba739-f783-4cc3-8d1f-7293619b6ce0", "embedding": null, "metadata": {"page_label": "59", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "68b58e61-9548-4e1e-abd5-3772aad56892", "node_type": "4", "metadata": {"page_label": "59", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5cf449397c496c43b78f2449ac92ab4cd67b91c5a88eab6ea67f94ef9d8fbeda", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2397e4fc-5100-4d28-bb40-f56de5fe3569", "node_type": "1", "metadata": {"page_label": "58", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b7d32bced4916c2df757d5cbb73e4dd6c930688ca9b02ef608fb7413090c1c2a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "988246c4-ae11-43c6-8c23-764dc3cc1feb", "node_type": "1", "metadata": {}, "hash": "fe88a2734b4927faec7370c68a723a63bc0dedaf6240a2deee4d7f610a8a5c0a", "class_name": "RelatedNodeInfo"}}, "hash": "7fb7aec3793588c5090ae45bcba34fb0eca2d8a43b53f6e85b312ab587dffb5d", "text": "Initial Evaluation and Follow up  \n3 - 13  Table 3. 6 Cont.  \n1 Recommended investigation should not delay ART initiation.  \n 2This is the recommended appointment schedule. Clinicians and patients should be encouraged to \nschedule additional appointments as needed. Patients should be encouraged to return to the HIV \nclinic for unscheduled appointment whenever  an acute issue arises, instead of seeking care at \nanother facility. Early after initiation of ART, and after any regimen modification , every \nappointment should include:  \n\u2212 Continued adherence counselling and support (started at the initial visit)  \n\u2212 Assessment of adherence and correct storage of medication  \n\u2212  Assessment for and management of early side effects of the drugs, and patient counselling \non the same  \n3 Patients who are adherent and virally suppressed at month 3, may not need subsequent \nmonthly appointments until month 6.  \n4 All PLHIV qualify for ART and should be initiated as soon as possible including same day and \nwithin 2 weeks. For patients who do not  start ART on the same day as enrolment into HIV care, \nthey should be followed up every week until ART initiation to address whatever issues are \ndelaying ART initiation, for ongoing management of acute medical issues and for treatment \npreparation and ART r eadiness assessment.  \n4Refer to table 3.1 for detailed history and physical examinations.  \n5children and adolescents, weight and height should be measured and recorded at every visit, \nwith weight -based dosing of ARVs confirmed at every visit.  \nIn adults, weig ht and height should be measured at the initial visit to determine nutritional status \nand calculate the BMI, and thereafter, weight should be measured at every visit.  \n6The first 2 -4 visits are critical for assessing and supporting adherence to ART, managi ng adverse \ndrug reactions, and treating any acute illnesses including IRIS. Adherence should be assessed at \nevery contact with the clinic. See Chapter 5 for specific adherence preparation, monitoring and \nsupport procedures for each visit  \nRequired laboratory tests are highly recommended for patient monitoring, but are not a pre -\nrequisite for ART initiation.  \nTargeted laboratory tests may be necessary to identify and manage inter -current diseases or \nadverse drug reactions.  \n3.7 Differentiated Care for Children, Adolescents and Pregnant/ breastfeeding \nWomen  \nChildren, adolescents, pregnant and breastfeeding women, and key populations face unique \nchallenges in retention  and viral suppression and  hence may benefit more from different iated \nservice delivery models  adapted to their needs.  \nChildren:  Children\u2019s care is dependent on family and care giver dynamics. Family centered \napproaches to care where clinic visits for parents/caregivers and the child are synchronized, \nshould be used.  A ssessment and categorization to determine establishment on ART should be \nconducted for pairs and follow -up tailored to their situations. Weight -based dose adjustments \nshould be incorporated in both the facility and community models (e.g., by using portable  weighing \nscales if out of the health facility) to determine optimal doses for ARVs at each review.  Aligning \nappointments with school calendar should be considered to avert disruption of treatment and \nlearning of the child.", "start_char_idx": 3, "end_char_idx": 3343, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "988246c4-ae11-43c6-8c23-764dc3cc1feb": {"__data__": {"id_": "988246c4-ae11-43c6-8c23-764dc3cc1feb", "embedding": null, "metadata": {"page_label": "60", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "269c8fb6-66c4-4e04-b2ff-975069bc73ee", "node_type": "4", "metadata": {"page_label": "60", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4ccf7904afeb7d7de37a8153290ccd46e4bd825f9d2be0548d7602b64d1a3f7b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a9eba739-f783-4cc3-8d1f-7293619b6ce0", "node_type": "1", "metadata": {"page_label": "59", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7fb7aec3793588c5090ae45bcba34fb0eca2d8a43b53f6e85b312ab587dffb5d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4d59a780-355f-4128-bfe0-c610ce2cdbc8", "node_type": "1", "metadata": {}, "hash": "1c43aa0fba6500cec1aa13b995a98c2a0022bc649ac7e330c06e6c1d0ccf0bb1", "class_name": "RelatedNodeInfo"}}, "hash": "fe88a2734b4927faec7370c68a723a63bc0dedaf6240a2deee4d7f610a8a5c0a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 14  Adolescents:  Adolescents requi re psychosocial support, ongoing adherence assessments and \ncounselling which should be aligned with clinic visits, community follow -up as well as school \ncalendar.  Considerations should be factored in during the clinical encounters with more focus to \nthose  with adherence and viral suppression challenges. Adolescents and Youth Friendly services \nthat incorporate life skills and extracurricular activities should be integrated where feasible.  \nPregnant/breastfeeding women:  Pregnant and breastfeeding women who h ave been established \non ART should have their HIV clinic appointments synchronized with Antenatal Care visits and with \nfollow -up of the HIV -exposed infant. Those initiated on ART during pregnancy may need close \nfollow up to support them in adherence, reten tion and achieving viral suppression. Breast feeding \nwomen and their babies will have their clinical visit aligned with the immunization clinics schedule. \nPsychosocial support groups are encouraged for both pregnant and breastfeeding mothers \nincluding peer  to peer support.  \n3.8 ART Prescription, Dispensing, and Distribution for clients established on \nART  \nPatients who are established on ART should be offered ART  refills of up to 3 months. The refill of \nother associated commodities such as cotrimoxazole, TPT a nd condoms should be aligned to the \nART refill schedule. Clients established on ART should receive their ART, CPT, family planning, and \nany other chronic medicines through a distribution system that minimizes the burden on them \n(travel costs, waiting times , inconvenience) and burden on the health facility (personnel time, \nspace constraints, etc.). This must be on a voluntary basis (i.e., the client can choose to remain in \nstandard care if they prefer).  \nThe health facility is responsible for ART prescription , dispensing, and distribution for all patients \nenrolled into care. ART distribution for patients established on ART can take place at the health \nfacility or through a community distribution system, depending on patient preference and health \nfacility syste ms and resources. The point of ART dispensing should be based on client ability \nto access treatment with ease.  Models for ART refills include:  \n\u25cf Facility -based  \no Fast track facility -based refills  \no Facility -based ART distribution groups  \n\u25cf Community -based  \no Community -based ART distribution groups  \no Community ART distribution points  \no Community pharmacy distribution  \nFacility -based Fast Track System for ART Refills  \nThe facility -based fast track system for ART  refills is a simple model implemented at the health \nfacility. The client is still required to come to the clinic every 3 months for ART refill, however the \nrefill appointments require minimal or no waiting time at the clinic.   Refer to DSD operational \nmanual for detailed information on community models.", "start_char_idx": 3, "end_char_idx": 2982, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "4d59a780-355f-4128-bfe0-c610ce2cdbc8": {"__data__": {"id_": "4d59a780-355f-4128-bfe0-c610ce2cdbc8", "embedding": null, "metadata": {"page_label": "61", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1806a26c-f200-4fee-bb2f-cd7f8e8358a6", "node_type": "4", "metadata": {"page_label": "61", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ebbb8d20077e126636171c4b411a1f14cfc3b91f072421d6432c383c44ccf0aa", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "988246c4-ae11-43c6-8c23-764dc3cc1feb", "node_type": "1", "metadata": {"page_label": "60", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fe88a2734b4927faec7370c68a723a63bc0dedaf6240a2deee4d7f610a8a5c0a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "69b817d7-d888-4c2e-8a26-236dda27c622", "node_type": "1", "metadata": {}, "hash": "a17e6625a84bc0de99926ea54f803b539bccb2d768d7008463ba7a17f6894a0b", "class_name": "RelatedNodeInfo"}}, "hash": "1c43aa0fba6500cec1aa13b995a98c2a0022bc649ac7e330c06e6c1d0ccf0bb1", "text": "Initial Evaluation and Follow up  \n3 - 15  Facility -based ART Distribution Group  \nFacility -based ART Distribution Groups are a model for ART distribution, whereby a group of \nPLHIVs meet at a designated location within their health facility for drug refills and dispense \ndrugs to their peers within the group while ensuring peer support and treatment literacy.  ART \nrefills are done through the group every 3 months and  each client is required to attend their \nclinical review appointment e very 6 months.   \nThis model may provide clients with psychosocial support if they are not already part of a support \ngroup. This may also be more convenient for clients who are in urban settings and would not wish \nto be enrolled in a community -based group. F acility -based groups can be peer or HCW led.  \nCommunity -based ART Distribution Models  \nClients may receive ART refills through community -based distribution. All clients may also benefit \nfrom home visits such as for adherence monitoring and support, on a case -by-case basis.  \nClients can receive their ART refill through community -based models such as:  \n\u25cf Community -based ART distribution groups  \n\u25cf Community ART distribution points  \n\u25cf Community pharmacy distribution  \nBefore implementing a community -based ART distribution program, a health facility should work \nwith the CHMT to design a program that meets the criteria listed in Annex 14, and the plan \napproved by the County HIV Technical Working Group before implementation. Refer to DSD \noperational manual for det ailed information on community models.", "start_char_idx": 3, "end_char_idx": 1585, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "69b817d7-d888-4c2e-8a26-236dda27c622": {"__data__": {"id_": "69b817d7-d888-4c2e-8a26-236dda27c622", "embedding": null, "metadata": {"page_label": "62", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "af3349a5-fc22-44c7-ae19-375396c5b6af", "node_type": "4", "metadata": {"page_label": "62", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8ef1baa914998fd5cead848eab3f64b64d7361ebf1c18ba46fb8406561b34be6", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "4d59a780-355f-4128-bfe0-c610ce2cdbc8", "node_type": "1", "metadata": {"page_label": "61", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1c43aa0fba6500cec1aa13b995a98c2a0022bc649ac7e330c06e6c1d0ccf0bb1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9b53795a-37ab-4b41-8717-d961a1222813", "node_type": "1", "metadata": {}, "hash": "091b5ead17cbb93a157c35d49c0cfb3ac2edcdd3f2d0bdc0ccfdc74296012c3e", "class_name": "RelatedNodeInfo"}}, "hash": "a17e6625a84bc0de99926ea54f803b539bccb2d768d7008463ba7a17f6894a0b", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n3 - 16", "start_char_idx": 3, "end_char_idx": 63, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9b53795a-37ab-4b41-8717-d961a1222813": {"__data__": {"id_": "9b53795a-37ab-4b41-8717-d961a1222813", "embedding": null, "metadata": {"page_label": "63", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "4359ca9e-f9ac-4b54-a6bd-c5af6e907ec6", "node_type": "4", "metadata": {"page_label": "63", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c2b300dfe5c7bb0d36ae44fb9227dd59becbfdba3698024b27568c7c8be40253", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "69b817d7-d888-4c2e-8a26-236dda27c622", "node_type": "1", "metadata": {"page_label": "62", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a17e6625a84bc0de99926ea54f803b539bccb2d768d7008463ba7a17f6894a0b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "583bd62c-287c-401e-8399-99c649fa3fd3", "node_type": "1", "metadata": {}, "hash": "18b641f21e80967bde2614592508a865fee77bae8cd453b11ceb6a717719f63e", "class_name": "RelatedNodeInfo"}}, "hash": "091b5ead17cbb93a157c35d49c0cfb3ac2edcdd3f2d0bdc0ccfdc74296012c3e", "text": "Standard Package of Care for PLHIV  \n4 - 1   \n4. Standard Package of Care for PLHIV  \n \nAll PLHIV should receive a package of services that are known to promote health, improve the \nquality of life, prevent further HIV transmission, and prevent HIV disease progression and \nmortality.  \nThe standard package of care for PLHIV in cludes: antiretroviral therapy; Positive Health, Dignity \nand Prevention (PHDP) services; screening and providing support in cases of gender -based \nviolence (GBV) or intimate -partner violence (IPV); HIV education/counselling; screening and \nprevention of spec ific opportunistic infections; reproductive health services; screening for and \nmanagement of non -communicable diseases; mental health screening and management; \nnutritional services; and prevention of other infections (Table 4.1).  \nThe standard package of ca re should always be applied using a patient - and family -\ncentered approach  in PLHIV management.  Patient -centered care includes: considering the \nindividual patient\u2019s health needs; eliciting and addressing the patient\u2019s concerns and expectations; \ninvolving th e patient\u2019s (and their family and friends as appropriate) in decision -making, and; \nrespecting the patient\u2019s values and preferences. Family -centered care identifies, engages and \nprovides care to all HIV -positive family members, prevents new infections among  family members \nat risk, and promotes family support and awareness.", "start_char_idx": 3, "end_char_idx": 1451, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "583bd62c-287c-401e-8399-99c649fa3fd3": {"__data__": {"id_": "583bd62c-287c-401e-8399-99c649fa3fd3", "embedding": null, "metadata": {"page_label": "64", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "62ea8629-8b8e-4c96-a7d1-0d2975051c1e", "node_type": "4", "metadata": {"page_label": "64", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "13529fda975728083d95b377c8df17e8b2c4cf4c4be5b169c94b5c06caccc1cf", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9b53795a-37ab-4b41-8717-d961a1222813", "node_type": "1", "metadata": {"page_label": "63", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "091b5ead17cbb93a157c35d49c0cfb3ac2edcdd3f2d0bdc0ccfdc74296012c3e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bfce81b3-8b4a-4018-8392-974bd71c81ec", "node_type": "1", "metadata": {}, "hash": "a9df190d778ebaafe603a14ebf8d067e52e1c4024eee2d0be3438384e8c2b355", "class_name": "RelatedNodeInfo"}}, "hash": "18b641f21e80967bde2614592508a865fee77bae8cd453b11ceb6a717719f63e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 2  Table 4.1: Components of the Standard Package of Care for PLHIV  \nComponent of Standard Package of Care Sub components  \nAntiretroviral therapy (ART)  \u25cf ART initiation  \n\u25cf Adherence assessment, counselling and support  \n\u25cf Monitoring (clinical and laboratory)  \nPositive health, dignity and prevention \n(PHDP); gender -based violence (GBV) \nand intimate -partner violence (IPV) \nscreening; and HIV \neducation/counselling  \u25cf Disclosure  \n\u25cf Index testing  \n\u25cf Condom use  \n\u25cf Family planning  \n\u25cf STI screening, prevention, and treatment  \n\u25cf Adherence counselling and support  \n\u25cf Pre-exposure prophylaxis for HIV -negative sexual partners  \n\u25cf GBV/IPV screening and support  \n\u25cf HIV education/counselling  \nSpecific opportunistic infection screening \nand prevention  \u25cf Cotrimoxazole preventive therapy  \n\u25cf Tuberculosis (TB)  \no Intensified case finding  \no TB preventive therapy  \no ART for TB/HIV co -infected patients  \n\u25cf Cryptococcal meningitis  \nReproductive health services  \u25cf Sexually transmitted infections screening and management  \n\u25cf Family planning and pre -conception services  \n\u25cf Maternal healthcare  \n\u25cf Cervical cancer screening  \nNon -communicable diseases (NCD) \nscreening and management  \u25cf Hypertension  \n\u25cf Diabetes mellitus  \n\u25cf Dyslipidemia  \n\u25cf Chronic kidney disease  \n\u25cf Other NCDs  \nMental health screening and management  \u25cf Depression  \n\u25cf Anxiety  \n\u25cf Stress  \n\u25cf Trauma  \n\u25cf Alcohol and drug use/addiction  \n\u25cf Self-care and wellbeing  \nNutritional services  \u25cf Assessment  \n\u25cf Counselling and education  \n\u25cf Management and support  \nPrevention of other infections  \u25cf Immunizations  \n\u25cf Malaria  \n\u25cf Safe water, sanitation and hygiene", "start_char_idx": 3, "end_char_idx": 1702, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bfce81b3-8b4a-4018-8392-974bd71c81ec": {"__data__": {"id_": "bfce81b3-8b4a-4018-8392-974bd71c81ec", "embedding": null, "metadata": {"page_label": "65", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "4162e785-e8c1-4434-bc92-f983dd6d94b2", "node_type": "4", "metadata": {"page_label": "65", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8955a4d78fd83136f40b01ee3c8c75e37c5740ab0e87b3289cc89a57e88fd67e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "583bd62c-287c-401e-8399-99c649fa3fd3", "node_type": "1", "metadata": {"page_label": "64", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "18b641f21e80967bde2614592508a865fee77bae8cd453b11ceb6a717719f63e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "49641710-b052-47a9-9562-18791cf94ad0", "node_type": "1", "metadata": {}, "hash": "c79ae58cd4f0eecdc0910929aeefd18f3aac352bf1c63e29384237013b1f3db0", "class_name": "RelatedNodeInfo"}}, "hash": "a9df190d778ebaafe603a14ebf8d067e52e1c4024eee2d0be3438384e8c2b355", "text": "Standard Package of Care for PLHIV  \n4 - 3  Table 4.1 Cont.  \nStandard Package of Care for HIV -Exposed and HIV -Infected Infants  \n\u25cf Determine HIV status at first contact through HTS/EID and link to HIV care  \n\u25cf Provide ARV prophylaxis for all HEIs and ART for all HIV -infected children ( confirming correct \nweight -based dosing of ARVs at every visit ); perform clinical and laboratory assessment  \n\u25cf Provide nutritional assessment, counselling and support (NACS, Section 4. 7) and monitor growth and \ndevelopment of the child (Annex 3)  \n\u25cf Ensure that all immunizations are provided following the national schedule (Section 4.8.1)  \n\u25cf Clinical assessment at every visit, treat infections early, identify, manage and report adverse drug \nreactions aggressively and refer appropriately where specialized care is required.  \n\u25cf Screen for opportunistic infections and provide prophylaxis (cotrimoxazole, TB Preventive Therapy \n(TPT), deworm every 6 months (starting at 1 year of age) and provide supplemen tal Vitamin A every 6 \nmonths (starting at age 6 months)  \n\u25cf Educate the caregiver on all aspects of care for the child including infant feeding, immunizations, \npersonal hygiene, HIV education/counselling, adherence, availability of support for child disclosure , \nand follow -up requirements  \n\u25cf Adherence assessment, counselling and support  \n\u25cf Provide age -appropriate psychosocial support for the family and child and refer to community -based \nsupport programs as appropriate  \n\u25cf Ensure that the caregiver and family members are r eceiving appropriate care, support and treatment  \n\u25cf Provide intensive case management for mother/infant pair until 2 years postpartum; identify \ndefaulters and prioritize this population for tracking  \n\u25cf Enroll in Orphans and Vulnerable Children (OVC) program for social protection and other services.", "start_char_idx": 3, "end_char_idx": 1849, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "49641710-b052-47a9-9562-18791cf94ad0": {"__data__": {"id_": "49641710-b052-47a9-9562-18791cf94ad0", "embedding": null, "metadata": {"page_label": "66", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "757952f7-d7f8-4805-9b05-e91e90534c90", "node_type": "4", "metadata": {"page_label": "66", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6de44d5620e51e8b73db1729c9ea59cc91bbd15a7513ae49aaf9c0bf7859661b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bfce81b3-8b4a-4018-8392-974bd71c81ec", "node_type": "1", "metadata": {"page_label": "65", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a9df190d778ebaafe603a14ebf8d067e52e1c4024eee2d0be3438384e8c2b355", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6eb8178e-f31d-4180-92f7-aab4fd84278b", "node_type": "1", "metadata": {}, "hash": "f2a27b0601818b1f94619c528bb31092d9680ec43433acee6ce58f3e40f66ab1", "class_name": "RelatedNodeInfo"}}, "hash": "c79ae58cd4f0eecdc0910929aeefd18f3aac352bf1c63e29384237013b1f3db0", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 4  Table 4.1 Cont.  \nStandard Package of Care for Adolescents Living with HIV  \nClinical care  \n\u25cf Provide immediate linkage to HIV care  \n\u25cf Provide ART to all HIV -infected adolescents  \n\u25cf Perform clinical and laboratory assessment  \n\u25cf Clinical assessment at every visit, treat infections early and refer appropriately where specialized care \nis required  \n\u25cf Screen for opportunistic infections and provide prophylaxis (cotrimoxazole, TPT)  \n\u25cf Provide NACS and monitor growth and  development  \n\u25cf Provide/refer for HPV vaccine  \nAdherence and psychosocial support  \n\u25cf Perform a baseline and regular subsequent psychosocial assessment  \n\u25cf Assess for and support disclosure of HIV status to the adolescent (Annex 5)  \n\u25cf Enroll in age -appropriate psychosoci al support groups  \n\u25cf Provide treatment literacy  \n\u25cf Provide life skills counselling  \n\u25cf Provide adherence counselling  \n\u25cf Support appropriate transition into adult HIV treatment and prevention  \n \nPrevention of HIV transmission  \n\u25cf Encourage index testing and support for disclosure  \n\u25cf Assess for and manage drug and alcohol use  \n\u25cf Perform a sexual risk assessment and STI screening and treatment, and linkage of sexual partner to \nPrEP where applicable  \n\u25cf Assess for and manage IPV  \n\u25cf Provide reproductive health services, including pregnan cy screening, pregnancy intention assessment, \nfamily planning and linkage to PMTCT for pregnant adolescents  \nReferrals, linkages and support for continuum of care  \n\u25cf Provide intra -facility & inter -facility referrals as needed for specialized care  \n\u25cf Link with youth community groups, targeting youth both in and out of school  \nOther services  \nlegal centers, paralegal services, gender -based violence recovery centers, educational institutions, \nbursary/scholarship programs, income generating activities, constituency development funds, vocational \ntraining centers for skills development, etc.  \n4.1 Antiretroviral Therapy  \nART is recommended for all PLHIV, regardless of WHO stage, CD4 count, age, pregnancy status, \nor comorbidities/co -infections. O nce a diagnosis of HIV infection is confirmed, ART should be \ninitiated as soon as possible (preferably within 2 weeks), once patient readiness has been \ndetermined. Other sections of these guidelines deal with initial evaluation and monitoring \n(Chapter 3), patient preparation and adherence support (Chapter 5), and specific recommended \nART regimens (Chapter 6).", "start_char_idx": 3, "end_char_idx": 2493, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6eb8178e-f31d-4180-92f7-aab4fd84278b": {"__data__": {"id_": "6eb8178e-f31d-4180-92f7-aab4fd84278b", "embedding": null, "metadata": {"page_label": "67", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "719947c2-98f2-4bce-b7d7-faed1791d867", "node_type": "4", "metadata": {"page_label": "67", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9f1a21b4541f97a6fa48df5d96bca0cd77b83cc30c6e614a957083b6405e623a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "49641710-b052-47a9-9562-18791cf94ad0", "node_type": "1", "metadata": {"page_label": "66", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c79ae58cd4f0eecdc0910929aeefd18f3aac352bf1c63e29384237013b1f3db0", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d849d73c-9892-4c35-89ff-9d5cc8c93572", "node_type": "1", "metadata": {}, "hash": "0325c233e04900d886aa78dbcae5a85f88aee260642e8b3007f8874df09ff867", "class_name": "RelatedNodeInfo"}}, "hash": "f2a27b0601818b1f94619c528bb31092d9680ec43433acee6ce58f3e40f66ab1", "text": "Standard Package of Care for PLHIV  \n4 - 5  4.2 PHDP, GBV/IPV & HIV Education/Counselling  \nPHDP (Positive Health, Dignity and prevention) is a framework that emphasizes the health and \nrights of P LHIV, including reducing risk of onward transmission of HIV.  Within PHDP are 7 core \ndomains of services that should be provided at the health facility to PLHIV and caregivers (Table \n4.2). Complementary community -based PHDP should also be implemented.  \nTabl e 4.2: Domains and Components for PHDP Services  \nPHDP Domain  Components  \nDisclosure of HIV status  \u25cf Assessment of disclosure status, particularly to sexual partners  \n\u25cf Assisted disclosure  \nNote: for children and adolescents, it is also necessary to evaluate for and \nsupport age -appropriate HIV disclosure to the child/adolescent (Annex 5)  \nIndex testing and \nengagement  \u25cf HIV testing of sexual and drug injecting partners  \n\u25cf HIV testing of other family members at risk  \n\u25cf Enrolment of positive partners/family members into HIV care  \n\u25cf Engagement of negative partners and family members in care and \nsupport for index patient, and PrEP as appropriate  \nCondom use  \u25cf Risk reduction counseling  \n\u25cf Correct and consistent condom use  \n\u25cf Provision of condoms at every visit  \nFamily planning  \u25cf Assessment of pregnancy intention  \n\u25cf Pre-conception counselling  \n\u25cf Dual contraception until ready for pregnancy  \n(See Section 4.4.2 for specific clinical guidelines)  \nSexually transmitted \ninfections (STI)  \u25cf Screening for symptoms of STIs  \n\u25cf Prevention of STIs  \n(See Section 4.4.1 for specific clinical guidelines)  \nTreatment adherence  \u25cf Benefits/importance of:  \no Adherence to clinical care  \no Adherence to ART  \n\u25cf Messaging on Undetectable=Untransmissible (U=U)  \n (Chapter 5)  \nPre-exposure prophylaxis  \u25cf Assess HIV -negative sexual partners for PrEP  \n(Chapter 11)  \nAdditional services that should be offered to PLHIV beyond the above components include screening for GBV and IPV \nand HIV education/counseling services.", "start_char_idx": 3, "end_char_idx": 2003, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d849d73c-9892-4c35-89ff-9d5cc8c93572": {"__data__": {"id_": "d849d73c-9892-4c35-89ff-9d5cc8c93572", "embedding": null, "metadata": {"page_label": "68", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2b64aff8-c6bb-4f90-b133-467764d7e536", "node_type": "4", "metadata": {"page_label": "68", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "82b068bac1338d97094511c7b7b8a8693ea268a9a67a19f8fec53e69da560707", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6eb8178e-f31d-4180-92f7-aab4fd84278b", "node_type": "1", "metadata": {"page_label": "67", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f2a27b0601818b1f94619c528bb31092d9680ec43433acee6ce58f3e40f66ab1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ffd194fb-77b7-42b0-a27b-9e0ee5ee49d8", "node_type": "1", "metadata": {}, "hash": "6bb5d0ba82a3061f7100e82b522a7f2251570983332ee9a67da5f43527f89909", "class_name": "RelatedNodeInfo"}}, "hash": "0325c233e04900d886aa78dbcae5a85f88aee260642e8b3007f8874df09ff867", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 6  4.2.1 Screening for Gender -Based Violence (GBV)/Intimate -Partner Violence (IPV)  \nNational data (KDHS 2014) shows that 45% of women and 44 % of men aged 15 -49 years have \nexperienced physical violence since age 15.; 14% of women and 6% of men age 15 -49 report \nhaving experienced sexual violence at least once in their lifetime.  To identify these survivors \nscreening is recommended. WHO recommends that facilities should meet the minimum \nrequirement before starting to routinely screening clients.  \nThe minimum require ments are:   \n\u2022 A protocol or Standard Operating Procedure exists for providing post -GBV and Violence \nAgainst Children  services  \n\u2022 A questionnaire, with standard questions where providers can document responses,  \n\u2022 Providers offer first -line support (LIVES)  \n\u2022 Providers have received training on how to ask about GBV and Violence Against Children  \n\u2022 Private setting, confidentiality ensured  \n\u2022 A system for referrals or linkages to other services within the facility is in place  \nIf any of these minimum requirements is mis sing, GBV and Violence Against Children  services are \nconsidered inadequate, and providers should ensure to have these systems in place before \nconducting routine enquiry or universal screening  \nAll clients accessing HIV care services should be screened for a ny form of violence \nincluding  IPV as part of the standard package of care for PLHIV.  \nThe following script can be used for screening:  \n \u201cMany people do not realize that violence can lead to various serious health problems. Many \npeople have problems with thei r husbands, partners or other people in their lives. Sometimes the \npeople who love us can hurt us. Has this ever happened to you?\u201d  \nHas your partner ever:  \n1. Insulted you or made you feel bad about yourself?  \n2. Belittled or humiliated you in front of other people?   \n3. Did things to scare or intimidate you on purpose  \n4. Threatened to hurt you or someone you care about?  \n5. Slapped you or thrown something at you that could hurt you?  \n6. Kicked, dragged, beat you up?  \n7. Chocked or  burned you on purpose?  \n8. Threatened to use or actually used a gun, knife or other weapon against you?  \n9. Physically forced you to have sexual intercourse when you did not want?  \n10. Did you ever have sexual intercourse you did not want because you were afraid of w hat \nhe might do?  \n11. Forced you to do something sexual that you found degrading or humiliating?  \nIf a survivor answers yes to any of these questions provide them with LIVES and do a mental \nassessment", "start_char_idx": 3, "end_char_idx": 2625, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ffd194fb-77b7-42b0-a27b-9e0ee5ee49d8": {"__data__": {"id_": "ffd194fb-77b7-42b0-a27b-9e0ee5ee49d8", "embedding": null, "metadata": {"page_label": "69", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2fb043e9-cbef-4dde-8435-a19e07e68816", "node_type": "4", "metadata": {"page_label": "69", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e095c83484887dcc2a09710b476ceb1315c70340c8fbd86d429294c6d931ff22", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d849d73c-9892-4c35-89ff-9d5cc8c93572", "node_type": "1", "metadata": {"page_label": "68", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0325c233e04900d886aa78dbcae5a85f88aee260642e8b3007f8874df09ff867", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2f19a758-510b-4d7e-9aa4-be2c849b8abf", "node_type": "1", "metadata": {}, "hash": "f13eb53b8a4b75615f0447bfa2c6e46da42c1e25ed106279653fabadb3b51bfb", "class_name": "RelatedNodeInfo"}}, "hash": "6bb5d0ba82a3061f7100e82b522a7f2251570983332ee9a67da5f43527f89909", "text": "Standard Package of Care for PLHIV  \n4 - 7  Table 4.2a: Components of screening for GBV/IPV (LIVES)  \nListen  Listen to the client closely, with empathy and without judging  \nInquire  Assess and respond to the client\u2019s various needs and concerns  \nValidate  Show the client that you understand and believe them. Assure the client that they \nare not to blame  \nEnhance safety  Discuss a plan to protect the client from further harm if violence occurs again  \nSupport  Support the client by helping them to access information, services and social \nsupport  \nSupportive messages that may be helpful include:  \n\u25cf \u201cWhat happened to you is not your fault\u201d  \n\u25cf \u201cMany women/men are in the same situation as you\u201d  \n\u25cf \u201cYou are not to blame.\u201d  \n\u25cf \u201cEverybody deserves to feel safe at home if you feel like you are in immediate danger, we can \ninvolve the police or local administration \u201c  \nMen, the  elderly, and children suffer different forms of violence and should be assessed if there \nis any clinical suspicion. Key populations are particularly vulnerable to abuse, including MSM, \ntransgender, and prisoners. For children art and play therapy is used during history taking and \npsychological assessment.  \n4.2.2 HIV Education/Counselling  \nAll PLHIV and caregivers should receive focused education about HIV and its treatment to \nempower them to succeed in management of the infection. Self -management is critica l to the \nsuccessful treatment of any chronic illness, including HIV. Key messages for HIV education and \nadherence counselling are described in Chapter 5 of these guidelines.  \nIn addition, psychosocial counselling and support for PLHIV and caregivers should include:  \n\u25cf Mitigation of fear, anger, self -stigma and discrimination  \n\u25cf Alleviation of grief, bewilderment and stress among partners and family members  \n\u25cf Behavior changes in support of healthy living and prevention of further HIV transmission  \n\u25cf Skills -building on how to live a healthy and productive life  \n\u25cf Identification and treatment of depression and substance abuse  \nHIV education and counselling can be offered in multiple settings, including: facility -based \nindividual, couples, family, and/or gro up counselling, and through community -based counselling \nand peer support groups.", "start_char_idx": 3, "end_char_idx": 2272, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2f19a758-510b-4d7e-9aa4-be2c849b8abf": {"__data__": {"id_": "2f19a758-510b-4d7e-9aa4-be2c849b8abf", "embedding": null, "metadata": {"page_label": "70", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3a660a5c-c1a9-4fed-a697-36d2c12dce19", "node_type": "4", "metadata": {"page_label": "70", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "36328ea09f64eb1a175234f69baa474ebcb741cb11b92e051779121f8009db0a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ffd194fb-77b7-42b0-a27b-9e0ee5ee49d8", "node_type": "1", "metadata": {"page_label": "69", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6bb5d0ba82a3061f7100e82b522a7f2251570983332ee9a67da5f43527f89909", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "dbc0b4b6-1e59-4c49-99c2-6e367d5dcc09", "node_type": "1", "metadata": {}, "hash": "869eec392e5b2608e32fcd36f25858869710858ad9b2bef7e97a3aebd2cb90b2", "class_name": "RelatedNodeInfo"}}, "hash": "f13eb53b8a4b75615f0447bfa2c6e46da42c1e25ed106279653fabadb3b51bfb", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 8  4.3 Specific Opportunistic Infection Screening and Prevention  \n4.3.1 Cotrimoxazole Preventive Therapy (CPT)  \nCPT is no longer recommended as life -long prophylaxis, and is only recommended in the \nfollowing sub populations, unless they have an allergy to sulfur drugs or develop toxicity from \nCPT:  \n\u25cf HIV exposed infants  \n\u25cf HIV infected children and adolescents <15 years of age  \n\u25cf PLHIV > 15 years of age:  \no Living in malaria -endemic zones * \no Presenting with WHO stage 3 or 4 event, or meeting the criteria AHD  \no Suspected treatment failure  \n\u25cf All Pregnant and Breast -feeding women  \nFor HIV exposed and infected infants, CPT should start at 6 weeks of age. CPT is effective in AHD, \nand preventing specific OIs for patients with low CD4 counts (PCP and toxoplasmosis), as well as \nreducing the risk of common bacterial infections, sepsis, diarrhea illness and malaria.  \n*Refer to the National Guidelines for the Diagnosis, Treatment and Prevention of Malaria in Kenya for the \ncurrent Kenya Malaria endemicity map  \nTable 4.3: Co -trimoxazole Preventive therapy  \nSub -Population  Starting/Restarting criteria  Ending criteria  \nHIV exposed Infants  All infants, starting 4 -6 weeks \nafter birth  Child is confirmed HIV -negative  \n \nHIV-infected children \nand adolescents \u2264 15 \nyears old  All children  Attains 15 years of age  \nPLHIV > 15 years old  Suspected treatment failure  \nWHO Clinical Stage 3 and 4  Clinically stable:  \no On ART for at least 12 months  \no Showing no signs or symptoms of \nWHO Clinical Stage 2,3 or 4  \nHIV-positive \nPregnant and \nbreastfeeding women  All Clinically stable:  \no On ART for at least 12 months  \no Showing no signs or symptoms of \nWHO Clinical Stage 2,3 or 4  \no Not pregnant or breastfeeding", "start_char_idx": 3, "end_char_idx": 1816, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "dbc0b4b6-1e59-4c49-99c2-6e367d5dcc09": {"__data__": {"id_": "dbc0b4b6-1e59-4c49-99c2-6e367d5dcc09", "embedding": null, "metadata": {"page_label": "71", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "4defc6f2-16b7-4f86-a9d9-8d04ddaba99c", "node_type": "4", "metadata": {"page_label": "71", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1371db99495e88aba5335a3c0fa4c7d8217b91231b2abdcd0f345b1b72cd8427", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2f19a758-510b-4d7e-9aa4-be2c849b8abf", "node_type": "1", "metadata": {"page_label": "70", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f13eb53b8a4b75615f0447bfa2c6e46da42c1e25ed106279653fabadb3b51bfb", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8bedb5b8-6c77-46e1-8ac1-ff64da2936cc", "node_type": "1", "metadata": {}, "hash": "76ee4a932c625d0ce55c0c4bd76976c1983ac67cf07877cbb0879d507d9eeb55", "class_name": "RelatedNodeInfo"}}, "hash": "869eec392e5b2608e32fcd36f25858869710858ad9b2bef7e97a3aebd2cb90b2", "text": "Standard Package of Care for PLHIV  \n4 - 9  Table 4.4: Daily Dose of Cotrimoxazole Preventive Therapy  \nWeight (kg)  If using oral suspension  \n(240mg per 5ml)  If using single \nstrength tablet 480 \nmg (SS)  If using double strength \ntablet 960 mg (DS)  \n1 \u2013 4 2.5 ml  \u00bc SS tab  -- \n5 \u2013 8 5 ml  \u00bd SS tab  \u00bc DS tab  \n9 \u2013 16 10 ml  1 SS tab  \u00bd DS tab  \n17 \u2013 30 15 ml  2 SS tabs  1 DS tab  \n> 30  20 ml  2 SS tabs  1 DS tab  \nAdult (any weight)   2 SS tabs  1 DS tab  \nNote: If CrCl 15 -30 ml/min then use 50% of normal recommended dose; if CrCl < 15 ml/min then CTX should \nbe avoided  \nDuring pregnancy, CPT should be initiated irrespective of the gestational age and should \ncontinue throughout pregnancy and breastfeeding. Additional intermittent preventive \ntherapy (sulfadoxi ne-pyrimethamine (SP)) for malaria is not required for women already \non CPT.  \nCotrimoxazole can cause anaemia and neutropenia in some patients, as well as a skin rash.  \nManagement of Patients with Cotrimoxazole Allergy  \n\u25cf A rash may occasionally develop, usually about 7 -14 days following initiation of CPT. It \nis often a relatively mild maculopapular rash with or without pruritus. Infrequently, rash \nmay develop with severe exfoliation of the skin and Stevens -Johnson syndrome. Rash \nseverity should b e assessed, with management based on severity (Table 4.5)  \n\u25cf Desensitization is effective in the majority of patients with mild to moderate rash (Table \n4.6a). The rapid desensitization regimen (Table 4.6 b) can be used in situations where \ntreatment for PCP is needed  \nTable 4.5: Management of Drug -Associated Skin Rash  \nSeverity  Characteristics  Action  \nMild  Dry; erythema +/ - fine \npapules; pruritus; affecting \n< 50% of body surface area  Continue CTX; close monitoring; symptomatic treatment with \nantihistamines +/ - topical steroids (NOT oral steroids)  \nModerate  Dry; erythema +/ - fine \npapules; pruritus; affecting \n\u2265 50% of body surface area  Stop CTX; symptomatic treatment with antihistamines +/ - \ntopical steroids (NOT oral steroids); trial of desensitization \nafter symptoms completely resolved  \nSevere  Mucosal involvement;  \nblistering; associated fever; \nany % of body surface area  Stop CTX; admission to hospital for supportive management (IV \nfluids, wound care, pain control, infection control, monitoring \nfor super -infection); patient should NEVER be re -challenged \nwith CTX or other sulfa -containing drugs;  document and \nreport adverse event and issue patient alert card", "start_char_idx": 3, "end_char_idx": 2504, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8bedb5b8-6c77-46e1-8ac1-ff64da2936cc": {"__data__": {"id_": "8bedb5b8-6c77-46e1-8ac1-ff64da2936cc", "embedding": null, "metadata": {"page_label": "72", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e3c34555-b0f0-44d1-9cac-03567d7d69a1", "node_type": "4", "metadata": {"page_label": "72", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3b9f8b44cc3a92413a819adde5685493515ef5ae52df362eb18321d5938be631", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "dbc0b4b6-1e59-4c49-99c2-6e367d5dcc09", "node_type": "1", "metadata": {"page_label": "71", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "869eec392e5b2608e32fcd36f25858869710858ad9b2bef7e97a3aebd2cb90b2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "db82b760-9d89-4e93-98a6-b6e2aa274a0d", "node_type": "1", "metadata": {}, "hash": "2123c781c8ea2d34927a75f18e4cef0e5b6db6ad905feb4c2f708e6e1cf6256a", "class_name": "RelatedNodeInfo"}}, "hash": "76ee4a932c625d0ce55c0c4bd76976c1983ac67cf07877cbb0879d507d9eeb55", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 10   \n \n Cotrimoxazole Desensitization Protocols (for patients who have fully recovered from \nmoderate reaction)  \nTable 4.6a: Standard Cotrimoxazole \nDesensitization Regimen (8 days)  Table 4.6b: Rapid Cotrimoxazole \nDesensitization Regimen (6 hours)  \n \nDay  \nDose of TMP/SMX Suspension  \n(40/200 mg per 5ml)  \nDay 1 0.5 ml  \nDay 2 1 ml \nDay 3 2 ml \nDay 4 3 ml \nDay 5 4 ml \nDay 6 5 ml \nDay 7 1 SS tablet  \nDay 8 2 SS tablets/1 DS tablet per day  \nNote: For children, continue up until they have \nreached their recommended weight -based dosage  \n  \nHour  \nDose of TMP/SMX Suspension \n(40/200  mg per 5ml) \nHour 0 0.5 ml \nHour 1 1 ml \nHour 2 2 ml \nHour 3 3 ml \nHour 4 4 ml \nHour 5 5 ml \nHour 6 1 SS tablet \nNote: The rapid desensitization protocol should \nnot be used for children because the cumulative \ndosage will be too high  \n \n \nDapsone as a Substitute for CPT  \nIn situations of severe allergy to cotrimoxazole or when desensitization is not successful, \ndapsone can be used instead of CTX. It is primarily effective as prophylaxis against PCP but does \nnot have the other prophylactic benefits of cotrimoxazole.  \nNote:  \nDapsone will contribute to anaemia in most patients, and causes haemolytic anaemia in some \npatients, so pati ents should have a baseline Hb before starting dapsone and Hb monitored every \n1-2 weeks for the first couple of months.  \nWhen dapsone (as a substitute for CPT) is being used as PCP prophylaxis, it is only \nrecommended for patients in WHO Stage 4 and/or with  absolute CD4 count \u2264 200 \ncells/mm3 (or CD4 % \u2264 25% for children \u2264 5 years old), and should be discontinued once \na patient achieves a sustained CD4 count of > 200 cells/mm3 (or > 25% for children \u2264 5 \nyears old) for at least 6 months.  \nDapsone is NOT recomme nded during breastfeeding.  \nDose of Dapsone  \n\u25cf Available as 25 mg and 100 mg tabs  \n\u25cf Children: 2 mg/kg once daily (maximum dose: 100 mg) OR 4 mg/kg once weekly \n(maximum dose: 200 mg)  \n\u25cf Adults: 100 mg once daily", "start_char_idx": 3, "end_char_idx": 2039, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "db82b760-9d89-4e93-98a6-b6e2aa274a0d": {"__data__": {"id_": "db82b760-9d89-4e93-98a6-b6e2aa274a0d", "embedding": null, "metadata": {"page_label": "73", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2bb419d5-4e91-458d-942c-bf872eb1a279", "node_type": "4", "metadata": {"page_label": "73", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ed697bcb38ec3e117aea731f8bc03b87dcd1fb3a75b0debc269887680e31b454", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8bedb5b8-6c77-46e1-8ac1-ff64da2936cc", "node_type": "1", "metadata": {"page_label": "72", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "76ee4a932c625d0ce55c0c4bd76976c1983ac67cf07877cbb0879d507d9eeb55", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "cd260002-a459-45c3-a05c-130b72e4657b", "node_type": "1", "metadata": {}, "hash": "b1f635684ffdd062d822d6127e3cf741a249cdccb6f9d3bef850574ab552b167", "class_name": "RelatedNodeInfo"}}, "hash": "2123c781c8ea2d34927a75f18e4cef0e5b6db6ad905feb4c2f708e6e1cf6256a", "text": "Standard Package of Care for PLHIV  \n4 - 11  4.3.2 Tuberculosis (TB) Prevention and Management for PLHIV  \nAll PLHIV should be screened for TB at every visit using the Intensified Case Finding (ICF) tool.  \nAll PLHIV older than 12 months of age who screen negative for TB should be provided with TB \nPreventive Therapy (TPT) unless they have a s pecific contraindication.  All patients who receive \na full course of TPT should have this clearly documented in their file (Section 8.2)  \nFor PLHIV who have presumptive TB, GeneXpert ultra is the preferred testing platform to \nconfirm the diagnosis, with TB -LAM used as an adjunct bedside test when indicated, while \nawaiting GeneXpert ultra -results. All PLHIV qualify for ART, including patients with HIV/TB co -\ninfection.  \nChapter 8 provides specific guidelines for ICF, TPT, use of GeneXpert ultra and TB -LAM, and ART \nfor patients with TB/HIV co -infection.  \n4.3.3 Cryptococcal Meningitis (CM) Screening and Treatment  \nAll adult and adolescent PLHIV with a baseline CD4 count of \u2264 200 cells/mm3   should be \nscreened for cryptococcal infection (Figure 4.1). This should be a  reflex test performed by the \nlaboratory as soon as the low CD4 count is noted, rather than requiring the clinician to order a \nspecial test for screening.  \nPLHIV, including children and adolescents, should receive cryptococcal screening if clinically \nsuspec ted. For patients who are symptomatic for meningitis but screen serum CrAg negative, \nalternative diagnoses for sub -acute meningitis should be explored, such as TB meningitis. All \npatients with clinical meningitis should be assessed and managed at a facilit y that can perform \nlumbar punctures.  \nWhenever performing CSF CrAg for patients with symptomatic meningitis, CSF GeneXpert \nultra for TB should be performed at the same time, as well as urine for TB -LAM . \nFluconazole use during first trimester of pregnancy in creases the risk of birth defects. All \npregnant women who screen positive with serum CrAg should be offered a lumbar puncture \n(irrespective of symptoms) to determine if they have cryptococcal meningitis. If the CSF CrAg is \npositive, they should be treated with 2 weeks of amphotericin B for induction (without \nfluconazole), while consulting Uliza!  Hotline (0726 460 000; ulizanascop@gmail.com) to discuss \nconsolidation/maintenance. Pregnant women with negative CSF CrAg should start ART \nimmediately (without pre -emptive fluconazole therapy) and be monitored for symptoms of CM.  \nTable 4. 7 provides detailed guidance on the use of amphotericin, fluconazole, flucytosine (once \navailable), and therapeutic lumbar punctures for the treatment of symptomatic cryptococcal \nmen ingitis", "start_char_idx": 3, "end_char_idx": 2712, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "cd260002-a459-45c3-a05c-130b72e4657b": {"__data__": {"id_": "cd260002-a459-45c3-a05c-130b72e4657b", "embedding": null, "metadata": {"page_label": "74", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6e6cc321-d3e8-495d-987d-3ab0a8a78eed", "node_type": "4", "metadata": {"page_label": "74", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "31cc2155b00f65b1ca8da6acd9d73c0e402d905526c0d90ff4953e2a91aae5a7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "db82b760-9d89-4e93-98a6-b6e2aa274a0d", "node_type": "1", "metadata": {"page_label": "73", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2123c781c8ea2d34927a75f18e4cef0e5b6db6ad905feb4c2f708e6e1cf6256a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "931d5b76-d9ef-4a93-82cb-0da084036890", "node_type": "1", "metadata": {}, "hash": "9a16907768a9bbb0102d00491c801ee3a3a7a628cb62cba1fff39682024e13ea", "class_name": "RelatedNodeInfo"}}, "hash": "b1f635684ffdd062d822d6127e3cf741a249cdccb6f9d3bef850574ab552b167", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 12  Table 4. 7: Treatment of Cryptococcal Meningitis  \nTarget \npopulation  Regimen  Induction (2 \nweeks)1,2 Consolidation \n(8 weeks)  Maintenance  When to start  \nART  \nAdults  Preferred  Ampho B 1.0 \nmg/kg/day + \nFluconazole \n1,200 mg/day  Fluconazole6  \n800 mg/day  Fluconazole 200 \nmg/day for at \nleast 1 year and \nuntil CD4 count  \n> 200 cells/mm3 \nfor two measures  \n6 months apart \nAND VL is \nundetectable  Defer ART until \nafter completing  \n5 weeks of CM \ntreatment and \nsymptoms have \nresolved  Alternative  Fluconazole,3,4,5,6  \n1,600 mg daily  Fluconazole6 \n800 mg daily  \nChildren and \nadolescents  Preferred  Ampho B 1.0 \nmg/kg/day + \nFluconazole 12 \nmg/kg/day (up \nto max 800 \nmg/day)  Fluconazole 6 -\n12 mg/kg/day \nup to  \n800 mg/day  Fluconazole  \n6mg/kg/day up \nto 200 mg/day  \nAlternative  Fluconazole3,4,5 \n12 mg/kg/day \n(up to max \n1,600 mg/  \nday)  Fluconazole 12 \nmg/kg/day up \nto \n800 mg/day  Fluconazole  \n6mg/kg/day up \nto 200 mg/day  \n1Amphotericin B should always be used for induction when available. If it is not possible to complete 2 weeks \nof induction with ampho due to availability, toxicity or monitoring, then use a shorter duration of ampho and \ncomplete the 14 -day induction period with the alternative regimen  \n2Once available, flucytosine may become part of the  preferred and alternative induction regimens, given \n100mg/kg per day divided into four doses per day  \n3Fluconazole requires a dose adjustment for impaired renal function; when CrCl \u2264 50 ml/min then use 50% \nof the standard recommended dose  \n4Fluconazole shou ld not be used with rifabutin -based TB treatment  \n5When using high -dose fluconazole check ALT after one week of treatment and based on symptoms \nthereafter  \n6Fluconazole is contraindicated in the first trimester of pregnancy. Amphotericin can be used. Please consult \nexpert or National or Regional TWG.", "start_char_idx": 3, "end_char_idx": 1935, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "931d5b76-d9ef-4a93-82cb-0da084036890": {"__data__": {"id_": "931d5b76-d9ef-4a93-82cb-0da084036890", "embedding": null, "metadata": {"page_label": "75", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "9654b988-d1ee-4e38-b194-31aeb03a10f7", "node_type": "4", "metadata": {"page_label": "75", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "66cd05494639a0bae5a38f9fd54ddd0eeb5e6fe123d9b0f302151783b7df4ee1", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "cd260002-a459-45c3-a05c-130b72e4657b", "node_type": "1", "metadata": {"page_label": "74", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b1f635684ffdd062d822d6127e3cf741a249cdccb6f9d3bef850574ab552b167", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ce1a574a-af27-42e5-9412-914d4ea3ee73", "node_type": "1", "metadata": {}, "hash": "8c81299ef8a5a0e3e4d0bea1053095a7faaf94a70049b3a141fecfe4dfa45b6e", "class_name": "RelatedNodeInfo"}}, "hash": "9a16907768a9bbb0102d00491c801ee3a3a7a628cb62cba1fff39682024e13ea", "text": "Standard Package of Care for PLHIV  \n4 - 13  Managing and Monitoring for Amphotericin B Therapy  \nAdults  \n\u2022 Give 1 L of normal saline with 20 mmol of KCl over 2 -4 hours before each controlled \ninfusion of Ampho B given with 1 litre of 5% dextrose. Add one to two tablets of 8 mEq \nKCl orally twice daily. An additional one 8 mEq KCl tablets twice daily may be added in \nthe second week. Include magnesium supplementation at 250 mg tablets of magnesium \ntrisilicate twice daily (or 4 mEq tablets of magnesium chloride t wice daily)  \nAdolescents and Children  \n\u2022 Give 1 L of normal saline with 20 mmol of KCl over 2 -4 hours before each controlled \ninfusion of Ampho B. Darrows or Ringer\u2019s solutions can also be used  \nNote: Avoid KCl replacement in patients with pre -existing renal imp airment or \nhyperkalemia  \n \nManaging hypokalaemia and raised creatinine levels  \n\u2022 Obtain a routine baseline and twice weekly potassium and creatinine:  \n- If K < 3.3 mmol/L, administer 1 L of normal saline with KCl 40 mmol in normal saline \nor 1 -2 tablets of 8mEq KCl every 8 hours. Add magnesium. Monitor potassium daily  \n- If creatinine level increases > 2 -fold from baseline, omit dose of Ampho B, increase \nhydration to 1 L every 8 hours. If there\u2019s improvement, re -start Ampho B at 0.7 \nmg/kg/day on alternate days. If n o improvement, discontinue Ampho B, give \nfluconazole 1,600 mg/day to complete induction. Monitor creatinine daily  \nTherapeutic lumbar punctures are a critical component of the management of CM and \nshould be standard of care:  \n\u2022 For all patients with symptomati c CM: perform daily therapeutic lumbar punctures:  \n- If opening pressure is \u2264 40 cm: draw off enough CSF to reduce pressure to 20 cm  \n- If opening pressure is > 40 cm: draw off enough CSF to reduce pressure by 50%  \n- Continue daily LPs until pressure is normal for 3 consecutive days  \n- Restart LPs if symptoms return  \nIf measuring intracranial pressure is not possible (even using a giving set and tape measure), \nthen perform daily therapeutic LPs until severe headache subsides, removing 10 -20 ml of CSF \neach tim e", "start_char_idx": 3, "end_char_idx": 2113, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ce1a574a-af27-42e5-9412-914d4ea3ee73": {"__data__": {"id_": "ce1a574a-af27-42e5-9412-914d4ea3ee73", "embedding": null, "metadata": {"page_label": "76", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "46186f23-16b8-4c8a-8cbf-b377ddaa5363", "node_type": "4", "metadata": {"page_label": "76", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b19f94143ed9a8507875b4a078ddc491fbe1fdfc5f634d4fb037f43a615abd8e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "931d5b76-d9ef-4a93-82cb-0da084036890", "node_type": "1", "metadata": {"page_label": "75", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9a16907768a9bbb0102d00491c801ee3a3a7a628cb62cba1fff39682024e13ea", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "29081261-1ba8-4d44-9fd5-55b7b1e04a91", "node_type": "1", "metadata": {}, "hash": "6e6afb18d520004c3426bb8c614a22b134d9c59614d8e81c515a21c8a7650f42", "class_name": "RelatedNodeInfo"}}, "hash": "8c81299ef8a5a0e3e4d0bea1053095a7faaf94a70049b3a141fecfe4dfa45b6e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 14  \nNewly diagnosed HIV -infected adult or adolescent\nCD4   200 cells/mm3\nAutomatic/reflex CrAg \nscreening\nSerum CrAg POSITIVE Serum CrAg NEGATIVE\nSymptom Screen: Progressive headache, fever, \nmalaise, neck pain, confusion\nSymptomatic: Admit and do \nLumbar puncture to obtain CSF \nfor CrAg and geneXpert\u2022 Asymptomatic1: Offer presumptive treatment for possible early CM with \nfluconazole 1,600 mg per day for 2 weeks, followed by fluconazole 800 \nmg per day for 8 weeks, followed by fluconazole 200 mg per day for at \nleast 1 year and until CD4 count >200 cells/mm3 for two measures 6 \nmonths apart and VL is undetectable (LDL <200copies/ml )\n\u2022 Defer ART for 5 weeks2\n\u2022 Monitor closely and perform LP if symptoms develop\nNB: Lumber puncture for CSF CrAg is strongly recommended for pregnant \nwomen irrespective of symptoms3\nCSF CrAg positive: Treat for cryptococcal \nmeningitis with amphotericin, fluconazole \nand therapeutic LPs (Annex 7)\nDefer ART until completed 5 weeks of \ntreatment and has resolution of \nsymptoms2\u2022 CSF CrAg negative: Offer pre -emptive therapy for non -meningeal \ndisease with fluconazole 800 mg per day for 2 weeks, followed by \nfluconazole 400 mg per day for 8 weeks, followed by fluconazole \n200 mg for at least 1 year and until CD4 count >200 cells/mm3 for \ntwo measures 6 months apart and VL is undetectable (LDL \n<200copies/ml )\n\u2022 Defer ART until completed 5 weeks of treatment and has \nresolution of symptoms2\nLP is recommended for all sCrAg positive patients irrespective of symptoms with management based on LP results. If \nLP is not available to rule out meningeal disease then patients should be treated for possible CM, even if \nasymptomatic\nPatients with cryptococcal meningitis are at high risk of developing life-threatening IRIS;  deferring ART has \nshown to improve survival for these specific \nFluconazole use during pregnancy increases the risk of birth defects. All pregnant women who screen positive with \nserum CrAg should be offered a lumbar puncture (irrespective of symptoms) to determine if they have cryptococcal \nmeningitis\nNote: \n\u2022 Fluconazole requires a dose adjustment for impaired renal function; when CrCl      ml/min then use 50% of the \nstandard recommended dose\n\u2022 Fluconazole should not be used with rifabutin -based TB treatment\n\u2022 When using high -dose fluconazole check ALT after one week of treatment and based on symptoms thereafter\u2022 No cryptococcal treatment required\n\u2022 Initiate ART within 2 weeks \nFigure 4.1: Routine Screening for Cryptococcal Meningitis for HIV -infected Adults and Adolescents", "start_char_idx": 3, "end_char_idx": 2624, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "29081261-1ba8-4d44-9fd5-55b7b1e04a91": {"__data__": {"id_": "29081261-1ba8-4d44-9fd5-55b7b1e04a91", "embedding": null, "metadata": {"page_label": "77", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d00c55b4-fbb9-48f9-af90-4b6f4de45725", "node_type": "4", "metadata": {"page_label": "77", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6d58302add75ea365b23b84e2e8edafa2957ec2bad5e15d932e989472306ced2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ce1a574a-af27-42e5-9412-914d4ea3ee73", "node_type": "1", "metadata": {"page_label": "76", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8c81299ef8a5a0e3e4d0bea1053095a7faaf94a70049b3a141fecfe4dfa45b6e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7ba4845b-fbe3-4097-8b9b-69d7a15dc052", "node_type": "1", "metadata": {}, "hash": "26241cdc8fba1e67f74e3575eade0fa7c9b0093a05c9b8047708ef8d9ddf777d", "class_name": "RelatedNodeInfo"}}, "hash": "6e6afb18d520004c3426bb8c614a22b134d9c59614d8e81c515a21c8a7650f42", "text": "Standard Package of Care for PLHIV  \n4 - 15  4.4 Reproductive Health Services  \n4.4.1 Sexually Transmitted Infections  \nScreening for syphilis using VDRL, TPHA, or RPR should be performed as a baseline investigation \nfor all adolescent and adult PLHIV. Pregnant women should be screened for Syphilis during the \nfirst ANC visit and 3rd trimester.  \n \nAll PLHIV should be assessed for symptoms of STIs using the National Algorithm s for Treating \nCommon STI Syndromes (Kenya National guidelines for management and control of STIs, 2018. \nAnnex 4). Sexual partners should be treated as well.  \n \nRisk reduction counselling and provision of condoms is an integral part of STI treatment.  \n \nPatien ts who have persistent signs and symptoms of STIs after syndromic treatment should \nundergo diagnostic evaluation for definitive diagnosis and treatment.  \n \nAt initial diagnosis of HIV, all sex workers should be treated for presumptive gonorrhoea and \nchlamydi a (following treatment recommendations of vaginal/urethral discharge syndrome as \nper national STI guidelines), with presumptive treatment every quarter.  \n \n4.4.2 Family Planning and Pre -Conception Counselling  \nPregnancy status should be determined for all wom en of reproductive age at every visit (based \non history of last menstrual period and, if uncertain, irregular, or delayed, then a urine pregnancy \ntest should be performed).  \n \nPregnancy intention should be determined for all women of reproductive age and the ir partners \nso that appropriate family planning or pre -conception counselling can be provided.  \n \nFor patients who do not have an immediate desire to become pregnant, dual contraception \n(defined as condoms plus another form of effective contraception) should  be provided \nimmediately with follow -up appointments scheduled to ensure no interruption in contraception \nprovision. Table 4.8  outlines contraception options for PLHIV based on the ARVs they are using.", "start_char_idx": 3, "end_char_idx": 1954, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7ba4845b-fbe3-4097-8b9b-69d7a15dc052": {"__data__": {"id_": "7ba4845b-fbe3-4097-8b9b-69d7a15dc052", "embedding": null, "metadata": {"page_label": "78", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "00d55a25-bc98-486d-9844-be9334bc8f24", "node_type": "4", "metadata": {"page_label": "78", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5fcc4a8b57137c8bc2589d8e0ded6153a6546e293655c041a27030b93d1c9f64", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "29081261-1ba8-4d44-9fd5-55b7b1e04a91", "node_type": "1", "metadata": {"page_label": "77", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6e6afb18d520004c3426bb8c614a22b134d9c59614d8e81c515a21c8a7650f42", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "cb389525-c2d8-4b20-94ea-1de1eb6a550f", "node_type": "1", "metadata": {}, "hash": "72df0ef87cf71172e17945c140b0eb7ece651ded5a973d9d1417331b3afda581", "class_name": "RelatedNodeInfo"}}, "hash": "26241cdc8fba1e67f74e3575eade0fa7c9b0093a05c9b8047708ef8d9ddf777d", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 16  Table 4.8 : Contraceptive Methods for PLHIV Based on  WHO 2018 Medical Eligibility Criteria  \nContraceptive Method  ARVs Being Used  Anti -TB \nNRTI \n(any)  NNRTI  \nPI/r \n(any)  INSTI  \nRifampicin or \nRifabutin  EFV \nor \nNVP  ETR  RAL  DTG*  \nIM medroxyprogesterone (DMPA; Depo \nProvera)  1 1 1 1 1 - 1 \nNorethisterone enanthate (NET -EN; \nnorethindrone)  1 2 1 2 1 - 2 \nImplants  1 2 1 2 1 - 2 \nCombined oral contraceptive (pill)  1 2 1 2 1 - 3 \nIntrauterine \ndevice (IUD)  Initiation  \u25cf Category 2 for asymptomatic or mild HIV disease (WHO Stage 1 \nor 2, or any WHO Stage once they are stable on ART)  \n\u25cf Category 3 for women with advanced and symptomatic HIV \ndisease UNTIL they are stable on ART and asymptomatic  \nContinuation  Category 2 for all women regardless of symptomatic HIV (do not \nrequire IUD to be removed)  \nCondoms  No restrictions; use encouraged in combination with a hormonal \ncontraception method or IUD as part of dual FP to prevent STI/HIV \ntransmission  \nEmergency contraceptive pill (ECP)  No restrictions; can be started up to 5 days after intercourse  \nSterilization  No reason to deny; delay in case of acute HIV -related infection  \nFertility awareness -based (FAB) methods  Can use if menstrual cycle is regular, although reliability is not as \ngood as hormonal contraceptive methods or IUD. Encoura ge to use \nin combination with condoms to prevent STI/HIV transmission  \nLactational amenorrhoea method (LAM)  Effective for women who are less than 6 months post -partum, are \nexclusively breastfeeding, and have not resumed menses. Encourage \nto use in combinat ion with condoms to prevent STI/HIV \ntransmission  \nSpermicides and diaphragm  Use is not recommended; may increase risk of HIV transmission  \nCategory 1: No restriction for the use of the contraceptive method  \nCategory 2: Advantages of using the method generally outweigh the theoretical or proven risks  \nCategory 3: The theoretical or proven risks usually outweigh the advantages of using the method  \n*DTG was not included in the WHO 2018 MEC Guidelines, however, drug interactions between DTG and \nhormonal con traception have not been identified  \nFor patients who intend to become pregnant, the key pre -conception messages and services are \npresented in Table 4. 9.", "start_char_idx": 3, "end_char_idx": 2333, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "cb389525-c2d8-4b20-94ea-1de1eb6a550f": {"__data__": {"id_": "cb389525-c2d8-4b20-94ea-1de1eb6a550f", "embedding": null, "metadata": {"page_label": "79", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e288874b-72fc-4602-a7be-816bde8816f4", "node_type": "4", "metadata": {"page_label": "79", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "63b5a02674abeebbe44e99d8aee8b25d2bdf511c95352a003128625a638460eb", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7ba4845b-fbe3-4097-8b9b-69d7a15dc052", "node_type": "1", "metadata": {"page_label": "78", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "26241cdc8fba1e67f74e3575eade0fa7c9b0093a05c9b8047708ef8d9ddf777d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "488b75b2-739a-4aa9-889f-77deb8ec663e", "node_type": "1", "metadata": {}, "hash": "fb12cf9b7882a94125a087e64b230282b9f404cd7ae1eee8f1209e002994d646", "class_name": "RelatedNodeInfo"}}, "hash": "72df0ef87cf71172e17945c140b0eb7ece651ded5a973d9d1417331b3afda581", "text": "Standard Package of Care for PLHIV  \n4 - 17  Table 4. 9: Pre -Conception Counselling Messages and Services for PLHIV  \nScenario  Key Counselling Messag es Pre-conception Services (in \naddition to the Standard Package of \nCare for PLHIV)  \nAll \nwomen/couples \nwith intention to \nconceive  \u25cf All PLHIV qualify for ART, with \ninitiation preferably within 2 weeks \nof HIV diagnosis  \n\u25cf Deferring pregnancy until confirmed \nviral suppression reduces risk of \nvertical transmission to the baby, \nimproves infant outcomes, and \nreduces risk of cross -transmission to \nthe sexual partner  \n\u25cf Unprotected sex should be limited to \ndays when ovulation is expected \n(based on basal tempe rature \nmonitoring, fertility calendar based \non menstrual cycles, and/or fertility \ncalendar app)  \n\u25cf Routine ANC and delivery by a \nskilled birth attendant improves \noutcomes for mother and baby  \u25cf ART for all PLHIV, including those \nintending to become pregnant  \n\u25cf Baseline investigations  \no Hb (with management of \nanaemia)  \no Syphilis screening  \no Cervical cancer screening  \n\u25cf STI symptom screening  \n\u25cf Nutritional assessment, \ncounselling, and support  \n\u25cf Folic acid supplementation  \n\u25cf Standard VL monitoring (Figure \n6.6)  \n\u25cf PrEP for the HIV -negative partner  \nAdditional \nmessages for \ndiscordant \ncouples: male \npartner HIV \npositive  \u25cf Defer unprotected sex until confirmed viral suppression in the HIV positive \npartner  \n\u25cf Discuss use of PrEP for the HIV-negative partner (Chapter 11)  \n\u25cf In situations where viral suppression is challenging, consider specialist referral \nfor additional options such as sperm washing and artificial insemination  \nAdditional \nmessages for \ndiscordant \ncouples: female \npartner HIV \npositive  \u25cf Defer unprotected sex until confirmed viral suppression in the HIV -positive \npartner  \n\u25cf Discuss use of PrEP for the HIV -negative partner (Chapter 11)  \n\u25cf Discuss self -insemination during the peri -ovulatory period, where \nappropriate/as preferred  \n\u25cf In situations where viral suppression is challenging, consider specialist referral \nfor additional options such as artificial insemination", "start_char_idx": 3, "end_char_idx": 2121, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "488b75b2-739a-4aa9-889f-77deb8ec663e": {"__data__": {"id_": "488b75b2-739a-4aa9-889f-77deb8ec663e", "embedding": null, "metadata": {"page_label": "80", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "465709ec-0704-47a2-832f-5f3db6db1a62", "node_type": "4", "metadata": {"page_label": "80", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "afd588c8ecd0b4868db4a608a7fb368c71fb47d7ab98579c1a15b04812c1a73e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "cb389525-c2d8-4b20-94ea-1de1eb6a550f", "node_type": "1", "metadata": {"page_label": "79", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "72df0ef87cf71172e17945c140b0eb7ece651ded5a973d9d1417331b3afda581", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "919942b9-2c87-490c-a1be-9e972f8c9a99", "node_type": "1", "metadata": {}, "hash": "4ac644ce51b5630b4264cb17ce61de43153713c6c9e67754033331f08062f6f0", "class_name": "RelatedNodeInfo"}}, "hash": "fb12cf9b7882a94125a087e64b230282b9f404cd7ae1eee8f1209e002994d646", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 18  4.4.3 Maternal Healthcare  \nMaternal healthcare begins with preconception counselling (Table 4. 9), and continues \nthroughout pregnancy and breastfeeding. The standard package of antenatal and postnatal \nservices in the context of HIV is described in Chapter 7 of these guidelines.  \n4.5 Non -communicable Diseases Screening and Management  \n4.5.1 Metabolic Disorders  \nScreening, prevention and management of specific NCDs are included in the standard package of \ncare for PLHIV because of their associated high morbidity and mortality. PLHIV are at higher risk \nfor cardiovascular, liver and kidney disease because o f the chronic inflammatory state associated \nwith HIV infection itself, and also as a side -effect of some of the ARVs.  \nThe modifiable risk factors for cardiovascular disease include tobacco use and exposure to \ntobacco smoke, unhealthy diets, overweight/obe sity, physical inactivity, harmful use of alcohol, \nhypertension, diabetes, hyperlipidemia, infections such as rheumatic fever and HIV. Advancing \nage, sex, race/ethnicity and family history are non -modifiable risk factors associated with \ncardiovascular dise ases  \nHIV and other chronic diseases require health systems that support chronic care and  \nadherence; their management should be integrated at the health facility, including at the \nprimary care level.  \nLifestyle modifications are always the first line of prev ention and management for \nhypertension, diabetes mellitus (DM), and dyslipidaemia (Table 4. 10). These are \nrecommended for all patients to prevent these NCDs and should be integrated into routine HIV \ntreatment and prevention. Recommendations for screening, diagnosis, and initial management \nof hypertension, type 2 DM, dyslipidaemia, and chronic kidney disease (CKD) are provided in \nTables 4.1 1-4.14. \nFor comprehensive guidelines on prevention, diagnosis and management of diabetes and \ncardiovascular diseases, re fer to Kenya National Clinical Guidelines for the Management of \nDiabetes  and Kenya National Guidelines for Cardiovascular Diseases Management , respectively.", "start_char_idx": 3, "end_char_idx": 2151, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "919942b9-2c87-490c-a1be-9e972f8c9a99": {"__data__": {"id_": "919942b9-2c87-490c-a1be-9e972f8c9a99", "embedding": null, "metadata": {"page_label": "81", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "98989702-e865-4d0e-b094-32d44284cb7f", "node_type": "4", "metadata": {"page_label": "81", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e7170148cf6dcedba00df6099ecf09123799af96809e72a3c13c9d8b41dbf843", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "488b75b2-739a-4aa9-889f-77deb8ec663e", "node_type": "1", "metadata": {"page_label": "80", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fb12cf9b7882a94125a087e64b230282b9f404cd7ae1eee8f1209e002994d646", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "12378d69-921e-413f-aa51-24f6b266a660", "node_type": "1", "metadata": {}, "hash": "22d9cfd50c409302d12d83ea9474b5f370006f087dc30a3c1df7bb05151c6277", "class_name": "RelatedNodeInfo"}}, "hash": "4ac644ce51b5630b4264cb17ce61de43153713c6c9e67754033331f08062f6f0", "text": "Standard Package of Care for PLHIV  \n4 - 19  Table 4. 10: Lifestyle Modifications to Prevent and Manage Cardiovascular Disease in PLHIV  \nSmoking Cessation  \n\u25cf Smoking cessation has multiple short -term and long -term benefits, including  \no Reduced premature aging/wrinkling of skin  \no Improved fitness and quicker recovery from common infections  \no Reduced risk of respiratory infections and chronic lung disease  \no Reduced risk of high blood pressure, diabetes, kidney disease, heart disease, and stroke  \no Improved infant outcomes (for pregnant women)  \no Reduced risk of cancers: lung, bladder, breast, mouth, throat, esophagus  \no Better response to ART (better viral suppression)  \no Reduced risk of developing TB or dying from TB  \n\u25cf Tobacco dependence treatment and cessation programs should combine behavioral/counseling \nsupport with pharmacotherapy treatment where necessary and available. For further details on \ncessation interventions, refer to the Kenya National Guidelines for Tobacco Dependence \nTreatment  \nRefer to Table 4.1 8 for tips to assist a client to quit smoking  \n \nDietary Changes and Weight Loss  \n\u25cf Weight loss to maintain a healthy BMI (nutritionists to be engaged in patient care)  \n\u25cf Drink 8 glasses of water per day  \n\u25cf Reduce/abstain from alcohol  \n\u25cf Cut down sugar intake  \n\u25cf Cut down red meat intake  \n\u25cf Cut down consumption of fatty foods, fat for flavoring, and fried foods  \n\u25cf Increase intake of whole grain s, vegetables, fruit, and beans  \n\u25cf Increase intake of fish  \n\u25cf Consume less than 5 g (just under a teaspoon) of salt per day  \n \nPhysical Activity  \n\u25cf Active lifestyle with moderate -intensity physical activity  \n\u25cf 30 minutes of aerobic activity such as brisk walking, at least 5 days per week", "start_char_idx": 3, "end_char_idx": 1751, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "12378d69-921e-413f-aa51-24f6b266a660": {"__data__": {"id_": "12378d69-921e-413f-aa51-24f6b266a660", "embedding": null, "metadata": {"page_label": "82", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "20279c91-2330-41a0-a09d-7bc44923010c", "node_type": "4", "metadata": {"page_label": "82", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2cbed7d374974b3d11eb11e9c0d65707db6459b1d0dd79d3e1d82bd0e1adaabb", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "919942b9-2c87-490c-a1be-9e972f8c9a99", "node_type": "1", "metadata": {"page_label": "81", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4ac644ce51b5630b4264cb17ce61de43153713c6c9e67754033331f08062f6f0", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a9ebc98a-0b6d-44db-8f92-b534d2b045ad", "node_type": "1", "metadata": {}, "hash": "996835ab8bacb3e4b9d0d58881556a86613cef9bae0f83b4cdbf28d91ae17ded", "class_name": "RelatedNodeInfo"}}, "hash": "22d9cfd50c409302d12d83ea9474b5f370006f087dc30a3c1df7bb05151c6277", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 20  Table 4.1 1: Hypertension Screening, Diagnosis, and Initial Management for Adult PLHIV  \nScreening  \n\u25cf BP should be measured and recorded for every adult at every visit  \nDiagnosis  \n\u25cf Hypertension requiring intervention is defined as BP \u2265 140/90 mmHg on at least 3 different occasions  \nAdditional Investigations for patients with hypertension  \n\u25cf Urinalysis: to assess for kidney disease and diabetes  \n\u25cf Creatinine, Na, K: to assess for kidney disease  \n\u25cf Blood glucose: to assess for diabetes  \n\u25cf Full blood count: anaemia may indicate chronic kidney disease  \n\u25cf Lipid profile: dyslipidemia is a cardiovascular risk factor  \n\u25cf ECG: to assess for cardiac pathology including cardiomegaly, ventricular dysfunction, ischemic heart \ndisease, etc.  \nManagement (treatment target is BP < 140/90 mmHg)  \n\u25cf If baseline BP is 120 -139/80 -89 (pre -hypertension)  \no Lifestyle modification, along with monthly BP monitoring  \n \n\u25cf If baseline BP is 140 -159/90 -99 \no Lifestyle modification (Table 4.9) for up to 6 months, along with monthly BP monitoring  \no If does not meet treatment target with lifestyle modifications, then add drugs to lifestyle \nmodification  \no In PLHIV without  kidney disease or diabetes, first -line antihypertensive therapy is a thiazide \ndiuretic s uch as hydrochlorothiazide starting at 12.5 mg OD (maximum dose 25 mg OD) OR a \ncalcium channel blocker such as amlodipine starting at 2.5 mg OD (maximum 10 mg OD)  \no In PLHIV with kidney disease or diabetes the first antihypertensive should be an ACE -I or ARB  \nsuch as enalapril 2.5 -10 mg OD (maximum dose is 20 mg BD); or, losartan 50 mg OD (maximum \ndose is 100 mg OD), with referral to a physician if available  \no Introduce one drug at a time. If the target blood pressure is not reached within one month after \ninitia ting therapy, the dosage of the initial medication should be increased. Titrate to maximum \nrecommended dosage (if tolerated) before adding an additional drug  \no If inadequate response once dose has been titrated, an additional agent may be required e.g., \nhydr ochlorothiazide starting at 12.5 mg OD (maximum dose 25 mg OD)  \no If inadequate response to two agents, consider consultation with or referral to a physician  \no Note: Calcium -channel blockers have known drug interactions with PIs and NNRTIs and \nshould be used with caution (Annex 13). ACE -I and thiazide diuretics do not have significant \ninteractions with ARVs  \n \n\u25cf If baseline BP \u2265 160/100 mmHg  \no Initiate lifestyle modifications and introduce anti -hypertensive medications concurrently", "start_char_idx": 3, "end_char_idx": 2625, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a9ebc98a-0b6d-44db-8f92-b534d2b045ad": {"__data__": {"id_": "a9ebc98a-0b6d-44db-8f92-b534d2b045ad", "embedding": null, "metadata": {"page_label": "83", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3390ea5c-2483-4d06-b06f-d64ac88465e5", "node_type": "4", "metadata": {"page_label": "83", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c0aa9f575e0f56f3840fd0ab7cbbe561f1edba5145aa704fcc870b51a9e6eb3f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "12378d69-921e-413f-aa51-24f6b266a660", "node_type": "1", "metadata": {"page_label": "82", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "22d9cfd50c409302d12d83ea9474b5f370006f087dc30a3c1df7bb05151c6277", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "97f3abaf-3464-4033-b05d-f325078c2171", "node_type": "1", "metadata": {}, "hash": "15f19d78ddc2515bf6091de35dfee8a1297b5279572b2500d477fee633e246fe", "class_name": "RelatedNodeInfo"}}, "hash": "996835ab8bacb3e4b9d0d58881556a86613cef9bae0f83b4cdbf28d91ae17ded", "text": "Standard Package of Care for PLHIV  \n4 - 21  Table 4.1 2: Type 2 Diabetes Mellitus Screening, Diagnosis, and Initial Management for PLHIV  \nScreening  \n\u25cf Blood glucose (fasting or random) should be evaluated at baseline for all PLHIV, then annually if \nbaseline screening is normal; urine dipstick for protein and glucose can be used if blood glucose \ntesting is not available  \nDiagnosis  \n\u25cf Diabetes Mellitus is defined as fasting blood sugar \u2265 7.0 mmol/L, or random blood sugar \u2265 11.1 \nmmol/L, or HbA1c > 6.5%, or oral glucose tolerance test \u2265 11.1 mmol/L  \n\u25cf Abnormal results should be repeated to confirm the diagnosis, particularly for patients without \nsymptoms of diabetes (such as polyuria, polydipsia, polyphagia, weight loss)  \n \nManagement (treatment target is HbA1c \u2264 7.0% or FBS 4 -7 mmol/L)  \n\u25cf For patients with pre -diabetes (abnormal results but does not meet criteria above for diabetes) \nmonitor FBS or HbA1c every 3 months and encourage lifestyle modifications (Table 4. 10) \n \n\u25cf For patients with diabetes, monitor HbA1c (or FBS if HbA1c is not available) every 3 months  \n \n\u25cf Lifestyle modification (weight loss, nutritional support to manage portion sizes and calculate \nglycaemic index of various foods to hel p with control of blood sugar) for 3 -6 months  \n \n\u25cf If does not meet treatment target with lifestyle modifications then add drugs  \no Metformin  \n\u25aa Obtain baseline Creatinine; do NOT use metformin if creatinine clearance < 45 ml/min  \n\u25aa Start with low dose (500 mg OD or BD) and titrate up every 1 -2 weeks until reaches 1 g BD (or \nmaximum tolerated dose if less than 1 g BD)  \n\u25aa Note:  DTG may increase metformin plasma levels: monitor blood glucose levels; dose reduction \nof metformin may be required, and maximum daily dose of met formin should be 1g  \no If does not meet treatment targets with metformin for 3 -6 months at maximum tolerated dose then \nconsider adding drug from another class (such as sulphonylureas (gliclazide)) and/or specialist \nconsultation. Some patients may require insu lin. \no At every visit: A thorough history (to elicit features of hypoglycemia, other cardiovascular disease \nrisk factors, neuropathy, diabetic foot ulcers) and a physical exam (for BP, neuropathy, foot ulcers)  \n \n\u25cf Additional routine screening for patients with diabetes  \no Annual ophthalmology examination for diabetic retinopathy  \no Annual urinalysis: start on an ACE -I/ARB if proteinuria develops (even if BP normal)  \nNote : patients with DM are at increased risk of developing TB", "start_char_idx": 3, "end_char_idx": 2529, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "97f3abaf-3464-4033-b05d-f325078c2171": {"__data__": {"id_": "97f3abaf-3464-4033-b05d-f325078c2171", "embedding": null, "metadata": {"page_label": "84", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "28533ec8-7b5c-4030-83cb-ead53eab41e4", "node_type": "4", "metadata": {"page_label": "84", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f3b8bd039c4d257be10b2adc13ecfea2b4c63f1a6770938276c50b8ff414b2e4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a9ebc98a-0b6d-44db-8f92-b534d2b045ad", "node_type": "1", "metadata": {"page_label": "83", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "996835ab8bacb3e4b9d0d58881556a86613cef9bae0f83b4cdbf28d91ae17ded", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "eb054551-ddf1-4f4b-b5b1-9215f86e2c87", "node_type": "1", "metadata": {}, "hash": "6da091ff8ff41632be8c853d7ae691878f5967955ec4b1c821175df7e72d0141", "class_name": "RelatedNodeInfo"}}, "hash": "15f19d78ddc2515bf6091de35dfee8a1297b5279572b2500d477fee633e246fe", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 22  Table 4.12: Dyslipidemia Screening, Diagnosis, and Initial Management for PLHIV  \nScreening  \n\u25cf Fasting lipid profile should be evaluated at baseline for all PLHIV, then annually if baseline screening \nis normal  \nDiagnosis  \n\u25cf Dyslipidemia is defined as high fasting total cholesterol (>5.2 mmol/L), LDL (>3.4 mmol/L) or \ntriglycerides (>2.2 mmol/L)  \nManagement  \n\u25cf Lifestyle modification for 3 -6 months (Table 4. 10) \n\u25cf If the patient is on an ARV known to cause or exacerbate dyslipidemia (primarily LPV/r & EFV) then \nconsider a single -drug substitution to a more lipid -friendly drug (such as ATV/r or DTG) as the \ntreatment of choice before adding a lipid -lowering drug. Rule out treatment failure before making \nsingle -drug substitutions (Figure 6.4)  \n\u25cf If patient does not meet treatment  target with lifestyle modifications, then add drugs  \no Atorvastatin: starting dose of 10 mg OD (maximum dose 20 mg once daily if patient is on a PI/r; \nmaximum dose 80 mg once daily if not on a PI/r)  \no Simvastatin and lovastatin are contraindicated in the presence of PI/r  \no Allow at least 3 months before repeating fasting lipids and titrating dose  \nOnce targets achieved can monitor lipids every 6 -12 months", "start_char_idx": 3, "end_char_idx": 1284, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "eb054551-ddf1-4f4b-b5b1-9215f86e2c87": {"__data__": {"id_": "eb054551-ddf1-4f4b-b5b1-9215f86e2c87", "embedding": null, "metadata": {"page_label": "85", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "12590ede-c76e-4450-b741-6138aae7faf9", "node_type": "4", "metadata": {"page_label": "85", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "33b3c2dbf522718cf96997cc4074233a33b62e829b12407689a5e42ae73a7452", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "97f3abaf-3464-4033-b05d-f325078c2171", "node_type": "1", "metadata": {"page_label": "84", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "15f19d78ddc2515bf6091de35dfee8a1297b5279572b2500d477fee633e246fe", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a75cd0a0-9302-4a2e-976b-ad4e67edc70f", "node_type": "1", "metadata": {}, "hash": "4bd3809f0e0e6037d2862efe55ff91fc8c9fa056a02ea05faa2f0ec378859bd4", "class_name": "RelatedNodeInfo"}}, "hash": "6da091ff8ff41632be8c853d7ae691878f5967955ec4b1c821175df7e72d0141", "text": "Standard Package of Care for PLHIV  \n4 - 23  Table 4.13: Chronic Kidney Disease Screening, Diagnosis, and Initial Management for PLHIV  \nScreening  \n\u25cf Urinalysis (for protein) and serum creatinine should be evaluated at baseline for all PLHIV and \nmonitored annually  \nDiagnosis  \n\u25cf Impaired renal function is defined as creatinine clearance < 90 ml/min, or dipstick proteinuria \u2265 1 \n(see Annex 15 for CrCl calculations)  \n\u25cf Abnormal results should be repeated to confirm diagnosis  \n\u25cf Chronic kidney disease is defined as evidence of kidney damage that persists for at least three \nmonths  \nManagement  \n\u25cf Management depends on the cause of the renal impairment; additional investigations and/or \nspecialist consultation may be required  \n\u25cf Consultations with a physician is recommended  \n\u25cf Treat dehydration promptly and aggressively  \n\u25cf If on TDF -containing regimen, substitute with another ARV if C rCl<50 ml/min (see Section 6.5), \nwith the exception of patients with HBV/HIV co -infection (Table 9.3 for renal dose adjustments of \nTDF and 3TC for patients with HIV/HBV co -infection)  \n\u25cf Avoid nephrotoxic drugs (e.g., aminoglycosides and NSAIDS)  \n\u25cf Evaluate for a nd treat hypertension  \n\u25cf All NRTIs except ABC require dose adjustments for renal impairment, depending on the severity \n(Table 6.6 for specific dose adjustments). NNRTIs, PIs, and INSTIs do not require dose adjustments \nfor impaired renal function  \nNote: DTG may  cause a small rise in serum creatinine levels but this does NOT represent a \ndecline in renal function, close monitoring is recommended.  \nPatients at higher risk for renal disease and for developing TDF -associated renal toxicity include \nthose with: pre-existing renal disease, hypertension, diabetes mellitus, severe wasting (weight \nbelow 60 kg in adults), age > 45 years, WHO stage 3 or 4, CD4 < 200 cells/mm3, high HIV viral \nload, and concomitant nephrotoxic agents.  \nGlomerular disease directly related to HIV infection, commonly known as HIV -associated \nnephropathy (HIVAN) is an important cause of chronic kidney disease among PLHIV.  \nPrevention, early identification, and management of kidney disease is important to reduce \nthe burden of dialysis and other c omplications.  \n4.5.2 Cancer Prevention, Early Detection and Management among PLHIV  \nPLHIV have a substantially higher risk for many cancers, mainly due to a weakened immune \nsystem which impairs control of oncogenic viral infections. A high prevalence of thes e infections \nand other modifiable risk factors (such as smoking, alcohol use, unhealthy diet and physical \ninactivity) contributes to the elevated risk. PLHIV are far more likely than the general population \nto be diagnosed with Kaposi Sarcoma, non -Hodgkin l ymphoma and other cancers (cervical, anal, \nliver, lung and oral/throat) hence the importance of prioritizing screening and early diagnosis \nprograms in this group.", "start_char_idx": 3, "end_char_idx": 2903, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a75cd0a0-9302-4a2e-976b-ad4e67edc70f": {"__data__": {"id_": "a75cd0a0-9302-4a2e-976b-ad4e67edc70f", "embedding": null, "metadata": {"page_label": "86", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6c556599-6556-42bc-9ce6-be1512eb7b8f", "node_type": "4", "metadata": {"page_label": "86", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f57f15a8a3f99e11a1343e26bb4cf9d0f9d8ec5d589b995296519a7f6e1ee078", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "eb054551-ddf1-4f4b-b5b1-9215f86e2c87", "node_type": "1", "metadata": {"page_label": "85", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6da091ff8ff41632be8c853d7ae691878f5967955ec4b1c821175df7e72d0141", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "c83be0cc-334b-43f4-88eb-82ab98daf462", "node_type": "1", "metadata": {}, "hash": "8ab4baecd4f94588d0b58dabb0cd78eadf6bcdeca92aa9122d593aea174daf48", "class_name": "RelatedNodeInfo"}}, "hash": "4bd3809f0e0e6037d2862efe55ff91fc8c9fa056a02ea05faa2f0ec378859bd4", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 24  4.5.2.1 Specific Interventions for Cancer Control in PLHIV  \nFour interventions are important f or cancer control among PLHIV:  \n\u25cf Achieve viral suppression:  uncontrolled viral replication is a major risk factor for \ncancer. All PLHIV should initiate ART, and be supported and monitored to achieve long -\nterm viral suppression in order to reduce risk for can cer, and to improve treatment \noutcomes for many cancers  \n\u25cf Primary prevention through avoidance of modifiable risk factors  \no Smoking cessation  \no Avoidance of harmful use of alcohol  \no Regular physical activity  \no Healthy diets  \no Vaccination: vaccination against Human Papillomavirus for girls 9 -14 years old are \neligible in Kenya, Hepatitis B Vaccine for newborns and high -risk groups  \n\u25cf Secondary prevention through screening and early diagnosis  \no Screening: application of simple tests to detect cancer in asymptomatic individuals  \n\u25aa Cervical cancer: all women LHIV who have been sexually active up to 49 years \nold (25 -49 years in the general population), through either visual inspection \nwith acetic acid (VIA) or PAP smear annually, or HPV testing every 2 years  \n\u25aa Breast cancer: mammogram annually from 40 -55 years; mammogram every \ntwo years from 56 -74 years; screening for younger women can be performed \non an individual basis based on family history or other risk factors. Clinical \nbreast exam can be used where mammogr am is not available  \n\u25aa Prostate cancer: serum prostate specific antigen (PSA) annually for men 40 \nyears and above; digital rectal examination can be used if PSA is not available, \nand for all men with urinary symptoms  \n\u25aa Colorectal cancer: fecal occult blood test ing of stool (guaiac or FIT) annually for \neveryone 45 -75 years old, or colonoscopy every 10 years  \n\u25aa Oral cancer: visual examination for everyone above 40 years with history of \ntobacco use, known HPV infection or immunosuppression  \no Early diagnosis: prompt diag nosis of cancer in symptomatic individuals  \n\u25aa Breast: lump, asymmetry, skin changes, nipple changes, blood -stained \ndischarge  \n\u25aa Cervix: post -coital bleeding, excessive vaginal discharge  \n\u25aa Colon and rectum: change in bowel habits, unexplained weight loss, anemia, \nblood in stool  \n\u25aa Oral: white or red lesions, growth, ulceration  \n\u25aa Naso -pharynx: nosebleed, permanent blocked nose, deafness, lymph nodes in \nupper neck  \n\u25aa Larynx: persistent hoarseness of voice  \n\u25aa Stomach: upper abdominal pain, indigestion, weight loss  \n\u25aa Skin: irregular growths, lesions, or non -healing sores  \n\u25aa Bladder: painful or frequent urination, blood in urine  \n\u25aa Prostate: difficulty (long time) in urination, frequent nocturnal urination  \n\u25aa Retinoblastoma: white spot in the pupil, convergent strabismus (in a child)  \n\u25aa Testis: swelling of one testicle", "start_char_idx": 3, "end_char_idx": 2860, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "c83be0cc-334b-43f4-88eb-82ab98daf462": {"__data__": {"id_": "c83be0cc-334b-43f4-88eb-82ab98daf462", "embedding": null, "metadata": {"page_label": "87", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "958b3611-de7a-468e-824c-8ab3773c4a99", "node_type": "4", "metadata": {"page_label": "87", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7337d05340eea26163a1714c6b50ab96f90c828c3adce40589fb32c8eff764f4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a75cd0a0-9302-4a2e-976b-ad4e67edc70f", "node_type": "1", "metadata": {"page_label": "86", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4bd3809f0e0e6037d2862efe55ff91fc8c9fa056a02ea05faa2f0ec378859bd4", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ad0aa945-c61c-40ab-a057-bbe3fc570d5c", "node_type": "1", "metadata": {}, "hash": "41d00f13e922b2776354b77c0574e2af1a83765df9208d9e17e2aba418deb9df", "class_name": "RelatedNodeInfo"}}, "hash": "8ab4baecd4f94588d0b58dabb0cd78eadf6bcdeca92aa9122d593aea174daf48", "text": "Standard Package of Care for PLHIV  \n4 - 25  \u25cf Tertiary prevention : Cancer management, prevention of complications and treatment \nof side effects and secondary cancers  \nNote: For screening, diagnosis, and management recommendations refer to national \nguidelines for prevent ion and management of cancers. For individual patient \nmanagement, referral to regional and national hospitals with capacity for comprehensive \noncology services may be warranted.  \n4.6 Mental Health Screening and Management  \nPLHIV are susceptible to psychological disturbances due to HIV itself and perceptions regarding \nHIV in their environment. Some of the most common psychological disturbances include \ndepression and suicide, anxiety, internalized stigma, post -traumatic stress disorder, cognitive \ndifficulties such as dementia, and perceived lack of social support. Any of these can significantly \ninterfere with a patient\u2019s sense of well -being and their adherence. Depression and alcohol/drug \naddiction are the most significant and are reviewed in this sect ion. For any patient with other \nsuspected mental health disorders, such as anxiety, psychosis or post -traumatic stress disorder, \nconsider formal screening and/or referral to a specialist.  \n4.6.1 Depression  \nDepression is one of the most common psychiatric il lnesses in the world, and chronic illness \n(including HIV) is a strong risk factor for depression. PLHIV are 3 -6 times more likely to suffer \nfrom depression than the general population, with significant disability and poorer treatment \noutcomes if it is not identified and managed. Depression can be a significant contributing factor \nto poor adherence and HIV treatment failure.  \nAll PLHIV should receive basic screening for depression upon enrollment and thereafter \nannually using the following two questions:  \n\u25cf Duri ng the past two weeks have you often been bothered by feeling down, depressed, or \nhopeless?  \n\u25cf During the past two weeks have you often been bothered by little interest or pleasure in \ndoing things?  \nAll patients who answer \u201cyes\u201d to either or both of the questi ons above, and all patients with a \ndetectable viral load after 3 or more months on ART (whether or not they had achieved viral \nsuppression in the past), should undergo a more thorough screening for depression using the \nPHQ -9 screening tool, with management  guided by the PHQ -9 score (Table 4.1 5).", "start_char_idx": 3, "end_char_idx": 2408, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ad0aa945-c61c-40ab-a057-bbe3fc570d5c": {"__data__": {"id_": "ad0aa945-c61c-40ab-a057-bbe3fc570d5c", "embedding": null, "metadata": {"page_label": "88", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "71ddd7aa-6b3c-4f3b-9490-fe1f0e44f72d", "node_type": "4", "metadata": {"page_label": "88", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d519da7f798a28047f8ab1829f87aacff3e7fe762bfb9df5211c18becbbdafde", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "c83be0cc-334b-43f4-88eb-82ab98daf462", "node_type": "1", "metadata": {"page_label": "87", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8ab4baecd4f94588d0b58dabb0cd78eadf6bcdeca92aa9122d593aea174daf48", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1b9a9718-afc1-4034-84e8-154efeb371d2", "node_type": "1", "metadata": {}, "hash": "78b73757040374ac59998f2ec0b56a73682243c847804eda32fa948bdb4e2d77", "class_name": "RelatedNodeInfo"}}, "hash": "41d00f13e922b2776354b77c0574e2af1a83765df9208d9e17e2aba418deb9df", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 26  Table 4.1 5: Patient Health Questionnaire -9 (PHQ -9) for Depression Screening  \nPHQ -9 Depression Screening                               Name:  _________________________    Date: __________________  \nAsk the patient the questions below for each of the 9 symptoms and circle the response for each question. After asking all \nquestions, add the points for each column  at the bottom. The total score is the sum of the column totals. Interpretation \nand management recommendations are provided at the bottom of the table.  \nQuestion:  \u201cOver the last 2 weeks, how often have you been \nbothered by any of the following problems?\u201d  Not at all  Several days  More than \nhalf the days  Nearly every \nday \n 1. Little interest or pleasure in doing things  0 1 2 3 \n2. Feeling down, depressed, or hopeless  0 1 2 3 \n3. Trouble falling or staying asleep, or sleeping too much  0 1 2 3 \n4. Feeling tired or having little energy  0 1 2 3 \n5. Poor appetite or overeating  0 1 2 3 \n6. Feeling bad about yourself, or that you are a failure, or that \nyou have let yourself or your family down  0 1 2 3 \n7. Trouble concentrating on things (linked with patient\u2019s usual \nactivities, such as reading the newspaper or listening to a radio \nprogram)  0 1 2 3 \n8. Moving or speaking so slowly that other people could have \nnoticed. Or the opposite, being so fidgety or restless that you \nhave been moving around a lot m ore than usual  0 1 2 3 \n9. Thoughts that you would be better off dead or of hurting \nyourself in some way  0 1 2 3 \nTotal ____ = (add the points from each column)  0 +___  +___  +___  \n \nInterpretation of PHQ -9 Score and Recommended Management  \nTotal Score  Provisional \nDiagnosis  Recommended Management  \n0-4 Depression unlikely  Repeat screening in future if new concerns that depression has developed  \n5-9 Mild depression  \u25cf Provide counselling support and continue to monitor; refer to mental \nhealth team if available  \n\u25cf If patient is on EFV, substitute with a different ARV after ruling out \ntreatment failure (Figure 6.4)  \n10-14 Moderate depression*  \u25cf Provide supportive counselling (refer to a psychologist if available)  \n\u25cf If patient is on EFV, substitute with a different ARV after ruling out \ntreatment failure (Figure 6.4)  \nand  \n\u25cf Begin antidepressant medication (or, if unfamiliar with use of \nantidepressants, then refer to an experienced clinician)  \nand  \n\u25cf Refer to a medical officer, psychiatrist, or mental health team if available  15-19 Moderate -severe \ndepression*  \n20-27 Severe depression*  \n*Symptoms should be present for at least 2 weeks for a diagnosis of depression and before considering treatment with \nantidepressant medication. Severe depression may require patients to start on anti -depressants immediately  \nDepression is a known adverse drug reaction with EFV although it is often mild and temporary. Patients on \nEFV who develop any persistent symptoms of depression should be switched to another ARV aft er ruling \nout treatment failure (Figure 6.4).", "start_char_idx": 3, "end_char_idx": 3063, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1b9a9718-afc1-4034-84e8-154efeb371d2": {"__data__": {"id_": "1b9a9718-afc1-4034-84e8-154efeb371d2", "embedding": null, "metadata": {"page_label": "89", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "acbf117e-93c7-4f3b-994c-0f9aeee067d9", "node_type": "4", "metadata": {"page_label": "89", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "49c303472bfc9130f7fe2b22b65dc074510811486a0f6b157da653f35edc131b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ad0aa945-c61c-40ab-a057-bbe3fc570d5c", "node_type": "1", "metadata": {"page_label": "88", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "41d00f13e922b2776354b77c0574e2af1a83765df9208d9e17e2aba418deb9df", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "36cf411f-8df0-4210-96ee-3366eddf91f9", "node_type": "1", "metadata": {}, "hash": "9364fb7d219dfcfed35bbc481193f085c7aec343f5389a972b15752e87718feb", "class_name": "RelatedNodeInfo"}}, "hash": "78b73757040374ac59998f2ec0b56a73682243c847804eda32fa948bdb4e2d77", "text": "Standard Package of Care for PLHIV  \n4 - 27  Supportive Counselling for Depression  \nPatients with mild depression should receive supportive counselling, which includes  \n\u25cf Psycho -education on the following key messages  \no Depression is common and can happen to anyone  \no Depressed people often have exaggerated negative opinions about themselves, \ntheir life and their future  \no Effective treatment is possible  \n\u25cf Counseling on self -management  \no Continuing ART as prescribed  \no Continuing activities that they used to find interesting/pleasurable  \no Maintaining a regular sleep cycle  \no Keeping physically active  \no Participating in community/social events  \no Returning to clinic if any thoughts of self -harm occur  \n\u25cf Addressing psychosocial stressors  \no Explore potential stressors in the patient \u2019s life  \no Assist in problem -solving to reduce stressors  \no Assess for and manage intimate partner violence  \n\u25cf Reactivation of or referral to social networks, including peer support groups  \n\u25cf Regular follow -up until symptoms improves and are stable  \n \nPharmacological Management of Depression  \nPatients with moderate depression or worse should be treated with supportive counselling plus \nan anti -depressant medication.  \nFluoxetine is an antidepressant and does not have significant drug interactions with ARVs.  \n\u25cf Starting dose for an adult is usually 20 mg once taken daily in the morning (can start with a \nlower dose for patients who frequently have side -effects from medications). Dose can be \ntitrated up by 20 mg every 2 -4 weeks as needed, up to a maximum of 80 mg p er day.  \n\u25cf Common side -effects include GI upset, headaches, insomnia, and disturbances of the \nmenstrual cycle. These usually resolve after 1 -2 weeks of continued use.  \n\u25cf Full effect is not achieved until around 4 weeks of continued use. Once symptoms of \ndepres sion resolve, antidepressants should be continued for at least another 6 months.  \n\u25cf If/when the patient is ready to discontinue antidepressant therapy it should be discontinued \nas a weekly taper (e.g., if the maintenance dose is 60mg then taper to 40mg, then 30mg, then \n20mg, then 10mg and then stop), with close monitoring for recurrence of symptoms.", "start_char_idx": 3, "end_char_idx": 2226, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "36cf411f-8df0-4210-96ee-3366eddf91f9": {"__data__": {"id_": "36cf411f-8df0-4210-96ee-3366eddf91f9", "embedding": null, "metadata": {"page_label": "90", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e3454f0b-9fd1-4b0d-add4-1ee51ad9686a", "node_type": "4", "metadata": {"page_label": "90", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9a428fac35192847cfedfea0904a7a9d09ebde338063044a8737ea0cf5b794ae", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1b9a9718-afc1-4034-84e8-154efeb371d2", "node_type": "1", "metadata": {"page_label": "89", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "78b73757040374ac59998f2ec0b56a73682243c847804eda32fa948bdb4e2d77", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b7030c1f-8986-424d-9db6-10cafc60510d", "node_type": "1", "metadata": {}, "hash": "24b1405309818642beaaad1b65426b03d262a7196681a0a0d706cb9bd869945b", "class_name": "RelatedNodeInfo"}}, "hash": "9364fb7d219dfcfed35bbc481193f085c7aec343f5389a972b15752e87718feb", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 28  4.6.2 Alcohol and Drug Use/Addiction  \nAlcohol and other drug use are common among the general population and among PLHIV. \nAlcohol and drug use can be a significant contributing factor to poor adherence and HIV \ntreatment failure.  \nAll adults and adolescents should be screened for alcohol and drug use before initiating ART and \nevery year using the following three questions:  \n\u25cf During the past 12 months, did you  drink any alcohol (more than a few sips)?  \n\u25cf During the past 12 months, did you smoke any marijuana?  \n\u25cf During the past 12 months, did you use anything else to get high?  \nPatients who answer \u201cyes\u201d to any of the questions above, and all patients with a detectable  viral \nload after 3 or more months on ART (whether or not they had achieved viral suppression in the \npast), should undergo a more thorough screening.  \nFor adolescents, use the CRAFFT screening tool (Table 4.1 6). For adults, use the CAGE -AID \nscreening tool (Table 4.1 7). Anyone who screens positive on these tools should have further \nassessment and management by clinical staff, ideally with experience in managing alcohol and \ndrug use disorders. Table 4.1 8 gives some general guidance on management of addictions . The \nNational Protocol for Treatment of Substance Use Disorders in Kenya provides more in -depth \nguidance.   \nTable 4.1 6: CRAFFT Screening Interview for Adolescents  \nCRAFFT Screening for Alcohol and Drug Use Disorders for Adolescents  \nAsk the patient the six questions below. Each question requires a yes/no response. Answering Yes to two \nor more questions indicates an alcohol or drug use problem and requires further assessment and \nmanagement.  \n\u201cI\u2019m going to ask you a few questions that I ask all my patients . Please be honest. I will keep your \nanswers confidential\u201d  \nQuestion  No Yes \n1. Have you ever ridden in a Car driven by someone (including yourself) \nwho was \u201chigh\u201d or had been using alcohol or drugs?    \n2. Do you ever use alcohol or drugs to Relax, feel better about yourself, or \nfit in?    \n3. Do you ever use Alcohol or drugs while you are alone?    \n4. Do you ever Forget things you did while using alcohol or drugs?    \n5. Do your Family or Friends ever tell you that you should cut down on \nyour drinking or drug use?    \n6. Have you ever gotten into Trouble while you were using alcohol or \ndrugs?", "start_char_idx": 3, "end_char_idx": 2404, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b7030c1f-8986-424d-9db6-10cafc60510d": {"__data__": {"id_": "b7030c1f-8986-424d-9db6-10cafc60510d", "embedding": null, "metadata": {"page_label": "91", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c636c290-7908-4e46-a13d-56a214ecb152", "node_type": "4", "metadata": {"page_label": "91", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9941442282484936a4d5640eb58b43548bca83340aeca8435b23a6970d96bdb3", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "36cf411f-8df0-4210-96ee-3366eddf91f9", "node_type": "1", "metadata": {"page_label": "90", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9364fb7d219dfcfed35bbc481193f085c7aec343f5389a972b15752e87718feb", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "403ae046-b771-40c8-b05b-13289bb10290", "node_type": "1", "metadata": {}, "hash": "852b896f3e5ecdba13a438a3655df4de832d7c669068ccdf65a1b3f983ec2149", "class_name": "RelatedNodeInfo"}}, "hash": "24b1405309818642beaaad1b65426b03d262a7196681a0a0d706cb9bd869945b", "text": "Standard Package of Care for PLHIV  \n4 - 29  Table 4.1 7: CAGE -AID Screening Questions for Adults  \nCAGE -AID Screening for Alcohol and Drug Use Disorders for Adults  \nAsk the patient the four questions below. Each question requires a yes/no response. Answering Yes to two \nor more questions indicates an alcohol or drug use problem and requires further assessment and \nmanagement.  \n\u201cI\u2019m going to ask you a few questions that I ask all my patients. Please be honest. I will keep your \nanswers confidential\u201d  \nQuestion  No Yes \n1. Have you felt you should Cut down on your drinking or drug use?    \n2. Have people ever Annoyed you by criticizing your drinking or drug use?    \n3. Have you ever felt bad or Guilty about your drinking or drug use?    \n4. Have you ever had a drink or used drugs first thing in the morning to \nsteady your nerves or to get rid of a hangover ( Eye opener)?    \nIf referral to the mental health team is not immediately possible for those who screen positive, or as a \nstarting point in supporting a patient while referral is being made, an assessment of whether the patient \nwants to quit and targeted messages/support based on their stage of quitting may be benefi cial (Table \n4.17). The National Protocol for Treatment of Substance Use Disorders in Kenya provides additional \nresources for assessments and interventions.", "start_char_idx": 3, "end_char_idx": 1355, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "403ae046-b771-40c8-b05b-13289bb10290": {"__data__": {"id_": "403ae046-b771-40c8-b05b-13289bb10290", "embedding": null, "metadata": {"page_label": "92", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "037de8a2-f9a7-448b-bcd8-b7a502bf12b6", "node_type": "4", "metadata": {"page_label": "92", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5c47c000b8e5811504544240acf02725c759f2f71a818b74be3d6097c6d16d4d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b7030c1f-8986-424d-9db6-10cafc60510d", "node_type": "1", "metadata": {"page_label": "91", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "24b1405309818642beaaad1b65426b03d262a7196681a0a0d706cb9bd869945b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ee180fda-097a-4a67-9739-bb9fb4186e8a", "node_type": "1", "metadata": {}, "hash": "4b34032dfec5c90c5688efc952490565df6222bad3014ef0a0cf45636b688e78", "class_name": "RelatedNodeInfo"}}, "hash": "852b896f3e5ecdba13a438a3655df4de832d7c669068ccdf65a1b3f983ec2149", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 30  Table 4.1 8: Addiction Support Based on Stages of Change  \nStage of Change  Counselling Approach  \nPre-contemplation: not \ncurrently considering \nquitting; no immediate \ndesire to quit  \u25cf Acknowledge that not everyone is ready to think about quitting  \n\u25cf Clarify that it is their decision  \n\u25cf Listen to them describe the benefits they get from their alcohol or drug \nuse (their motivation for continuing to use)  \n\u25cf Explore why other people might think it is a good idea to quit  \nContemplation: not sure if \nhe/she wants to quit, or \nthinking about quitting but \nwith no immediate plan to \nquit  \u25cf Acknowledge that not everyone is ready to quite immediately  \n\u25cf Clarify that it is their decision  \n\u25cf Listen to them describe the benefits they get from the alcohol or drug use \n(their motivation for continuing to use)  \n\u25cf Listen to them describe the negative effects o f their alcohol or drug use \n(their motivation for considering quitting)  \n\u25cf Discuss any ideas they have on how they could go about quitting  \nPreparation: would like to \nquit within the next month  \u25cf Congratulate them on their decision to quit  \n\u25cf Listen to them describe the benefits they expect to get from quitting  \n\u25cf Discuss any plan they have to try quitting  \n\u25cf Discuss the challenges they may face with quitting  \n\u25cf Problem -solve with them on overcoming challenges, including identifying \nsupport systems  \n\u25cf Encourage small ste ps towards quitting (e.g., avoiding situations that \ntrigger use)  \n\u25cf Acknowledge that they have the strength to succeed  \nAction: actively trying to \nquit, or has recently quit \n(within past 6 months)  \u25cf Listen to their experience with quitting  \n\u25cf Congratulate them on the steps they have taken so far  \n\u25cf Problem -solve with them on overcoming challenges, including identifying \nsupport systems  \n\u25cf Review the long -term benefits of quitting  \nMaintenance: has quit (more \nthan 6 months ago) and \nwants to remain abstinent  \u25cf Congratulate them on their success so far  \n\u25cf Discuss potential for relapse and how to deal with it  \n\u25cf Review the long -term benefits of maintaining abstinence from drug or \nalcohol use  \nRelapse  \u25cf Acknowledge that relapse is common  \n\u25cf Evaluate what triggered the relapse  \n\u25cf Reassess motivation to quit and barriers to quitting  \n\u25cf Problem -solve with them on overcoming challenges and what additional \nsupport systems and strategies can be used  \nAs indicated in the introduction of this section on mental health (Section 4.6), the following are \nkey areas of concern in mental ill health and there needs to be a high index of suspicion in order \nto identify these often -debilitating conditions that negatively affect an individual\u2019s ability to cope \nwith the tasks  of daily living. The last to items in this section contribute towards building \nresilience which positively affects an individual\u2019s mental health enabling them to positively \ninteract with their environments   and live more meaningful lives.", "start_char_idx": 3, "end_char_idx": 3016, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ee180fda-097a-4a67-9739-bb9fb4186e8a": {"__data__": {"id_": "ee180fda-097a-4a67-9739-bb9fb4186e8a", "embedding": null, "metadata": {"page_label": "93", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8c216560-9cdf-4b3a-b026-350c1baf80c7", "node_type": "4", "metadata": {"page_label": "93", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "85bb6d979067c705396546f2dd8ed1e4a4e812cc83655b8aa9b3869015f23edc", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "403ae046-b771-40c8-b05b-13289bb10290", "node_type": "1", "metadata": {"page_label": "92", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "852b896f3e5ecdba13a438a3655df4de832d7c669068ccdf65a1b3f983ec2149", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f415ceae-de30-48a3-84aa-6d2cd6cee43f", "node_type": "1", "metadata": {}, "hash": "40f616abfc187a902c6f7bbc831e5b5d25fcf301b68272be34a66a4bce74ea68", "class_name": "RelatedNodeInfo"}}, "hash": "4b34032dfec5c90c5688efc952490565df6222bad3014ef0a0cf45636b688e78", "text": "Standard Package of Care for PLHIV  \n4 - 31  4.6.3 Anxiety  \nAnxiety and other anxiety related disorders are mental health conditions that are often \ncharacterized by experiences of one or several of the following:  \n\u2212 Feelings of nervousness  \n\u2212 Fear, or worry that interfere with the ability to sleep or otherwise function  \n\u2212 A lack of appetite  \n\u2212 Tremulousness and or frank trembling  \n\u2212 Sweating and clamminess  of hands  \n\u2212 Other symptoms may include a racing heart (rapid heartbeat ), difficulty breathing,  \nheadaches, difficulty falling asleep, and difficulty concentrating.  \nConcerns around anxiety, especially within the context of living with HIV or caring for persons \nliving with HIV may reveal themselves during the history taking. These manifestations need to be \ntaken seriously and addressed with sincerity and compassion.  \nMany of these may require basic reassurance and support or even just a listening ear during the \nevaluation session. These will go a long way in alleviating many patient\u2019s anxieties and conc erns. \nA quick screening tool can be used to assess whether the anxiety demonstrated or identified may \nrequire further attention.  \nThe Generalized Anxiety Disorder Assessment (GAD -7) is a seven -item instrument that is used to \nmeasure or assess the severity of generalized anxiety disorder (GAD). Each item asks the \nindividual to rate the severity of his or her symptoms over the past two weeks.", "start_char_idx": 3, "end_char_idx": 1439, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f415ceae-de30-48a3-84aa-6d2cd6cee43f": {"__data__": {"id_": "f415ceae-de30-48a3-84aa-6d2cd6cee43f", "embedding": null, "metadata": {"page_label": "94", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a8643865-6fb1-419a-bce8-f2e6b2cf554c", "node_type": "4", "metadata": {"page_label": "94", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0e301a4f02fe5433870284f75db5399145cd79e31c3904dbcfd912f92f2e2046", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ee180fda-097a-4a67-9739-bb9fb4186e8a", "node_type": "1", "metadata": {"page_label": "93", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4b34032dfec5c90c5688efc952490565df6222bad3014ef0a0cf45636b688e78", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e6a0b7ec-cd24-44fb-a05b-9a393ed708b5", "node_type": "1", "metadata": {}, "hash": "06ab2b6510e940d321a6ad5620135c56b950c464088e060f624cf02a73d1737b", "class_name": "RelatedNodeInfo"}}, "hash": "40f616abfc187a902c6f7bbc831e5b5d25fcf301b68272be34a66a4bce74ea68", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 32  \nOver the last 2 weeks,  how \noften have you been bothered \nby the following problemsNot at all Several daysMore than half \nthe daysNearly every \nday\n1. Feeling nervous, anxious or \non edge\n2. Not being able to stop or \ncontrol worrying\n3. Worrying too much about \ndifferent things\n4. Trouble Relaxing\n5. Being so restless that it is \nhard to sit still\n6. Becoming easily annoyed or \nirritable\n7. Feeling afraid as if \nsomething awful might \nhappen\n0 +1 +2 +3\n0 +1 +2 +3\n0 +1 +2 +3\n0 +1 +2 +3\n0 +1 +2 +3\n0 +1 +2 +3\n0 +1 +2 +3 \nFigure 4.2: Generalized Anxiety Disorder Assessment (GAD -7) \nThe following cut -offs correla te with level of anxiety severity:  \n\u2022 Score 0 -4: Minimal Anxiety  \n\u2022 Score 5 -9: Mild Anxiety  \n\u2022 Score 10 -14: Moderate Anxiety  \n\u2022 Score greater than 15: Severe Anxiety  \nTreatment options can then be explored including referral to psychologists, psychiatrists for \npossible  psychotherapy and medication if required  \n4.6.4 Stress and stress management  \nThis is a feeling of emotional or physical tension. The symptoms include ache and pains, \npalpitations, exhaustion, insomnia, headache,  dizziness or shaking, digestive problems, we ak \nimmune system, muscles tension or jaw tension.  \nMany patients may experience these symptoms individually or in clusters and they interfere with \nthe lives they are living. Sources of stress may be from difficulties in understanding issues around \nHIV, from  addressing different concerns within themselves, from their significant others, from", "start_char_idx": 3, "end_char_idx": 1575, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e6a0b7ec-cd24-44fb-a05b-9a393ed708b5": {"__data__": {"id_": "e6a0b7ec-cd24-44fb-a05b-9a393ed708b5", "embedding": null, "metadata": {"page_label": "95", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "90864ef5-8036-4ebd-ba78-8289d0af4da8", "node_type": "4", "metadata": {"page_label": "95", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b521b5f9ee8df9ef204c20dbeae2b4ccb5a4341b6052a606d8d5d10dd928e4e1", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f415ceae-de30-48a3-84aa-6d2cd6cee43f", "node_type": "1", "metadata": {"page_label": "94", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "40f616abfc187a902c6f7bbc831e5b5d25fcf301b68272be34a66a4bce74ea68", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ce4b1fa0-632a-46b5-a59c-a8f4d1ffb803", "node_type": "1", "metadata": {}, "hash": "6117520c3fbfa4751d253692a8a74d4cb45c6c217ef314307364d4f64c8cee68", "class_name": "RelatedNodeInfo"}}, "hash": "06ab2b6510e940d321a6ad5620135c56b950c464088e060f624cf02a73d1737b", "text": "Standard Package of Care for PLHIV  \n4 - 33  their workplaces. These issues could be social, financial or environmental concerns and may be \nsevere enough to negatively impact their lives. The stress may be so severe  as to be observed by \nanyone interacting with the individual and may manifest in their behaviour and the symptoms \nthey complain about. It is important for the health care worker to be calm, and assured as they \naddress the patient\u2019s concerns around stress. Further, a  screening tool can be used to assess the \nneed for referral to more specialized mental health workers to provide much needed support.  \n4.6.5 experiences of Trauma  \nTrauma results from exposure to an incident or series of events that are emotionally disturbing \nor life -threatening with lasting adverse effects on the individual\u2019s functioning and mental, \nphysical, social, emotional, and/or spiritual well -being. Past traumatic experiences in PLHIV must \nbe addressed for their wellbeing.  \nAssessi ng for Trauma - Primary Care PTSD Screen for DSM -5 (PC -PTSD -5) \nThe Primary Care PTSD Screen for DSM -5 (PC -PTSD -5) is a screening tool designed to identify \npersons with probable PTSD. Results of the screening should be considered \"positive\" if the \nrespondent  answers \"yes\" to any 3 items in the questions listed below. Those screening positive \nshould have further assessment with a structured interview for PTSD, preferably performed by a \nmental health professional who has experience in diagnosing PTSD.  \n\u201cSometim es things happen to people that are unusually or especially frightening, horrible, or \ntraumatic. \u201d For example:  \n1. A serious accident or fire  \n2. A physical or sexual assault or abuse  \n3. An earthquake or flood  \n4. A war  \n5. Seeing someone be killed or seriously injured  \n7. Having a loved one die through homicide or suicide  \n\u201cIf you have ever experienced this type of event, please answer the following in the past month, \nhave you \u201d \n\u2022 Had nightmares about the event(s) or thought about the event(s) when you did not want \nto? \n\u2022 Tried hard not to think about the event(s) or went out of your way to avoid situations that \nreminded you of the event(s)?  \n\u2022 Been constantly on guard, watchful, or easily startled?  \n\u2022 Felt numb or detached from people, activities, or your surroundings?  \n\u2022 Felt guil ty or unable to stop blaming yourself or others for the events(s) or any problems \nthe event(s) may have caused?", "start_char_idx": 3, "end_char_idx": 2445, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ce4b1fa0-632a-46b5-a59c-a8f4d1ffb803": {"__data__": {"id_": "ce4b1fa0-632a-46b5-a59c-a8f4d1ffb803", "embedding": null, "metadata": {"page_label": "96", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e41184d3-1c75-448d-8467-d3ee0eb6e062", "node_type": "4", "metadata": {"page_label": "96", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fb3e83e3ae9a804797844cda68e9835028cceae99c27532e852ddabcc8495d36", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e6a0b7ec-cd24-44fb-a05b-9a393ed708b5", "node_type": "1", "metadata": {"page_label": "95", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "06ab2b6510e940d321a6ad5620135c56b950c464088e060f624cf02a73d1737b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "aef2f1bb-bfb7-4a3b-8fab-5e75a8accb41", "node_type": "1", "metadata": {}, "hash": "0321d70e4350676d7a8168394d29eeab8075bf76b4bb6893df6105b9d5feed11", "class_name": "RelatedNodeInfo"}}, "hash": "6117520c3fbfa4751d253692a8a74d4cb45c6c217ef314307364d4f64c8cee68", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 34  4.6.6 Psychosis  \nPsychosis is a mental disorder characterized by a disconnection from reality.  \nPsychosis may occur as a result of a psychiatri c illness such as schizophrenia. In other instances, \nit may be caused by a health condition, medication or drug use.  \nSigns and Symptoms of psychosis  \n\u2022 Marked behavioural changes  \n\u2022 Neglecting usual responsibilities related to work, school, domestic or social activities  \n\u2022 Agitated, aggressive behaviour, decreased or increased activity  \n\u2022 Fixed false beliefs not shared by others in the person\u2019s culture  \n\u2022 Hearing voices or seeing things that are not there  \n\u2022 Lack of realization that one is having mental health problems  \nTreatment may include medication and talk therapy.  \n4.6.7 Self -Care  \nOverall, in the context of mental health, taking up self -care strategies will help individuals live \nboth more responsibly, and more satisfactorily as this helps boost both physical and mental \nhealth.  \nSelf-care strategies include the following;  \n\u2212 Getting regular exercise  \n\u2212 Eating healthy, regular meals and staying well hydrated  \n\u2212 Making sleep a priority. Many people struggle with this but just getting regular sleep with \na constant waking and sleeping time contribute tremendously to good self-care  as well as \ngood, well rested physical and mental health  \n\u2212 Taking up a relaxing activity  \n\u2212 Setting goals and priorities.  \nThis allows for being realistic in one\u2019s expectation in life and formulat ing realistic strategies to \nachieve one\u2019s goals  \nPracticing gratitude  \nReminding oneself that things that one is grateful for. The more specific one is, the easier it is to \neven be grateful for them. Listing them down is a good way of getting such clarity  \nFocusing on positivity  \nThe calls for appreciating the good and positive things that have happened, are going on and are \nplanned for in one\u2019s life. The things to look forward to. This strategy also calls for the identification \nand challenging of negative and unhelpful thoughts. Good friends and counsellors, as well as other \nhealth workers with mental health skills can assist in this.", "start_char_idx": 3, "end_char_idx": 2186, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "aef2f1bb-bfb7-4a3b-8fab-5e75a8accb41": {"__data__": {"id_": "aef2f1bb-bfb7-4a3b-8fab-5e75a8accb41", "embedding": null, "metadata": {"page_label": "97", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "301c7782-a403-4e48-8fa6-e95a78e356d2", "node_type": "4", "metadata": {"page_label": "97", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a7119bb86505264e4841998029dc715c5a071098cf69963c87c58f99139bdd0d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ce4b1fa0-632a-46b5-a59c-a8f4d1ffb803", "node_type": "1", "metadata": {"page_label": "96", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6117520c3fbfa4751d253692a8a74d4cb45c6c217ef314307364d4f64c8cee68", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ed76a09d-2bbb-452d-b861-5fe0f0951543", "node_type": "1", "metadata": {}, "hash": "b286bae7207087309a7ab7ce7253c4fc5d2b00259d59184c9998a5d779025722", "class_name": "RelatedNodeInfo"}}, "hash": "0321d70e4350676d7a8168394d29eeab8075bf76b4bb6893df6105b9d5feed11", "text": "Standard Package of Care for PLHIV  \n4 - 35  Staying connected  \nThis is extremely important. Increasingly in the present world disconnection is leading to more \nand more phy sical and mental ill health. Staying connected with family and friends as well as \nspiritual support systems enable  one to better manage their lives as they work towards being as \nmentally healthy as possible.  \n4.6.8 Wellbeing  \nAccording to the WHO, mental hea lth is a state of well -being in which an individual realizes his or \nher own abilities, can cope with the normal stresses of life, can work productively and is able to \nmake a contribution to his or her community.  \nSupport structures for wellbeing:  \nThe suppor t structures for wellbeing are available at different levels of implementation which are:  \n\u2022 Individual counselling  \n\u2022 Group therapy  \n\u2022 Networks of organizations providing support to different categories of populations in \ndifferent age sets such as adolescents, me n, women etc.  \nHealth workers in facilities should take the initiative to set up/ maintain these structures and \nestablish referral systems for clients in need of these services. Referral for PLHIV should include \nservices that address issues that potentially could affect the mental health of PLHIV such as social \nand financial issues.", "start_char_idx": 3, "end_char_idx": 1313, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ed76a09d-2bbb-452d-b861-5fe0f0951543": {"__data__": {"id_": "ed76a09d-2bbb-452d-b861-5fe0f0951543", "embedding": null, "metadata": {"page_label": "98", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1bedd1c2-269b-4b39-affe-2a469272da9f", "node_type": "4", "metadata": {"page_label": "98", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6f14eaaf0022fc407b6fbf98cd4f7b53df7060329bb6c3bb37d99e47099f5b88", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "aef2f1bb-bfb7-4a3b-8fab-5e75a8accb41", "node_type": "1", "metadata": {"page_label": "97", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0321d70e4350676d7a8168394d29eeab8075bf76b4bb6893df6105b9d5feed11", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b8c1d723-4902-46fb-8911-08f947403d79", "node_type": "1", "metadata": {}, "hash": "8aeaa36745b35910e48ffe3dcb637f9cef97dd21c4d3f22266bc8d65ca4b99ce", "class_name": "RelatedNodeInfo"}}, "hash": "b286bae7207087309a7ab7ce7253c4fc5d2b00259d59184c9998a5d779025722", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 36  4.7 Nutritional Services  \nGood nutrition is a critical component of management of HIV because it contributes to: reducing \nrisk and frequency of other infections; delaying progression from HIV infection to AIDS; a healthy \nappearance and weight; gaining strength, maintaining and building muscle, and having energy to \nremain active, and reducing side effects of ART.  \n4.7.1 Nutritional Assessment, Counselling  and Support (NACS)  \nAll PLHIV should receive nutritional assessment, counselling, and support  \nAll PLHIV should receive nutritional assessment, counselling, and support tailored to the \nindividual needs of the patients, including:  \n\u25cf Nutrition assessment and diagnosis (timed with routine clinic visits, preferably monthly for \nthe first year of life, and then quarterly up to 14 years old, and then every 3 -6 months)  \no Anthropometric (Tables 4.1 9, 4.20 and 4.2 1 provide interpretation and required acti ons \nfor anthropometric results for children and adults)  \no Biochemical (investigations as listed in Table 3.2 for baseline and Table 3.5 for follow -up \ninvestigations)  \no Clinical (physical examination as described in Table 3.1 for initial evaluation)  \no Dietary (24 -hour recall for food type/frequency and household food security)  \no Environmental and psychosocial  \no Functional (ability to care for self, bedridden, etc.)  \n\u25cf Counselling and education  \no Benefits of maintaining good nutritional status for a person living with HIV \no Mother infant and young child nutrition (MIYCN) including exclusive breastfeeding  \no Reassuring the client that it is possible to  \no Attain/maintain good nutritional status  \no Look well and live a healthy life  \no Identifying locally available foods they can access given their own context, food safety \nand food preparation  \no Helping the client to plan meals and snacks with a variety of foods in order to meet their \nenergy and nutrient needs and treatment plans  \no Identifying any constraints, the client may face and f ind ways to minimize them  \no Helping the client to understand the potential side effects and food interactions of the \nmedicines they are taking, and help the client identify ways to manage these side effects  \no Exploring with the client the cause(s) of poor appetite and appropriate responses (type \nof food, disease, pain, depression, anxiety, or side effects of medications)  \no Counsel on critical nutrition practices  \nMessages: Critical Nutrition Practices (CNPs)  \n1. Have periodic nutritional status assessments  \n2. Increase energy intake through a balanced diet  \n3. Maintain high levels of sanitation and food hygiene  \n4. Practice positive living behaviors  \n5. Carry out physical activity or exercises  \n6. Drink plenty of clean, safe water  \n7. Seek prompt treat ment for all opportunistic infections and manage diet -related symptoms  \n8. Manage drug -food interactions and side effects", "start_char_idx": 3, "end_char_idx": 2969, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b8c1d723-4902-46fb-8911-08f947403d79": {"__data__": {"id_": "b8c1d723-4902-46fb-8911-08f947403d79", "embedding": null, "metadata": {"page_label": "99", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6b77ab7a-2607-4b98-99eb-1e8e6326799e", "node_type": "4", "metadata": {"page_label": "99", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d83a3fa9edbb731eecc7794939870d8a897af881d11ec9548b2d8cd6248e9a9c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ed76a09d-2bbb-452d-b861-5fe0f0951543", "node_type": "1", "metadata": {"page_label": "98", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b286bae7207087309a7ab7ce7253c4fc5d2b00259d59184c9998a5d779025722", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b6a1ab8f-bf53-4102-a9ef-a13ce652e8de", "node_type": "1", "metadata": {}, "hash": "619f61dc1f4e8540511c5a3e743cd8e993a47345386bdecdee5dd5990917341c", "class_name": "RelatedNodeInfo"}}, "hash": "8aeaa36745b35910e48ffe3dcb637f9cef97dd21c4d3f22266bc8d65ca4b99ce", "text": "Standard Package of Care for PLHIV  \n4 - 37  Support  \no Therapeutic and supplementary foods to treat clinical malnutrition (food by prescription, \ntherapeutic feeds, fortified blended flour): Figures 4. 3 and 4. 4 provide malnutrition \nmanagement recommendations for adults and children; Table 4. 10 provides specific \nnutritional recommendations for patients with non -communicable diseases  \no Exclusive breastfeeding for the first 6 months of life; complementary foods for children \naged 6 - 24 months with continued breastfeeding to prevent malnutrition (Table 7.7 \nprovides complementary feeding recommendations)  \no Micronutrient supplements to prevent vitamin and mineral deficiencie s \no Food security and linkage to HIV sensitive social protection such as household food \nsupport, home -based care, agricultural extension services, and economic strengthening \nand livelihood support  \nSome aspects of nutrition support (such as prescription of th erapeutic and supplementary foods) \nshould be provided by a trained healthcare professional, however all aspects should be promoted \nand supported at the community level.  \nTable 4.1 9: Interpretation of MUAC Results for Children and Pregnant/Lactating Women  \nMUAC Level by Age (cm)  Classification  Action to Take  \n6-59 \nmonths  5-9 yrs.  10-17 yrs.  \n< 11.5  < 13.5  < 14.5 cm  Severe acute \nmalnutrition  Irrespective of clinical signs, admission \n(referral) for stabilization/therapeutic \nrehabilitation  \n11.5\u201312.5  13.5 -14.5  14.5 -18.5  Moderate acute \nmalnutrition  Admission for supplementary feeding is \nrecommended  \n12.6\u201313.5    Mild acute \nmalnutrition  Nutritional education and counselling  \n> 13.5    Normal  Education and counselling of caregivers  \nPregnant and Breastfeeding Women  \n\u2264 23  Malnourished  Provide nutritional support (Figure 4.3)  \n> 23  Normal  Education and counselling  \nTable 4. 20: Interpretation of Z -scores for Children  \nRatio  Indicator   Z-score  Severity  \nWeight/Age  Underweight  < - 3 Severe  \nHeight/Age  Stunting  - 3 to - 2 Moderate  \nWeight/Height  Wasting*  > - 2 to - 1 Mild  \n> - 1 Normal  \n*Children with weight/height z -score of -2 or less should be supported with therapeutic/supplementary \nfoods", "start_char_idx": 3, "end_char_idx": 2218, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b6a1ab8f-bf53-4102-a9ef-a13ce652e8de": {"__data__": {"id_": "b6a1ab8f-bf53-4102-a9ef-a13ce652e8de", "embedding": null, "metadata": {"page_label": "100", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c355d9eb-2ada-4265-a1bb-07ede05dfec3", "node_type": "4", "metadata": {"page_label": "100", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4d2ecd0a0f2e5bf05d6b8cd81f656da7476828c7adbd9f3ce5b4d6a3387bdd96", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b8c1d723-4902-46fb-8911-08f947403d79", "node_type": "1", "metadata": {"page_label": "99", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8aeaa36745b35910e48ffe3dcb637f9cef97dd21c4d3f22266bc8d65ca4b99ce", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "485e8073-2938-4bae-8a7c-09cfca0ac6d3", "node_type": "1", "metadata": {}, "hash": "d5b190750af853151ca3341c381736afa309c804c2a9b42cd5038dde2159d444", "class_name": "RelatedNodeInfo"}}, "hash": "619f61dc1f4e8540511c5a3e743cd8e993a47345386bdecdee5dd5990917341c", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n4 - 38   \nScreening\nMeasure  anthropometry and check bilateral\nPitting oedema\nMedical History and Physical examination:\n-  Evaluate nutritional status and health condition\n-  Check for medical complications\n-  Perform appetite test\nIf SAM without  medical \ncomplication and passed appetite \ntestIf SAM with  medical complication \nand/or failed  appetite test\nMedical complication developed, decreased \nappetite, weight loss or stagnant weight, \noedema increase or no decreaseAdmission to \nOutpatient careAdmission to \nInpatient care\nReferral for continuing treatment in out patient \ncare:\nAppetite returning (passed appetite test)\nOedema decreasing,\nMedical complication resolvingTreatment Treatment\nSAM Treatment completed (based on discharge criteria):\nDischarge to home or refer for supplementary feeding and other services\n that address underlying causes of malnutritionTREATMENTADMISSION\n \nFigure 4. 3: Management of Severe Acute Malnutrition in Children  \n Other medical complications that necessitate hospitalization  \nIn addition to severe bilateral pitting oedema (+++), marasmic \nkwashiorkor and poor appetite, the following complications \nnecessitate inpatient care:  \n\u2714 Intractable vomiting  \n\u2714 Convulsions  \n\u2714 Lethargy  \n\u2714 Unconsciousness  \n\u2714 Lower respiratory tract infection  \n\u2714 High fever  \n\u2714 Severe dehydration  \n\u2714 Severe anaemia  \n\u2714 Hypoglycaemia  \n\u2714 Hypothermia  \n\u2714 Eye signs of vitamin A deficiency  \n\u2714 Skin lesions  \nThe following complications require referral of patient for further \nmedical evaluation:  \n\u2714 No appetite (failed appetite test)  \n\u2714 IMCI danger signs  \n\u2714 Increase in or newly developed bilateral pitting oedema  \n\u2714 Weight loss because of diarrhoea (r e-feeding or of other \norigin)  \n\u2714 Weight loss for three consecutive weeks  \n\u2714 Static weight (no weight gain) for five consecutive weeks  \n\u2714 Other signs of failure to respond to treatment", "start_char_idx": 3, "end_char_idx": 1932, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "485e8073-2938-4bae-8a7c-09cfca0ac6d3": {"__data__": {"id_": "485e8073-2938-4bae-8a7c-09cfca0ac6d3", "embedding": null, "metadata": {"page_label": "101", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "81f7f192-e154-4092-beb0-2bd6db8ee505", "node_type": "4", "metadata": {"page_label": "101", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3135f1854b7eb80b44e4d43f6f091a46e35d079271db2bdfb9ea8040899ad80f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b6a1ab8f-bf53-4102-a9ef-a13ce652e8de", "node_type": "1", "metadata": {"page_label": "100", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "619f61dc1f4e8540511c5a3e743cd8e993a47345386bdecdee5dd5990917341c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "11b7c0f1-3381-4a56-af5a-f46490c9a06a", "node_type": "1", "metadata": {}, "hash": "143ac295a466f8ed68b1690575981c51e19f4a7517c7eac6124543c5bdd614b3", "class_name": "RelatedNodeInfo"}}, "hash": "d5b190750af853151ca3341c381736afa309c804c2a9b42cd5038dde2159d444", "text": "Standard Package of Care for PLHIV  \n 4 - 39 \nA. Weight loss score\n<5% \u2013 Low Risk\n5-10% \u2013 Moderate Risk\n>10% \u2013 High RiskUnplanned % weight loss in the last 1 -3mnthsB. Opportunistic Infections score\nNo opportunistic infection\nSub acute OI \u2013 Moderate Risk\nAcute OI \u2013 High RiskOpportunistic infections statusC. Food intake score\nAdequate Intake\nLow intake \u2013 Moderate Intake\nNausea/Vomiting Non/Fasted \nfor >5 days \u2013 High RiskFood Intake/barriersD. Food Security score\nLittle or No H/H Hunger = 0 -1\nModerate H/H Hunger= 2 -3 (High Risk)\nSevere H/H Hunger= 4 -6 (High Risk)Household hunger score a\nPregnant & Postpartum women\nMUAC (cm)<19\n(SAM)\n19.0 - 20.9\n(MAM)\n21.0 - 23.1\n(HIGH \nRISK)\n>23.1\n(NORMAL)Nutritional anemia (Hb < 11g/dl) \u2013 \ndeficiency  of iron, folate, Vit. B12;\nBitot spots due to Vitamin A \ndeficiency; Pellagra due to vitamin \nB1 deficiencyMicronutrient deficiency/diseases Other Adults\nBMI (Kg/m2) b< 16\n(SAM)\n16 \u2013 18.5\n(MAM)\n18.6 - 21.9\n(HIGH \nRISK)\n22 \u2013 24. \n(NORMAL)\nSEVERE MALNUTRITION (SAM)\nSAM with medical complications \nand cannot eat ( Clinical status or \nfailed appetite test)\nActions  c\ni. Initiate Phase I therapeutic \nfeeding until stable (Inpatient \u2013 \nrescue phase feeding)Clinically stable, able to eat and \ngood appetite\nActions  c\n i.  Initiate Phase II therapeutic \nfeeding for nutritional \nreconstitution\nii.  Nutrition counselling & \neducation\niii.  Review (in or out patients) \nweekly\niv.  Transition to supplemental \nfeeding upon recovery from \nSAMActions  c\ni. Nutrition counselling & \neducation\nii. Initiate supplemental \nfeeding\niii.  Multiple micronutrient \nsupplementation\niv.  Review monthly\nv.  Post -discharge review every \n2-3monthsMODERATE MALNUTRITION \n(MAM)\nActions  c\ni.  Nutrition \ncounselling & \neducation\nii.  Repeat nutrition \nscreening every 2 -3 \nmonthsNORMAL/LOW RISK\nActions  c\ni.   Nutrition counselling & \neducation\nii.   Multiple micronutrient \nsupplementation\niii.   Review nutrition status \nand risk factors every \n2-4 weeks until stable\niv.  Repeat nutrition \nscreening every 2 -3 \nmonths once stable\n v.  For pregnant or \npostpartum mothers \nenroll on FBPNORMAL/HIGH RISK\nRefer food insecure \nclients for livelihood\na Refer to household food security assessment tool\nb For overweight and obese, refer for counselling\nc Implement local clinical policy and protocol\nNUTRITIONAL \nINTERVENTIONSNUTRITIONAL \nDAIGNOSISNUTRITIONAL \nASSESSMENT\nRefer non responders for \nfurther clinical assessment \nand management \nFigure 4. 4: Management of Malnutrition in Adults with HIV", "start_char_idx": 1, "end_char_idx": 2531, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "11b7c0f1-3381-4a56-af5a-f46490c9a06a": {"__data__": {"id_": "11b7c0f1-3381-4a56-af5a-f46490c9a06a", "embedding": null, "metadata": {"page_label": "102", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f246d058-a62c-47bb-822a-0831b3fdb7a5", "node_type": "4", "metadata": {"page_label": "102", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2c163be4ecff6384ed63acb14f2e18baa66a66df235957f51df1211588f3cdac", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "485e8073-2938-4bae-8a7c-09cfca0ac6d3", "node_type": "1", "metadata": {"page_label": "101", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d5b190750af853151ca3341c381736afa309c804c2a9b42cd5038dde2159d444", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9e80364c-4e3a-4d03-8ecb-a299f3368ac1", "node_type": "1", "metadata": {}, "hash": "09390d93e29ad065c4eca06c076745cab4fa69b76a28abd7166aee9e34830fa0", "class_name": "RelatedNodeInfo"}}, "hash": "143ac295a466f8ed68b1690575981c51e19f4a7517c7eac6124543c5bdd614b3", "text": "Guidelines on Use of Antiretroviral Drugs for Tre ating and Preventing HIV Infection in Kenya  \n \n4 - 40 Table 4.2 1: Interpretation of BMI Results for Adults  \nBMI Level  Classification  Action to Take  \n< 16 Severe \nmalnutrition  \u2022 Refer for facility -based therapeutic intervention; rehabilitation with \ntherapeutic foods; counselling on intake issues and possible metabolic issues  \n\u2022 Screen for TB  \n16.0 \u201318.4 Mild/moderate \nmalnutrition  \u25cf Nutritional counselling and supplementary feeding  \n\u25cf Screen for TB  \n18.5 \u201325.0 Normal/ \nrecommended  Nutritional counselling, consistent exercise to build muscles  \n25.1 \u201330 Overweight  Nutritional counselling to reduce energy intake; aerobic physical activity to \nreduce weight  \n>30 Obese  Counselling to change lifestyle and reduce energy intake; aerobic physical activity \nto reduce weight  \n4.8 Prevention of Other Infections  \n4.8.1 Immunizations  \nAll children, regardless of HIV status, should be immunized following the full KEPI schedule, \nwith a few exceptions for infants with severe immunosup pression (Table 4.2 2). For infants \nliving with HIV and HEIs, an earlier dose of measles vaccines should be given at 6 months of age.  \nTable 4.2 2: Kenya Expanded Program on Immunizations 2016 Schedule  \nAge  Vaccines  \nBirth  OPV1, BCG2 \n6 weeks  OPV3, Pentavalent (DPT -HepB -HiB), Pneumococcal (PCV10), Rotavirus  \n10 weeks  OPV3, Pentavalent (DPT -HepB -HiB), Pneumococcal (PCV10), Rotavirus  \n14 weeks  IPV, Pentavalent (DPT -HepB -HiB), Pneumococcal (PCV10)  \n6 months  Measles/Rubella (MR) - for HIV exposed and infected infants; Vitamin A  \n9 months  Measles/Rubella (MR); Vitamin A; Yellow Fever4 \n18 months  Measles/Rubella (MR); Vitamin A  \n10 years (girls only)  HPV (2 doses at 6 months apart in the general population; 3 doses for \nPLHIV, at month 0, 1 -2, and 6)  \n11-12 years  Tdap (tetanus, diphtheria and pertussis)  \n1Give OPV to all infants at birth or within the first two weeks of life. If missed in the neonatal period and the child \nhas symptoms of advanced HIV disease (WHO Stage 3 or 4) or severe immunosuppressio n (CD4% < 25%) then \ndefer BCG until virally suppressed on ART and with immune system recovery  \n2Give BCG to all infants at birth or within the first two weeks of life. If missed in the neonatal period and the child \nhas symptoms of advanced HIV disease (WHO Stage 3 or 4) or severe immunosuppression (CD4% < 25%) then \ndefer BCG until virally suppressed on ART and with immune system recovery . Do not give BCG vaccine to babies \nborn to smear positive mothers. Investigate to rule out TB, give TPT then vaccination d one two weeks after \ncompletion of TPT  \n3If HIV+ with symptoms of advanced HIV disease (WHO Stage 3 or 4) or severe immunosuppression (CD4% < 25%) \nthen use IPV instead of OPV  \n4Yellow fever vaccine is only routinely used in certain counties as specified by National Vaccines and Immunization \nProgram; defer yellow fever vaccine if symptoms of advanced HIV disease (WHO Stage 3 or 4) or severe \nimmunosuppression (CD4% < 25%), until virally suppressed on ART and with immune system recovery", "start_char_idx": 3, "end_char_idx": 3113, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9e80364c-4e3a-4d03-8ecb-a299f3368ac1": {"__data__": {"id_": "9e80364c-4e3a-4d03-8ecb-a299f3368ac1", "embedding": null, "metadata": {"page_label": "103", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ab741490-9821-493a-87f4-135ab5b7f0cf", "node_type": "4", "metadata": {"page_label": "103", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "04b074a7c3f5b929a56a4eee5ba60d7ad1d1c6636db4f96715a24b28dcc424bf", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "11b7c0f1-3381-4a56-af5a-f46490c9a06a", "node_type": "1", "metadata": {"page_label": "102", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "143ac295a466f8ed68b1690575981c51e19f4a7517c7eac6124543c5bdd614b3", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8d16c04e-dd1c-4c87-a7c7-966e42b6cc8d", "node_type": "1", "metadata": {}, "hash": "eb52eb1156572bcd5e3a2b3c98eab52fdf6f55ea28fad23378eeb43fbedb94e1", "class_name": "RelatedNodeInfo"}}, "hash": "09390d93e29ad065c4eca06c076745cab4fa69b76a28abd7166aee9e34830fa0", "text": "Standard Package of Care for PLHIV  \n4 - 41 PLHIV may have an inadequate response to immunizations, particularly before they achieve full \nviral suppression. The ideal timing, dose, and frequency of re -immunizations for children on ART \nare not well known. Providers will receive specific guidance or r evaccination from the National \nVaccines and Immunization Program and NASCOP.  \nRecommended vaccinations for adolescents and adults living with HIV are listed in Table 4.2 3. \nTable 4.2 3: Vaccinations in Adolescents and Adults Living with HIV  \nInfection  Vaccine  Live  \n(Y/N)  Course  Comments  \nCOVID -19 Various  N Variable  Follow national guidelines on dosing for the \nspecific vaccine available  \nHepatitis B  Subunit  N 4 doses (at  \n0, 1, 2 and 6 \nmonths)  Use double dose if non -adjuvanted; use standard \ndose if adjuvanted  \nPneumococcus  Conjugate  N 1 dose (PCV  \n13)  \nPreferable to polysaccharide  \nPolysaccharide  N 1 dose  Use if >65 years and with co -morbidity other \nthan HIV  \nHuman \nPapillomavirus \n(HPV)  Virus -like \nparticles   \nN 3 doses (at \nmonths 0, 1 -\n2, and 6)  All girls at 9 -14 years old  \nInfluenza  Inactivated  N 1 dose  Annually  \nHepatitis A  Inactivated  N 2 - 3 doses  3 doses if CD4 count < 350 cells/mm3 at 0, 1 and \n6 months. If CD4 count > 350 cells/mm3, give 2 \ndoses at 0 and 6 months. For those at continued \nrisk, one booster dose every 10 years  \nAdditional Vaccines for Special Circumstances  \nYellow fever  Live attenuated  Y 1 dose  Use only in patients <60 yrs of age and  CD4 > \n200 cells/mm3 \nTyphoid  Polysaccharide  N 1 dose  Give the ViCPS parenteral. Repeat every 3 years  \nCholera  Subunit  N 2 doses  As indicated (usually in epidemics). 2 oral doses \nof the non -replicating vaccine given 1 -6 weeks \napart with a single booster dose at 2 years from \nprimary vaccination", "start_char_idx": 3, "end_char_idx": 1843, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8d16c04e-dd1c-4c87-a7c7-966e42b6cc8d": {"__data__": {"id_": "8d16c04e-dd1c-4c87-a7c7-966e42b6cc8d", "embedding": null, "metadata": {"page_label": "104", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "23470c99-e0e9-44c8-92f0-157d171059a7", "node_type": "4", "metadata": {"page_label": "104", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "74db958d0b41116de5f72e764779e4a53c7f62b5459caa6d727bc15df1be3b23", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9e80364c-4e3a-4d03-8ecb-a299f3368ac1", "node_type": "1", "metadata": {"page_label": "103", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "09390d93e29ad065c4eca06c076745cab4fa69b76a28abd7166aee9e34830fa0", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b1f4b44f-ee65-4224-afde-76d8c33f2e35", "node_type": "1", "metadata": {}, "hash": "0ff839acc37519cd92aa63599e23a416bf6b5dd24301fc4a1e4b46e6f7173296", "class_name": "RelatedNodeInfo"}}, "hash": "eb52eb1156572bcd5e3a2b3c98eab52fdf6f55ea28fad23378eeb43fbedb94e1", "text": "Guidelines on Use of Antiretroviral Drugs for Tre ating and Preventing HIV Infection in Kenya  \n \n4 - 42 4.8.2 Malaria  \nChildren and adults living with HIV suffer heavier parasitaemia and more malaria morbidity with \nadvanced HIV disease. Further, people with advanced immunosuppression are at risk of failure \nof anti -malarial treatment. In pregnancy, there is increased risk of placental malaria,  severe \nanaemia, premature delivery and perinatal mortality. Drug interactions between ARVs and \nantimalarial drugs may further complicate management.  \nRecommendations for malaria prevention for PLHIV include:  \n\u25cf Offer cotrimoxazole preventive therapy (CPT) for  protection against malaria infection \n(Table 4. 3: Co-trimoxazole Preventive therapy)  \n\u25cf In areas of stable malaria transmission, PLHIV should have access to insecticide treated \nmosquito nets (ITNs) or indoor residual spraying to reduce exposure to mosquito bi tes \nand therefore malaria transmission  \n\u25cf PLHIV travelling from non -malarious zones to malaria endemic areas should sleep under \nITNs  \n\u25cf Pregnant women with HIV living in areas of stable malaria transmission who are not able \nto take CPT should be given at least t hree doses of sulfadoxine -pyrimethamine (SP) \nintermittent preventive treatment for malaria as part of routine antenatal care  \nNote:  SP should not be given to women who are taking CPT  \n\u25cf PLHIV on CPT who develop fever should not be treated for an unconfirmed presumptive \ndiagnosis of malaria. Laboratory confirmation of malaria should be obtained prior to \ninitiation of anti -malarial therapy  \n\u25cf PLHIV with malaria should receive standard antimalarial therapy according to national \nguidelines.  Those on CPT should not be given sulfa -containing anti -malarial drugs. \nPatients on ART receiving anti -malarial therapy should be monitored closely for adverse \ndrug reactions  \n4.8.3 Safe Water, Sanitation and Hygiene  \nDiarrheal illnesses are common causes of morbidity and  mortality among PLHIV. These diseases \nare often due to lack of access to safe drinking water, improper disposal of human and animal \nwaste, and poor personal hygiene, leading to contamination of food and water.  \nRecommendations for prevention of faecal -oral ly spread illnesses include:  \n\u25cf Offer CPT for protection against some GI infections (Table 4.3: Co -trimoxazole \nPreventive therapy)  \n\u25cf Hand washing with soap and water after handling human or animal faeces, after using \nthe toilet, and before food preparation or eating  \n\u25cf Facilities for proper disposal of human waste.  \n\u25cf Training on household -based water treatment methods and water storage containers \nthat prevent direct hand contact with drinking water", "start_char_idx": 3, "end_char_idx": 2709, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b1f4b44f-ee65-4224-afde-76d8c33f2e35": {"__data__": {"id_": "b1f4b44f-ee65-4224-afde-76d8c33f2e35", "embedding": null, "metadata": {"page_label": "105", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1f8118ee-9fc4-4958-a3ce-696e60a69431", "node_type": "4", "metadata": {"page_label": "105", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0e4fc6c8150b6aad561a748db994cca727e5bf3647e86f66210b174fe3a06572", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8d16c04e-dd1c-4c87-a7c7-966e42b6cc8d", "node_type": "1", "metadata": {"page_label": "104", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "eb52eb1156572bcd5e3a2b3c98eab52fdf6f55ea28fad23378eeb43fbedb94e1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "987de3c0-9a2e-4d3a-aa4f-2903459e6095", "node_type": "1", "metadata": {}, "hash": "6563cc8575df1f18231a59c0204ce0450766826739ab9cf6517cbfca94bc6f57", "class_name": "RelatedNodeInfo"}}, "hash": "0ff839acc37519cd92aa63599e23a416bf6b5dd24301fc4a1e4b46e6f7173296", "text": "Adherence Preparation, Monitoring and Support  \n5 - 1  \n5. Adherence Preparation, Monitoring and \nSupport  \n \nThe individual and population benefits of ART are dependent on high levels of adherence to the \nprescribed medication, the accompanying medical advice and the follow -up plans. Adherence -\nenhancing strategies should be implemented beginning at the point of HIV di agnosis (as part of \npost -test counselling and linkage), continued during initial evaluation, and thereafter during the \nentire follow -up period for ART.  \n \nTo avoid treatment failure and the need to switch patients to 2nd or 3rd line ART, it is key to have \nan adherence support strategy in place before ART initiation, anticipating common and individual \nbarriers to good adherence. Prevention of treatment failure starts at the time of HIV diagnosis. \nThis is particularly important with the current recommendation t hat all PLHIV qualify for ART, \nand ART should be initiated within 2 weeks of diagnosis. Adherence preparation must begin at \ntime of HIV testing, and close follow -up is required after ART initiation.  \n \nThe adherence preparation, monitoring, and support that a patient requires should be tailored to \ntheir level of adherence, the stage of ART initiation, and the follow -up stage that they are at (Figure \n5.1).  \n \nWhenever possible, follow -up should be provided by the same care provider or team of care \nproviders (e.g ., same clinician and same counsellor) at each visit. This is particularly important \nduring the first few months of HIV care.", "start_char_idx": 3, "end_char_idx": 1554, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "987de3c0-9a2e-4d3a-aa4f-2903459e6095": {"__data__": {"id_": "987de3c0-9a2e-4d3a-aa4f-2903459e6095", "embedding": null, "metadata": {"page_label": "106", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0f27dbb9-708a-4133-b0a9-2e6fcc28ad19", "node_type": "4", "metadata": {"page_label": "106", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4ef3471e0f9b2b334350c96c28be1f729cc01a121af7bf678b71167423d93071", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b1f4b44f-ee65-4224-afde-76d8c33f2e35", "node_type": "1", "metadata": {"page_label": "105", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0ff839acc37519cd92aa63599e23a416bf6b5dd24301fc4a1e4b46e6f7173296", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "14d931d8-7a73-4b91-8b4f-23cfd8c1c3a4", "node_type": "1", "metadata": {}, "hash": "e557a2a6ee069582c6dafdc18f1f18d4b712fbe0189d5db0e2961d61959fba91", "class_name": "RelatedNodeInfo"}}, "hash": "6563cc8575df1f18231a59c0204ce0450766826739ab9cf6517cbfca94bc6f57", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 2 \nHTS post -test counselling: key treatment preparation messages for all patients who test positive\n\u2022 Treatment is available and recommended for everyone with HIV\n\u2022 Starting treatment early reduces your chance of becoming ill or infecting your sexual partner(s)\n\u2022 With good adherence you can live a long and productive life\nEnrolment Visit\n\u2022 HIV education and adherence preparation for all patients/caregivers (Table 5.1)\n\u2022 ART Readiness Assessment for all patients/caregivers (Table 5.4), along with \nindividualized adherence support plan\nReady to start ART Not ready to start ART\n\u2022 Initiate ART\n\u2022 Baseline investigations if not already completed\n\u2022 Provide standard package of care and differentiated \ncare based on initial presentation (advanced disease vs \nwell)\n\u2022 Book follow -up appointment for week 2 and 4 to \nreview adherence and side -effects\n\u2022 Continue adherence support plan\u2022 Weekly appointments  to review clinical \nstatus, barriers to ART initiation, and provide \nongoing HIV education and counselling\n\u2022 Provide standard package of care\n\u2022 Re-assessment of ART readiness at every \nvisit, until ready (target is within 2 weeks)\nFollow -up with adherence monitoring at every \nvisit (Table 5.10) and counselling based on \nlevel of adherence (Table 5.14) until first VL at \n3 months\nVL undetectable ( LDL <200copies/ml )\n\u2022 Ongoing adherence assessment and \ncounselling (Table 5.16)\n\u2022 Continue routine VL monitoring as per \nthe population groupVL       copies/ml\n\u2022 Suspect poor adherence\n\u2022 Assess for barriers to adherence (Table 5.15)\n\u2022 Follow VL algorithm with enhanced \nadherence assessment and interventions and \nassessment for other causes of viremia \n(Figure 6.6) \nFigure 5.1: Adherence Preparation, Monitoring and Support until Viral Load after 3 Months on \nART", "start_char_idx": 3, "end_char_idx": 1837, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "14d931d8-7a73-4b91-8b4f-23cfd8c1c3a4": {"__data__": {"id_": "14d931d8-7a73-4b91-8b4f-23cfd8c1c3a4", "embedding": null, "metadata": {"page_label": "107", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "fc2a471f-1959-40a4-be6b-170b4272c093", "node_type": "4", "metadata": {"page_label": "107", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "db08367dd6d401a3c629e5ae296cd0ca731bdc6f5a6d772a288987d517084a93", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "987de3c0-9a2e-4d3a-aa4f-2903459e6095", "node_type": "1", "metadata": {"page_label": "106", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6563cc8575df1f18231a59c0204ce0450766826739ab9cf6517cbfca94bc6f57", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "018f42a3-5120-4c28-a51b-ddd7c58c6851", "node_type": "1", "metadata": {}, "hash": "03086ad2135dcf800dc897e7693d3759db88ddb3a940709096e7262bc3e5d2b2", "class_name": "RelatedNodeInfo"}}, "hash": "e557a2a6ee069582c6dafdc18f1f18d4b712fbe0189d5db0e2961d61959fba91", "text": "Adherence Preparation, Monitoring and Support  \n5 - 3 Adherence is most difficult during the first few months of treatment: the patient is not yet in the \nhabit of taking their medications every day, they are not familiar with common side -effects, and \nthey have more challenges with disclosure and stigma,  all of which can interfere with adherence. \nPoor adherence within the first few months of therapy is also the most risky period for \ndevelopment of resistance mutations, when the viral load is still high.  \n \nFor these reasons, adherence preparation, monitorin g and support must be emphasized \nduring the first few months of ART until the patient achieves full virological suppression,  \nafter which adherence monitoring and support can continue at lower intensity.  \n \nPatient preparation and counselling should be a coll aborative process between the provider and \nthe patient or caregiver, to enable the patient to initiate and continue lifelong treatment. This is \nbest done when the same adherence counsellor follows an individual patient throughout the \npreparation, initiatio n, and early ART period.  \n \nART can be initiated concurrently with the first adherence counselling session, even during \nthe enrolment visit, especially for infants and for pregnant women. This may also apply to \npatients with a good understanding of HIV and A RT and strong motivation for immediate \nART initiation.  \n \nEach member of the multidisciplinary team should have the requisite training to provide \ntreatment education and offer appropriate support to address potential barriers to adherence. \nTreatment preparat ion and support can be offered at triage, consultation, pharmacy or any other \nclinic station where confidentiality and privacy are assured and providers are adequately trained. \nIt should also be incorporated into health talks, peer support group activities , and group \ncounselling sessions.  \n \nBefore commencement of a counseling session, the counselor should ensure that adequate space is available \nto conduct the counseling, that confidentiality can be maintained, and that tools such as psychosocial \nassessment f orms, treatment literacy flip charts, PHDP flip charts, and tools to document the counseling \nsessions are available.", "start_char_idx": 3, "end_char_idx": 2260, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "018f42a3-5120-4c28-a51b-ddd7c58c6851": {"__data__": {"id_": "018f42a3-5120-4c28-a51b-ddd7c58c6851", "embedding": null, "metadata": {"page_label": "108", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2802641e-c920-4d05-9a44-8ba087c15b58", "node_type": "4", "metadata": {"page_label": "108", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4804d24d0a336bd65ea89da15d6c91f53a753ed16ec4a46a644eea6dfe40e5e1", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "14d931d8-7a73-4b91-8b4f-23cfd8c1c3a4", "node_type": "1", "metadata": {"page_label": "107", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e557a2a6ee069582c6dafdc18f1f18d4b712fbe0189d5db0e2961d61959fba91", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b608dca3-b2c0-4a75-ae47-17382bd98b4e", "node_type": "1", "metadata": {}, "hash": "ddf394a5a45aa32c99ca01f398e2883305ca5e1097357a0177f122927666474a", "class_name": "RelatedNodeInfo"}}, "hash": "03086ad2135dcf800dc897e7693d3759db88ddb3a940709096e7262bc3e5d2b2", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 4 Persons living positively (adolescent and adult peer educators who can share personal \nexperiences when needed) should be engaged to support patient education as indicated in the \noperational guidance below.  \nOperational Guidance: Meaningful Involvement of People Living with HIV  \nFor best patient outcomes, PLHIV themselves should be engaged to lead facility -based and \ncommunity -based HIV ed ucation and support systems. They are often referred to as \u201cpeer \neducators\u201d, \u201cmentor mothers\u201d, and \u201clay health workers\u201d in these roles. PLHIV have successfully and \nsignificantly contributed to: improving identification of people at risk for HIV or infected  with HIV; \nincreasing linkage from testing to treatment; reducing onward transmission of HIV; providing \npsychosocial support, and improving adherence and retention to care and ART.  \n \nIdentifying PLHIV to offer peer -led patient support:  \n\u25cf PLHIV on ART for \u2265 1  year  \n\u25cf Good adherence and undetectable VL  \n\u25cf Positive attitude and interest in supporting peers  \n \nPreparing and supporting PLHIV to play a role in patient support systems:  \n\u25cf Must be trained for the role they are expected to provide  \n\u25cf Must have job aids and IEC material appropriate for their role  \n\u25cf Must be supervised by healthcare professionals  \n \nPotential roles for PLHIV include  \n\u25cf Supporting HIV self -testing  \n\u25cf Providing HIV testing services  \n\u25cf Acting as peer linkage supporters  \n\u25cf Leading or contributing to facility -based or community -based support groups  \n\u25cf Providing individual or group HIV education  \n\u25cf Providing individual or group adherence counselling  \n\u25cf Distribution of ART refills for stable patients  \n \nCompensation for PLHIV who contribute to patient support systems  \n\u25cf Recognition (e.g., ID badges; certificates of service; acknowledgement at community forums)  \n\u25cf Training opportunities with certification  \n\u25cf Financial compensation (e.g., salaries; stipends; transportation allowances)  \n\u25cf Priority consideration for em ployment opportunities", "start_char_idx": 3, "end_char_idx": 2074, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b608dca3-b2c0-4a75-ae47-17382bd98b4e": {"__data__": {"id_": "b608dca3-b2c0-4a75-ae47-17382bd98b4e", "embedding": null, "metadata": {"page_label": "109", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d2161700-5f04-460d-91e8-fb6e20206626", "node_type": "4", "metadata": {"page_label": "109", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "74fa42b56d184a2266aeb5b02fdaa9cb28f5bc70697b678421efe1296d20906e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "018f42a3-5120-4c28-a51b-ddd7c58c6851", "node_type": "1", "metadata": {"page_label": "108", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "03086ad2135dcf800dc897e7693d3759db88ddb3a940709096e7262bc3e5d2b2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "dd5ef993-e899-46f7-9e0c-e66a980c844b", "node_type": "1", "metadata": {}, "hash": "8fa716e568a1a07d50d288ae7874580896e579d038464143e8612a9f9870be9f", "class_name": "RelatedNodeInfo"}}, "hash": "ddf394a5a45aa32c99ca01f398e2883305ca5e1097357a0177f122927666474a", "text": "Adherence Preparation, Monitoring and Support  \n5 - 5 5.1 Undetectable = Untransmittable (U=U)  \nART adherence resulting to durable viral suppression eliminates risk of sexual transmission of \nHIV and is key to HIV epidemic control. Adoption of the Undetectable equals Untransmittable \n(U=U) campaign is posed to revolutionize HIV treatment among PLHIV and fortify treatment -for-\nprevention strategies. Multiple studies have showed that durable viral suppression of <50 \ncopies/ml eliminates risk of sexual transmission of HIV. (Table 5. 17 Viral load cut -offs)  \nThe framework of U=U offers a unique opportunity to dismantle HIV stigma and discrimination, \nemphasizes the critical importance of antiretroviral therapy (ART), daily adherence, and \ncontinuous engagement in medical care for  PLHIV.  \nDefinitions:  \n\u25cf Durably Undetectable: 2 consecutive viral load results of <50 copies/ml  \n\u25cf Untransmittable: The finding established by various clinical trials and observational \nstudies, that people who maintain an undetectable viral load have minimal HIV virus in their \nblood and other body fluids secretions that they have \u201ceffectively no risk\u201d of passing HIV to \nothers through sex.  \n5.1.1 Benefits of U=U  \n\u25cf Diminish stigma associated with having HIV  \n\u25cf Reduce barriers to HIV testing and treatment  \n\u25cf Incre ase interest in starting and staying on ART  \n\u25cf Improve self -esteem by removing the fear of being contagious  \n\u25cf Support healthy sexuality regardless of HIV status  \n\u25cf Reduce sex partners\u2019 concerns  \n5.1.2 Considerations for implementation of U=U within clinical setting s \n\u25cf Viral load monitoring as per the recommended intervals for various populations  \n\u25cf Continuous adherence monitoring and support at all clinical visits  \n\u25cf STI screening at all visits  \n\u25cf Messaging on U=U should be provided for all PLHIV as part of treatment literacy  \n5.1.3 Messaging to Patients on U=U  \n\u25cf Keeping your HIV undetectable helps you live a long and healthy life  \n\u25cf To get your HIV to an undetectable level and to keep it undetectable, take antiretroviral \nmedicines as prescribed  \n\u25cf It may take up to 6 months o f taking HIV treatment medicines to bring your HIV viral load \ndown to an undetectable level  \n\u25cf If you are durably suppressed and you are taking your medications as prescribed, you can \nbe sure you will not pass HIV through sex  \n\u25cf People who keep their HIV at an undetectable level will not pass HIV to others through sex  \n\u25cf If you stop taking HIV medicines, your HIV can rebound to a detectable level within 1 to 2 \nweeks, and you may pass HIV to your sex partners  \n\u25cf Keeping your HIV at durably suppressed level helps you sa fely conceive a child with your \npartner", "start_char_idx": 3, "end_char_idx": 2700, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "dd5ef993-e899-46f7-9e0c-e66a980c844b": {"__data__": {"id_": "dd5ef993-e899-46f7-9e0c-e66a980c844b", "embedding": null, "metadata": {"page_label": "110", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "42e51376-d8c1-49fc-abe1-296274d35de0", "node_type": "4", "metadata": {"page_label": "110", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d7c2c4dfcb64a1c09ee96ee8e1b4706625331a3963520b197267b54266ccf20e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b608dca3-b2c0-4a75-ae47-17382bd98b4e", "node_type": "1", "metadata": {"page_label": "109", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ddf394a5a45aa32c99ca01f398e2883305ca5e1097357a0177f122927666474a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6405ba9c-7473-44c4-9a18-ddf22392704e", "node_type": "1", "metadata": {}, "hash": "16932034a9e52df2507934560d131c571e31aa9d624142c78297a0c99e8df4d7", "class_name": "RelatedNodeInfo"}}, "hash": "8fa716e568a1a07d50d288ae7874580896e579d038464143e8612a9f9870be9f", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 6 5.1.4 How patients can discuss U=U with others  \n\u25cf Counsel patients to share information about the research on U=U as follows:  \no In recent research studies that involved thousands of couples, no one who was on \nHIV treatment and whose HIV was durably undetectable passed HIV to their HIV -\nnegative sex partner  \n\u25cf Advise patients that they can share the following personal information with current or \npotential sex partners:  \no When they last had a viral load test and if their viral load was undetectable  \n\u25cf Individuals should tell their partner(s) that their HIV is undetectable only if they have \ntaken HIV medicines consistently since their last test with an undetectable viral load  \n5.1.5 Counselling patients about other preven tion combination interventions  \n\u25cf PrEP:  PrEP is a safe and effective daily pill that prevents HIV infection. The partner without \nHIV may decide to take PrEP if they:  \no Are unsure that their partner\u2019s HIV viral load is undetectable, especially if their \npartner has only recently started ART  \no Have mo re than 1 sexual partner  \no Feel more secure with the added perception of protection provided by PrEP  \n\u25cf PEP:  After a possible HIV exposure (e.g., Occupational exposure or if a sex partner with HIV \nhas not consistently taken ART and is not virally suppressed), t he immediate initiation of \nemergency PEP can prevent HIV infection  \n\u25cf Condom use:  Condoms protect against other STIs, such as gonorrhea, chlamydia, and \nsyphilis, and help prevent pregnancy.  \nCounsel patients to find a prevention strategy that works for them:  \n\u25cf If an individual who does not have HIV is unsure if their partner has an undetectable level of \nvirus or is anxious about acquiring HIV, care providers should encourage that person to \nchoose a prevention strategy that works for them, whether that is use of P rEP, emergency \nPEP, condoms, or a combination of these strategies  \nNote: Care providers should emphasize that no one should ever be compelled to have \nsex without condoms  \n5.1.6 Application of U=U in other settings  \n\u25cf Breastfeeding:  Studies demonstrate that ART greatly reduces the risk of transmission \nthrough breast milk. However, research has not established that people whose HIV is \nundetectable do not transmit virus during breastfeeding. Prophylaxis should be provided \nto HIV expose d infants during the breastfeeding period as per the guidelines regardless \nof the viral load status  \n\u25cf Injection drug use:  Studies demonstrate that ART greatly reduces the risk of \ntransmission through sharing of injection drug use. However, research has not \nestablished that people whose HIV is undetectable do not transmit virus through needle \nsharing. All people who inject drugs should only use their own needles and not share \nneedles or other paraphernalia with others  \n\u25cf Needle stick injuries:  Research has not es tablished that people with undetectable viral \nload do not transmit HIV to people who are stuck by needles containing their blood. HIV \nPEP should be provided as per the guidelines", "start_char_idx": 3, "end_char_idx": 3112, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6405ba9c-7473-44c4-9a18-ddf22392704e": {"__data__": {"id_": "6405ba9c-7473-44c4-9a18-ddf22392704e", "embedding": null, "metadata": {"page_label": "111", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3214b900-b2d5-4ffc-ae22-ae9cc9d6e625", "node_type": "4", "metadata": {"page_label": "111", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "534566b34363a81319f4970727de7c7bc1a7eed9d244e03e70676b8b825fc187", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "dd5ef993-e899-46f7-9e0c-e66a980c844b", "node_type": "1", "metadata": {"page_label": "110", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8fa716e568a1a07d50d288ae7874580896e579d038464143e8612a9f9870be9f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "46f30541-460c-4792-9677-650358a47040", "node_type": "1", "metadata": {}, "hash": "3684d7ca2e77eed49c31187825e9ec9e7b29bb188f83280d3e29ee017ac0bb1b", "class_name": "RelatedNodeInfo"}}, "hash": "16932034a9e52df2507934560d131c571e31aa9d624142c78297a0c99e8df4d7", "text": "Adherence Preparation, Monitoring and Support  \n5 - 7 5.2 ART Adherence Preparation and Support  \nPreparation for ART begins at the t ime of HIV diagnosis and continues until initiation of ART.  \n5.2.1 Treatment Preparation as Part of HIV Testing Services  \nWith the current treatment guidelines recommendation that all PLHIV qualify for ART, post -test \ncounselling by the HTS provider should no w include three key messages that begin the ART \ntreatment preparation process for all PLHIV  \n\u25cf Treatment (called antiretroviral therapy (ART)) is available and is recommended for \neveryone with HIV  \n\u25cf Starting treatment as soon as possible (preferably within two weeks of testing positive \nfor HIV) reduces the chance of your illness getting worse or of passing HIV to others  \n\u25cf If you take your ART properly and do not miss pills you can expect to live a long and \nproductive life  \n \n5.2.2 ART Treatment Preparatio n \nART treatment preparation involves HIV education and counselling, including identifying likely \nbarriers to adherence, a discussion of strategies and support systems to overcome possible \nbarriers to adherence, and an individualized adherence plan, as summ arized in Table 5.1. The \neducation and counseling sessions should be documented in patient charts.  \nTable 5.1: Treatment Preparation and Adherence Counselling Guide  \nHIV Education  \n\u2022 Ask the patient what they know about HIV  \n\u2022 Ask the patient what they know about treatment for HIV  \n\u2022 Correct/clarify as needed, ensuring you cover:  \no Modes of transmission and importance of testing partners/children  \no HIV effect on the immune system and health  \no HIV viral load and its relationship to health and to HIV transmission  \no Goals of ART  \no Relationship between adherence and viral suppression, treatment failure, and drug \nresistance  \no Consequences of drug resistance  \n\u2022 Ensure the patient understands by asking them to explain it back to you  \nBarriers to Adherence  \n\u2022 Ask the patient what they think will be most difficult about taking ART every day  \n\u2022 As the patient what they think will be most difficult about attending all clinic appointments  \n\u2022 Discuss common reasons patients have trouble with excellent adherence and identify which may \nbe most relevant for them, including:", "start_char_idx": 3, "end_char_idx": 2280, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "46f30541-460c-4792-9677-650358a47040": {"__data__": {"id_": "46f30541-460c-4792-9677-650358a47040", "embedding": null, "metadata": {"page_label": "112", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "931d824e-edf0-47bc-b8c0-4b51d061bee8", "node_type": "4", "metadata": {"page_label": "112", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "39d4222ff756ea406a8983d04b967d3b4ca977aa9d0f3aeb02ec9cf6eabfd1f0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6405ba9c-7473-44c4-9a18-ddf22392704e", "node_type": "1", "metadata": {"page_label": "111", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "16932034a9e52df2507934560d131c571e31aa9d624142c78297a0c99e8df4d7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7d260b6e-e934-4eab-bbd1-efe53e71f6b2", "node_type": "1", "metadata": {}, "hash": "c4f4bd00f4248ced36b67ad14fde77b5831ca18498bb1e31c7a77a6c0c81cbbf", "class_name": "RelatedNodeInfo"}}, "hash": "3684d7ca2e77eed49c31187825e9ec9e7b29bb188f83280d3e29ee017ac0bb1b", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 8 Table 5.1 Cont.  \n\u25cf Patient Factors  \no Stigma and non -disclosure (having to hide \ntheir ARV pill -taking)  \no Lack of support systems  \no Alcohol or drug use  \no Depression or other psychiatric illness  \no Loss or grief  \no Cognitive disorders  \no Change in daily routine  \no Chaotic lifestyle; no consistent daily \nroutine  \no Forgetting to take pills  \no Feeling better so does not think the ART is \nneeded any more  \no Feeling too sick to take ART  \no Age (adolescents - impulsive, more \nsusceptible to social pressure; children \u2013 \ncaregiver dependent)  \u25cf Provider/System Factors  \no Side effects (many patients have side \neffects when they first start their ART, \nincluding nausea, headaches, and \ndifficulty sleeping.  These side effects \nalmost always resolve with continued \nuse)  \no Pill burden  \no Poor patient -provider relationship  \no Inadequate HIV education  \no Cost of care (direct and indirect)  \no ARV supply -chain limitations (stock -outs, \nor low stock levels resulting in small refill \nquantities)  \nIndividualized Adherence Plan  \n\u25cf Ask the patient what they can do to ensure excellent adherence  \n\u25cf Ensure the adherence plan incorporates details of the patient\u2019s specific ART regimen:  \no Number of pills, frequency, food requirements/restrictions  \no Common side effects  \no Important drug interactions  \n\u25cf Work with the patient to make an individualized adherence plan, which may include:  \no Disclosing their HIV status to a close friend or family member who can help support their \ntreatment; bringing their treatment buddy to clinic with them or to a session with a \ncounsellor to learn more about HIV  \no Disclosing their HIV status to household members so they do not have to hide pill -taking  \no Combining pill taking with a consistent activity in their daily routine  \no Keeping the ARVs in a place that they are lik ely to see every day  \no Setting a daily alarm on their phone/watch/clock  \no Connecting with a support group for additional counseling/education/support  \no Getting treatment for alcohol or drug use  \no Getting treatment for depression or other psychiatric illness  \n\u25cf Discuss what to do if:  \no Develops side effects  \n\u25aa Discuss common and serious adverse events for their specific regimen  \n\u25aa Encourage patient to return to clinic for any side effects rather than stopping ART  \no Forgets to take a dose: take it late rather than skipping the dose completely  \no Travels without their ART: go to the nearest health facility or call clinic for guidance  \n\u25cf Ask the patient to summarize their individualized adherence plan", "start_char_idx": 3, "end_char_idx": 2638, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7d260b6e-e934-4eab-bbd1-efe53e71f6b2": {"__data__": {"id_": "7d260b6e-e934-4eab-bbd1-efe53e71f6b2", "embedding": null, "metadata": {"page_label": "113", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a5463343-8444-49f7-b13d-87aa5d4bcfcb", "node_type": "4", "metadata": {"page_label": "113", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6392f12e565cfc33bce702ca8f8774fc05d1647a28a74af70665c711f3e4a2e4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "46f30541-460c-4792-9677-650358a47040", "node_type": "1", "metadata": {"page_label": "112", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3684d7ca2e77eed49c31187825e9ec9e7b29bb188f83280d3e29ee017ac0bb1b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "90a4ed85-06d2-4616-8ef1-27af5d70565d", "node_type": "1", "metadata": {}, "hash": "84cdc5c85b02b2261f26b31d49f109e4caace01b879019a2f234fe1c931a1ed1", "class_name": "RelatedNodeInfo"}}, "hash": "c4f4bd00f4248ced36b67ad14fde77b5831ca18498bb1e31c7a77a6c0c81cbbf", "text": "Adherence Preparation, Monitoring and Support  \n5 - 9 Table 5.1 Cont.  \nOngoing Support at Subsequent Visits  \n\u25cf Review the patient\u2019s HIV knowledge  \n\u25cf Review the patient\u2019s motivation to take ART  \n\u25cf Elicit any concerns the patient may have about their ART, side effects, visit schedule, or health  \n\u25cf Review the ART dosing schedule and ask about any missed pills  \n\u25cf Explore barriers to adherence that were previously identified or new ones that have developed  \n\u25cf Explore any recent or expected changes in their life or daily routine  \n\u25cf Discuss their individualized adherence plan and if any changes are required  \n \nHIV Education and Counselling  \nHIV education should be a standard component of the enrolment visit. Prior to ART initiation, all \npatients/caregivers must be provided with enough information to make an informed choice about \nART initiation and adherence (Table 5.2), including for patients who initiate ART during the \nenrolment visit. A detailed content guide for HIV education and adherence counselling is provided \nin Annex 8. This information can be provided through group or individual counselling. The ART \nReadiness Assessment an d the management plan should be completed for each patient \nindividually (Table 5.4).", "start_char_idx": 3, "end_char_idx": 1246, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "90a4ed85-06d2-4616-8ef1-27af5d70565d": {"__data__": {"id_": "90a4ed85-06d2-4616-8ef1-27af5d70565d", "embedding": null, "metadata": {"page_label": "114", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3735a287-4a1d-402a-a562-8e837a58f4d0", "node_type": "4", "metadata": {"page_label": "114", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "bf3c6013ec6c5446b16b8629f5f0520bb61739b324fbbe8f377c4d1ab226bdee", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7d260b6e-e934-4eab-bbd1-efe53e71f6b2", "node_type": "1", "metadata": {"page_label": "113", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c4f4bd00f4248ced36b67ad14fde77b5831ca18498bb1e31c7a77a6c0c81cbbf", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "119d6de3-50eb-47a0-b849-1050fb279f4a", "node_type": "1", "metadata": {}, "hash": "b0d191a8303aeee11730ab62bb7d3be5b5e06005af1500f9a99d8c93fd01a158", "class_name": "RelatedNodeInfo"}}, "hash": "84cdc5c85b02b2261f26b31d49f109e4caace01b879019a2f234fe1c931a1ed1", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 10 Table 5.2: Components of HIV Education (see Annex 8 for detailed content guide)  \nComponent  Questions to be Covered  \n \nHIV \u25cf What is HIV  \n\u25cf How is HIV transmitted  \n\u25cf Why should partners and family members be tested for HIV  \n \nViral load  \u25cf What is viral load  \n\u25cf How often is viral load measured  \n\u25cf What do viral load measurements mean, including the goal of achieving viral suppression  \n \n \nCD4 cells  \u25cf What are CD4 cells  \n\u25cf How are CD4 cells affected by HIV  \n\u25cf What happens when CD4 cells decrease  \n\u25cf How often is CD4 cell count measured  \n \n \n \nAntiretroviral \ntherapy (ART)  \u25cf What is ART  \n\u25cf What are the benefits of ART  \n\u25cf When is ART started  \n\u25cf Does ART cure HIV  \n\u25cf Can you still give HIV to others while taking ART  \n\u25cf How long is ART taken  \n \n \nTreatment failure  \u25cf What happens if you stop taking ART  \n\u25cf What happens if you do not take ART regularly  \n\u25cf What happens if the viral load increases  \n\u25cf What happens in treatment failure  \n \nART side effects  \u25cf What are the side -effects of ART  \n\u25cf What should you do if you notice any side effects  \n \n \n \nAdherence  \u25cf What is adherence  \n\u25cf How should ART be taken  \n\u25cf What usually interferes with good adherence  \n\u25cf What might make it difficult for you to take your ART as prescribed  \n\u25cf What can help you take ART as prescribed  \n\u25cf What happens if you miss an appointment  \nOther medications  \u25cf  What other medications will you take, in addition to ART (e.g., CPT, TPT)  \n \nNutrition  \u25cf Why is nutrition important  \n\u25cf What can you do to improve your nutrition  \n \nFollow -up \u25cf How often will you need to come for clinic visits?  \n\u25cf What will we be checking for during your clinic visits  \nAdherence Support  \nPsychosocial support for PLHIV and their families is essential for their well -being and good health \noutcomes. HIV affects virtually every aspect of one\u2019s life, as well as the lives of those close to them. \nPLHIV need psychological and social support to deal with various issues that are common to \nchronic illness as well as those that are unique to HIV. These include sti gma, bereavement, self -\nimage, loss of earning capacity, life skills, and chronic illness, among others. Providing \npsychosocial support entails identifying any needs that they may have and addressing them. In \nsome cases, some of these needs can be anticipat ed and addressed even before they come to play \nin the individual\u2019s life.  \nThe individualized patient management plan should include establishing appropriate adherence \nsupport interventions (Table 5.3).", "start_char_idx": 3, "end_char_idx": 2588, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "119d6de3-50eb-47a0-b849-1050fb279f4a": {"__data__": {"id_": "119d6de3-50eb-47a0-b849-1050fb279f4a", "embedding": null, "metadata": {"page_label": "115", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6df7624d-2665-4837-a742-79057261a58c", "node_type": "4", "metadata": {"page_label": "115", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e5af1605a92f922746fad159e11112681c0a3addcd290317ee6ea6ca084fa657", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "90a4ed85-06d2-4616-8ef1-27af5d70565d", "node_type": "1", "metadata": {"page_label": "114", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "84cdc5c85b02b2261f26b31d49f109e4caace01b879019a2f234fe1c931a1ed1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "836016bb-2267-437a-bfaf-d542313b1c5b", "node_type": "1", "metadata": {}, "hash": "6a05fe30833772eca056d842444d3e2aa51317be6dffe2d6a3ae270d8c094fbb", "class_name": "RelatedNodeInfo"}}, "hash": "b0d191a8303aeee11730ab62bb7d3be5b5e06005af1500f9a99d8c93fd01a158", "text": "Adherence Preparation, Monitoring and Support  \n5 - 11 Table 5.3: Adherence Support and Retention Intervention s \nStandard Adherence Support Interventions  \nStructural \ninterventions  \u25cf Conduct a baseline psychosocial assessment to explore the various aspects of \nthe client\u2019s life that may influence their adherence to treatment and \nprevention, and their general well -being. This teases out issues that need to \nbe explored in detail during the counselling session e.g., disclosure, family \nplanning, living circumstances etc.  \n\u25cf Use a multidisciplinary team approach to develop and implement treatment \nplans for each patien t \n\u25cf Engage peer educators to lead HIV education and support services  \n\u25cf Adequately prepare and assess the patient\u2019s readiness to initiate and continue \nwith ART  \n\u25cf Implement a system for identifying and taking action when patients miss an \nappointment  \n\u25cf Formalize a sy stem for providing health talks and treatment literacy classes \nfor patients  \n\u25cf Formalize a system for linking patients to community -based resources, \nincluding: community support groups, religious groups, CBOs, groups \nsupporting income -generating activities, o rganizations providing food \nsupport, NEPHAK, child welfare societies, community health volunteers/units, \nschools, children\u2019s homes etc.  \n \nHIV \neducation \nand \ncounselling  \u25cf Remind the patient about HIV disease, how ART works, the importance of \nhigh -level adherence and the consequences of non -adherence  \no Risk of ill health caused by HIV  \no Role of ART in restoring and maintaining good health  \no Link between adherence and viral load, CD4 and health  \no Side effects of medications and how to avoid, recognize and manage them. \nManage side effects aggressively  \no Address misconceptions and beliefs about HIV and ART  \n\u25cf Discuss and agree on a treatment plan with the patient. Gain commitment \nfrom the patient to follow through  \n\u25cf Discuss use of alcohol and drugs and  how to prevent these from affecting the \ntreatment plan  \n\u25cf It is important to maintain a non -judgmental attitude, establish trust with \nparents/caregivers, and involve the child as they mature", "start_char_idx": 3, "end_char_idx": 2152, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "836016bb-2267-437a-bfaf-d542313b1c5b": {"__data__": {"id_": "836016bb-2267-437a-bfaf-d542313b1c5b", "embedding": null, "metadata": {"page_label": "116", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d5176033-e770-44cc-a43b-099aeb5c87f6", "node_type": "4", "metadata": {"page_label": "116", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "11d974d65f9e181c512ba77289d806b1d88a80c599d933a6542c21b4c3e7791a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "119d6de3-50eb-47a0-b849-1050fb279f4a", "node_type": "1", "metadata": {"page_label": "115", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b0d191a8303aeee11730ab62bb7d3be5b5e06005af1500f9a99d8c93fd01a158", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2f7c5e18-855b-41f3-8b71-9512000d8f23", "node_type": "1", "metadata": {}, "hash": "6515cb3b5de7bbcc4d3fd72b5aa0c08a16d4f951f1fe01135cf8752c812ce510", "class_name": "RelatedNodeInfo"}}, "hash": "6a05fe30833772eca056d842444d3e2aa51317be6dffe2d6a3ae270d8c094fbb", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 12 Table 5.3 Cont.  \nDisclosure and \nstigma  \u25cf Respect patient privacy and confidentiality  \n\u25cf Discuss with the patient the role of disclosure to close family \nmembers/trusted friend in promoting adherence  \n\u25cf Offer to facilitate disclosure  \n\u25cf For children/adolescents, discuss age -appropriate disclosure with the \ncaregiver and off er to support the process (Annex 5)  \n\u25cf Conduct stigma assessment and support appropriately  \n \nTreatment \nsupporter  \u25cf Encourage the patient to identify a treatment supporter/buddy who will \nprovide the patient with encouragement and social support and even remind \nthe patient to take medication  \n\u25cf Invite the treatment supporter to at least one of the adherence counselling \nsessions  \n\u25cf Obtain consent from the patient to contact the treatment supporter if needed  \nSupport group  \u25cf Link the patient to psychosocial support groups and other community -based \nsupport mechanisms (preferably through direct introduction)  \no Support groups give confidence and encouragement and promote positive \nattitude towards HIV status and may promote disclosure  \no Support groups offer opportunities for additional counselling and \nexperience sharing and are an avenue for developing/strengthening life \nskills  \no Some support groups engage in economic empowerment activities  \no Support groups can be used for ART distribution to improve  convenience \nto the patient  \n\u25cf Develop population -specific support groups when possible (e.g., youth \ngroups with peer educators for adolescents; children\u2019s clubs; caregiver \nsupport groups)  \n\u25cf MDT members should be patrons to the support groups, to guide activiti es in \nline with intended objectives  \n \nSMS reminder \nsystem  \u25cf Enroll patients into an automated SMS reminder system with their consent  \n\u25cf Review the type of messages the patient may receive, the frequency of \nmessages, and any actions the patient should take when receiving the \nmessage  \n\u25cf Ensure the system and messages maintain patient privacy and confidentiality  \nOther reminder \nstrategies  \u25cf Encourage patient/caregiver to set a specific time of day to take ART, and to \nassociate ART time with a specific event/s in their daily schedule  \n\u25cf Encourage patient/caregiver to set an alarm on their phone", "start_char_idx": 3, "end_char_idx": 2309, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2f7c5e18-855b-41f3-8b71-9512000d8f23": {"__data__": {"id_": "2f7c5e18-855b-41f3-8b71-9512000d8f23", "embedding": null, "metadata": {"page_label": "117", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "cd263f00-3857-4024-b611-8e7e71573d83", "node_type": "4", "metadata": {"page_label": "117", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d9986a31efdc3fa63e31c56cf90689946587ed4042fcfb01c0d32e782a38e9e8", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "836016bb-2267-437a-bfaf-d542313b1c5b", "node_type": "1", "metadata": {"page_label": "116", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6a05fe30833772eca056d842444d3e2aa51317be6dffe2d6a3ae270d8c094fbb", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "34d38a37-6036-4a2b-95b1-5eb40f82f142", "node_type": "1", "metadata": {}, "hash": "0928ce4ec028dbace55e278f75173ba3291f5b14a79de1abcacd4a96a1f028d8", "class_name": "RelatedNodeInfo"}}, "hash": "6515cb3b5de7bbcc4d3fd72b5aa0c08a16d4f951f1fe01135cf8752c812ce510", "text": "Adherence Preparation, Monitoring and Support  \n5 - 13 5.2.3 Age -Specific Treatment Preparation and Support  \nTreatment preparation must be customized to the patient\u2019s age, gender, needs and clinical status: \nfor patients who present with advanced/symptomatic disease, the focus is on getting better; for \npatients who present clinically well, the focus is on staying healthy. Specific needs for children, \nadolescents, caregivers, pregnant and breastfeeding women and men should also be taken into \nconsideration.  \nThe HIV education and counselling sessions should be provided at every visit until the patient is \nready and wi lling to start ART, as determined using the ART Readiness Assessment Form (Table \n5.4). Each repeat session should begin with a review of what the patient remembers from the \nprevious session as well as any key issues the counsellor documented in the patient \u2019s chart, so the \nsession can be customized to meet their needs. ART preparation should not take more than 1 -2 \nweeks except for special circumstances such as with uncontrolled mental health issues or \nuntreated drug addictions. However, once the patient has initiated ART, continued HIV education, \ncounselling and adherence support must be provided. The counselling sessions should preferably \nbe conducted by the same counsellor, peer educator, social worker, nurse, community health \nvolunteer, and/or clinician wh o is professionally certified to counsel based on a certified \ncurriculum, and they possess the requisite competencies to provide quality counselling. In order \nto prepare children and adolescents for ART, the counsellor should be trained in providing \npsycho social support to this age group.  \nTable 5.4: ART Readiness Assessment Form  \nCriteria  Y N* \nA. Psychosocial/Knowledge Criteria (applies to patients and caregivers)  \n1. Understands the nature of HIV infection and benefits of ART?    \n2. Has screened negative for alcohol or other drug use disorder, or is stable on \ntreatment (see Section 4.6)    \n3. Has screened negative for depression or other psychiatric illness, or is stable on \ntreatment (see Section 4.6)    \n4. Is willing to disclose/has disclosed HIV status, ideally to a family member or close \nfriend?    \n5. Has received demonstration of how to take/administer ART and other prescribed \nmedication?    \n6. Has received information on predictable side effects of ART and understands what \nsteps to take in case of these side effects?    \n7. For patients dependent on a caregiver: is the caregiver committed to long -term \nsupport of the patient, daily administration of ART, and meets the criteria above?    \n8. Other likely barriers to adherence have been identified and there is a plan in place \nto address them (e.g., frequent travel for work, plan to deal with unexpected travel, \ndistance from clinic, etc.)?    \n9. Has the Patient/caregiver provided accurate locator information and contact details?    \n10. Patient/caregiver feels ready to start ART today?", "start_char_idx": 3, "end_char_idx": 3000, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "34d38a37-6036-4a2b-95b1-5eb40f82f142": {"__data__": {"id_": "34d38a37-6036-4a2b-95b1-5eb40f82f142", "embedding": null, "metadata": {"page_label": "118", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "dade095d-0e1d-4b1c-b750-9789ee2b2466", "node_type": "4", "metadata": {"page_label": "118", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "21b80ea4fb851ea46e44e485b8454a1f2b66ba46628acb10c7d40fd313244d6e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2f7c5e18-855b-41f3-8b71-9512000d8f23", "node_type": "1", "metadata": {"page_label": "117", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6515cb3b5de7bbcc4d3fd72b5aa0c08a16d4f951f1fe01135cf8752c812ce510", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "84faac3a-293d-4318-b900-8f8281894080", "node_type": "1", "metadata": {}, "hash": "5b939489729ada88d72606db1c035e7f85bb9753e57963ab4554bb336496703e", "class_name": "RelatedNodeInfo"}}, "hash": "0928ce4ec028dbace55e278f75173ba3291f5b14a79de1abcacd4a96a1f028d8", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 14 Table 5.4 Cont.  \nB. Support Systems Criteria (applies to patients and caregivers)  \n1. Has identified convenient time/s of day for taking ART, and/or associated \ndose/s with daily event/s?    \n2. Treatment supporter has been identified and engaged in HIV education, or will \nattend next counselling session?    \n3. Is aware of support group meeting time/s?    \n4. If facility has SMS reminder system: Has enrolled into SMS reminder system?    \n5. Other support systems are in place or planned (e.g., setting phone alarm, pill box)?    \nC. Medical Criteria (applies to patients)  \n1. Newly diagnosed with TB: defer ART until patient tolerates anti -TB medication; \ninitiate ART as soon as possible preferably within 2 weeks; for TB meningitis \ndelay ART for 4 to 8 weeks); monitor closely for IRIS    \n2. Newly diagnosed cryptococcal meningitis (CM), or symptoms consistent with CM \n(progressive headache, fever, malaise, neck pain, confusion): defer ART until \ncompleted 5 weeks of CM treatment, or until ruling out CM as the cause of \nsymptoms; monitor closely f or IRIS    \n*If the response to any of the psychosocial criteria or support systems criteria is \u201cNo\u201d: develop a \nstrategy to address the issue as quickly as possible and consider assigning a case manager. ART \nmay be initiated with adequate adherence support while the criteria is being addressed, on a \ncase -by-case basis  \n \nAt each visit up until ART initiation, every patient should be assessed for readiness to \nstart ART (Table 5.4), with the patient/caregiver allowed to make the final decision on \nwhether and when to start ART.  \nSpecial Considerations when Counselling Children and Adolescents  \nChildren and adolescents depend on caregivers to support their adherence so there are special \nconsiderations for adherence preparation and support. All topics covered in the HIV Education \nand Adherence Counselling sessions (Table 5.2 and Annex 8) should be covered with the \ncaregiver, with involvement of the child/adolescent as appropriate based on the stage of \ndisclosure and their developmental stage (Tab le 5.5).", "start_char_idx": 3, "end_char_idx": 2157, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "84faac3a-293d-4318-b900-8f8281894080": {"__data__": {"id_": "84faac3a-293d-4318-b900-8f8281894080", "embedding": null, "metadata": {"page_label": "119", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2d4ac0a7-ea74-4c1a-b3eb-bb723df94b89", "node_type": "4", "metadata": {"page_label": "119", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b24af5c67a839b0c7f6b054cc0112714719e73e05c5a14e370e2ac8a9dbf46fc", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "34d38a37-6036-4a2b-95b1-5eb40f82f142", "node_type": "1", "metadata": {"page_label": "118", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0928ce4ec028dbace55e278f75173ba3291f5b14a79de1abcacd4a96a1f028d8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1a380ad9-d0d2-4784-8465-fed9fe6bf557", "node_type": "1", "metadata": {}, "hash": "16659de72dbe78747a121e1d005da45beab3992c24e6c01dd3d948b82cf5619a", "class_name": "RelatedNodeInfo"}}, "hash": "5b939489729ada88d72606db1c035e7f85bb9753e57963ab4554bb336496703e", "text": "Adherence Preparation, Monitoring and Support  \n5 - 15 Table 5.5: Age -appropriate Involvement of Child/Adolescent in HIV Education and \nAdherence Counselling  \nAge  Counselling Approach  \n< 6 years old  The counselling sessions will focus on engaging all of the child\u2019s \ncaregivers  \n6-12 years old  Both the caregiver and the child will be involved. The counselling will \nfocus on the caregiver; younger children can be given a paper and pen \nand asked to draw their family, school, etc., and talk about their \nexperiences. Disclosure of HIV status to the child s hould commence by 5 \nyears of age and be completed by 10 -12 years of age (Annex 5)  \n> 12 years old with \ncaregiver present  Most of the counselling can focus on the adolescent, who is often fully \nresponsible for medication administration. However, it is neces sary to \nkeep the caregiver coming and involved in supporting the adolescent. A \nrecommended approach is to start with the caregiver alone, then see the \ncaregiver and adolescent together, and then see the adolescent alone. \nUse the HEADSSS tool* to facilitate  discussion  \n> 12 years old \nwithout the \ncaregiver present  Use the HEADSSS tool* to facilitate discussion. Negotiate involvement \nof a treatment supporter  \n* HEADSSS assesses: Home; Education/Employment; Activities; Drugs; Sexuality; \nSuicide/depression/self -image; Safety  \n \nIn addition to the standard HIV Education and Adherence Counselling topics, unique issues need \nto be addressed for caregivers, children and adolescents (Table 5.6).", "start_char_idx": 3, "end_char_idx": 1540, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1a380ad9-d0d2-4784-8465-fed9fe6bf557": {"__data__": {"id_": "1a380ad9-d0d2-4784-8465-fed9fe6bf557", "embedding": null, "metadata": {"page_label": "120", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "af4fe868-6420-4bf8-ba55-c50e0238bfa8", "node_type": "4", "metadata": {"page_label": "120", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e28fe36b58c4a246df070c7444f2002c3e28d6642bd778df561532ffd4a96a4e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "84faac3a-293d-4318-b900-8f8281894080", "node_type": "1", "metadata": {"page_label": "119", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5b939489729ada88d72606db1c035e7f85bb9753e57963ab4554bb336496703e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b8a6896a-fb78-4637-8054-d3afbb87abcc", "node_type": "1", "metadata": {}, "hash": "38d7eeaa187f3294706232591f42247bf4c21bb4e336c59233de6a90235c9877", "class_name": "RelatedNodeInfo"}}, "hash": "16659de72dbe78747a121e1d005da45beab3992c24e6c01dd3d948b82cf5619a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 16 Table 5.6: Unique Considerations for Caregivers, Children and Adolescents  \nCaregiver Barriers to Adherence  \n\u2022 Frequently changing or multiple simultaneous caregivers  \n\u2022 Loss or grief  \n\u2022 Absent or sick caregiver  \n\u2022 Poor understanding of HIV management due to inadequate counselling, elderly, or illiterate \ncaregiver  \n\u2022 Depression, alcohol and other drug use  \n\u2022 Living far from the health facility  \n\u2022 Economically unstable  \n\u2022 Lack of affection between caregiver and child  \n\u2022 Lack of support systems for the caregiver  \nChild/Adolescent Barriers to Adherence  \n\u2022 Level of disclosure (is the child/adolescent aware of their HIV status?)  \n\u2022 Lack of understanding of disease/treatment  \n\u2022 Developmental stage and emotional state  \n\u2022 Child refusal to swallow medicine (do not allow refusal to take medicines: all activities should \nbe stopped for the child until the dose is swallowed)  \n\u2022 Stigmatization and discrimination  \n\u2022 Low self -esteem  \n\u2022 Depression  \n\u2022 Defiance related to a troublesome caregiver -child relationship  \n\u2022 Inadequate structures at school (day or boarding) to support adherence  \n\u2022 Lack of support systems for the child/adolescent  \nTreatment Barriers to Adherence  \n\u2022 Large volumes of syrups  \n\u2022 Bad taste of syrups  \n\u2022 Pill burden  \n\u2022 Confusing regimens combining syrups and tablets  \n\u2022 Side effects  \n\u2022 Dose adjustment requirements as the child grows  \nFor all children/adolescents, the level of disclosure should be assessed at first visit and the \nmanagement plan should include a plan for age -appropriate disclosure (Annex 5). Treatment \npreparation and support se ssions should be customized to the patient\u2019s age (Tables 5.7 -5.9).", "start_char_idx": 3, "end_char_idx": 1733, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b8a6896a-fb78-4637-8054-d3afbb87abcc": {"__data__": {"id_": "b8a6896a-fb78-4637-8054-d3afbb87abcc", "embedding": null, "metadata": {"page_label": "121", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c588044b-b915-4c70-87ce-4439d45aeff2", "node_type": "4", "metadata": {"page_label": "121", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ed25983d7049e0d812731addfb64ed7d53421c210277e4b4741fcfe4eef337b5", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1a380ad9-d0d2-4784-8465-fed9fe6bf557", "node_type": "1", "metadata": {"page_label": "120", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "16659de72dbe78747a121e1d005da45beab3992c24e6c01dd3d948b82cf5619a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7b0b322b-f28b-4a73-bd16-3d3fd3ee4edb", "node_type": "1", "metadata": {}, "hash": "816128f777ebf4bfd2d82b58dff9cb71e71a92be4c7f557d4b3ed592c4efb217", "class_name": "RelatedNodeInfo"}}, "hash": "38d7eeaa187f3294706232591f42247bf4c21bb4e336c59233de6a90235c9877", "text": "Adherence Preparation, Monitoring and Support  \n5 - 17 Table 5.7: Treatment Preparation and Support for Children (\u2264   years) and Caregivers  \nVisit  Standard of Care  \nAt \nenrolment \ninto care  \n Use the 5As (Assess, Assist, Advice, Agree, Arrange)  \n\u2022 Perform a psychosocial assessment at enrolment to evaluate for possible \npsychological, emotional and social adherence boosters and barriers  \n\u2022 Assess growth and developmental milestones (Annex 3) to rule out growth \nretardation, developmental challenges such as autism, deafness and any other \nphysical challenge. Any child with developmental challenges should be referred for \nappropriate care  \n\u2022 Identify the primary caregiver as soon as possible after diagnosis of HIV in a child. In \nthe absence of a caregiver, link the child to a community health volunteer or a peer \neducator while a more permanent solution is sought, and link with Department of \nChildren and Social Protection  \n\u2022 The child and their caregiver, if also infected, should be enrolled in the sa me clinic, \nand have appointments booked on the same clinic day for family -centered care  \n\u2022 Provide HIV education and counselling to caregiver (and child as appropriate for age, \nTable 5.5) as outlined in Table 5.2  \n\u2022 Identify and establish appropriate adherence s upport interventions (Table 5.3), \nincluding linkage to pediatric and caregiver support groups  \n\u2022 Discuss benefits of disclosure of HIV status of the child and formulate a disclosure \nplan for children aged 5 years and above (Annex 5)  \n\u2022 Conduct readiness assessme nt to initiate ART (Table 5.4); ART should be initiated \nsame day or the date of initiation agreed upon  \n\u2022 Review ART dosing and timing (including having the caregiver demonstrate how they \nmeasure and administer the ART)  \n\u2022 Conclude the session by agreeing on a t reatment and follow -up plan  \n\u2022 Where ART is initiated book the child to return within two weeks. Those unwilling to \ninitiate should return weekly for further counselling on barriers to initiation  \n\u2022 Identify referral needs and link as appropriate  \n\u2022 Document sessi on in the patient\u2019s chart  \nTwo weeks \nafter ART \nInitiation  \n \u2022 Review and reinforce the messages delivered at enrolment; confirm the caregiver\u2019s \nunderstanding of key messages  \n\u2022 Review ART dosing, timing and reminders (including having the caregiver \ndemonstrate how they measure and administer the ART)  \n\u2022 Explore any barriers to adherence  \n\u2022 Revisit benefits of disclosure and the individualized age -appropriate disclosure plan  \n\u2022 Identify referral needs and link as appropriate  \n\u2022 Document the session in the patien t\u2019s chart  \nFour weeks \nafter ART \nInitiation, \nand further \nfollow -up \nvisits  \n \u2022 Review and reinforce the messages delivered in previous sessions; confirm the \ncaregiver\u2019s understanding of key messages  \n\u2022 Review ART dosing, timing and reminders (including having the caregiver \ndemonstrate how they measure and administer the ART)  \n\u2022 Explore any barriers to adherence  \n\u2022 Revisit benefits of disclosure and the individualized age -appropriate disclosure plan  \n\u2022 Identify referral needs and link as appropriate  \n\u2022 Document the session in the patient\u2019s chart", "start_char_idx": 3, "end_char_idx": 3192, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7b0b322b-f28b-4a73-bd16-3d3fd3ee4edb": {"__data__": {"id_": "7b0b322b-f28b-4a73-bd16-3d3fd3ee4edb", "embedding": null, "metadata": {"page_label": "122", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "35f39843-73a3-4394-866d-e888da174518", "node_type": "4", "metadata": {"page_label": "122", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7857e728a6ba0aff63339ec8635d96e31fc0dee3988460de182d388fd14eae84", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b8a6896a-fb78-4637-8054-d3afbb87abcc", "node_type": "1", "metadata": {"page_label": "121", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "38d7eeaa187f3294706232591f42247bf4c21bb4e336c59233de6a90235c9877", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "fa01bcd0-4d9c-4284-a5b8-8b51ab7dc459", "node_type": "1", "metadata": {}, "hash": "e45e6c77d9a6e030878faf505e6046e5071b8664cf06fe97d981339599ce6b05", "class_name": "RelatedNodeInfo"}}, "hash": "816128f777ebf4bfd2d82b58dff9cb71e71a92be4c7f557d4b3ed592c4efb217", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 18 Table 5.8: Treatment Preparation and Support for Adolescents (10 -19 years)  \nVisit  Standard of care  \nAt \nenrolment \ninto care  Use the 5As (Assess, Assist, Advice, Agree, Arrange)  \n\u2022 Perform a psychosocial assessment at enrolment to evaluate for possible psychological, \nemotional and social adherence boosters and barriers  \n\u2022 Assess growth and developmental milestones to rule out growth retardation, \ndevelopmental challenges such as autism, deafness and any other physical challenge. \nAny adolescent with developmental challenges should be referred for appropriate care  \n\u2022 Identify the primary caregiver as soon as possible after diagnosis of HIV in an \nadolescent. Adolescents older than 15 years and emancipated minors may not have or \nmay not want the presence of a caregiver. In this case, the clinical team should explore \nalternative options to support the adolescent until they are ready to disclose to their \ncaregivers/guardian or identify someone to disclose to. The alterna tive options include \nadolescent mentors, peer educators, social worker, nurses or community health \nvolunteers as may be appropriate.  An adolescent can have both private and joint \nsessions with the caregiver when deemed appropriate  \n\u2022 The health provider shou ld explore Sexual and Reproductive Health (SRH) \nunderstanding, fears and needs of the adolescent and prioritize interventions as \nappropriate. SRH counseling should be introduced in a one -to-one session with the \nadolescent. The care giver can be excused fro m the sexual and reproductive health \nsession to enable adolescent to open up during the session  \n\u2022 The adolescent and their caregiver, if also infected, should be enrolled in the same \nclinic, and have appointments booked on the same clinic day for family -cent ered care  \n\u2022 Provide HIV education and counselling to caregiver (and adolescent as appropriate for \nage, Table 5.5) as outlined in Table 5.2  \n\u2022 Identify and establish appropriate adherence support interventions (Table 5.3), \nincluding linkage to adolescent and car egiver support groups  \n\u2022 Discuss with the caregiver the benefits of disclosure of HIV status to the adolescent (if \nnot aware of status) and formulate a disclosure plan for adolescents (see Annex 5 for \nage-appropriate disclosure)  \n\u2022 Conduct readiness assessment to initiate ART (Table 5.4); ART should be initiated \nsame day or the date of initiation agreed upon  \n\u2022 Review ART dosing and timing (including having the adolescent and/or caregiver \ndemonstrate how they measure and administer the ART)  \n\u2022 Conclude the session by agreeing on a treatment and follow -up plan  \n\u2022 Where ART is initiated, book the adolescent to return within two weeks. Those \nunwilling to initiate should return weekly for further counselling on barriers to \ninitiation  \n\u2022 Identify referral needs and li nk as appropriate  \n\u2022 Document session in the patient\u2019s chart", "start_char_idx": 3, "end_char_idx": 2962, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "fa01bcd0-4d9c-4284-a5b8-8b51ab7dc459": {"__data__": {"id_": "fa01bcd0-4d9c-4284-a5b8-8b51ab7dc459", "embedding": null, "metadata": {"page_label": "123", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a2f5ce8c-c7d7-4785-a075-2ecbcba56d09", "node_type": "4", "metadata": {"page_label": "123", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1850bd55341f96597f1a6c82916ffdb5ce2abf9ce13ae6fc497df4b41428ab4f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7b0b322b-f28b-4a73-bd16-3d3fd3ee4edb", "node_type": "1", "metadata": {"page_label": "122", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "816128f777ebf4bfd2d82b58dff9cb71e71a92be4c7f557d4b3ed592c4efb217", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "c9f62f5c-2694-415d-9e52-7e89a104200e", "node_type": "1", "metadata": {}, "hash": "08d21ea92e2aa764a551653ddc6c3dc50a48581f7d024964bacbbd84d720cb47", "class_name": "RelatedNodeInfo"}}, "hash": "e45e6c77d9a6e030878faf505e6046e5071b8664cf06fe97d981339599ce6b05", "text": "Adherence Preparation, Monitoring and Support  \n5 - 19 Table 5.8 Cont.  \nTwo \nweeks \nafter ART \ninitiation  \u2022 Review and reinforce the messages delivered at enrolment; confirm the adolescent\u2019s \nand/or caregiver\u2019s understanding of key messages  \n\u2022 Review ART dosing, timing and reminders (including having the adolescent and/or \ncaregiver demonstrate how they measure and administer the ART)  \n\u2022 Explore any barriers to adherence, including issues related to the school environment  \n\u2022 Review support systems (including adol escent support group)  \n\u2022 Revisit benefits of disclosure and the individualized age -appropriate disclosure plan  \n\u2022 Review SRH needs  \n\u2022 Identify referral needs and link as appropriate  \n\u2022 Document the session in the patient\u2019s chart  \nFour \nweeks \nafter ART \ninitiation, \nand \nfurther \nfollow -up \nvisits  \n \u2022 Review and reinforce the messages delivered in previous sessions; confirm the \nadolescent\u2019s and/or caregiver\u2019s understanding of key messages  \n\u2022 Review ART dosing, timing and reminders (including having the adolescent a nd/or \ncaregiver demonstrate how they measure and administer the ART)  \n\u2022 Explore any barriers to adherence, including issues related to the school environment  \n\u2022 Review support systems (including adolescent support group)  \n\u2022 Revisit benefits of disclosure and the in dividualized age -appropriate disclosure plan  \n\u2022 Review SRH needs  \n\u2022 Link to psychosocial support group  \n\u2022 Identify referral needs and link as appropriate  \n\u2022 Document the session in the patient\u2019s chart  \nTable 5.9: Treatment Preparation and Support for Adults  \nVisit  Standard of care  \nAt \nenrolment \ninto HIV \ncare  \n Use the 5As (Assess, Assist, Advice, Agree, Arrange)  \n\u25cf Perform a psychosocial assessment to evaluate adherence boosters and barriers e.g., \nmental, emotional and social status assessments; refer for appropriate care if mental \ndisorder diagnosed  \n\u25cf Identify a treatment buddy (family member, friend, peer educator, community health \nvolunteer, etc.) and involve them in HIV education and adherence counselling  \n\u25cf Provide HIV education and counselling to patient  \n\u25cf Identify and establish appropriate adherence support interventions (Table 5.3), \nincluding linkage to a support g roup  \n\u25cf Discuss benefits of disclosure of HIV status to a trusted family member/friend; how to \ndisclose; and establish a disclosure plan  \n\u25cf Discuss importance of child and sexual partner testing as well as assisted partner \nnotification services (aPNS)  \n\u25cf Discus pr evention methods such as condoms, PrEP, PEP, STI screening and treatment  \n\u25cf Conduct an assessment of readiness to initiate ART (Table 5.4); ART should be initiated \nsame day or the date of initiation agreed upon  \n\u25cf Review ART dosing and timing  \n\u25cf Conclude the sessi on by agreeing on a treatment and follow -up plan  \n\u25cf Where ART is initiated, book the patient to return within two weeks. Those unwilling \nto initiate should return weekly for further counselling on barriers to initiation  \n\u25cf Document session in the patient\u2019s cha rt", "start_char_idx": 3, "end_char_idx": 3043, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "c9f62f5c-2694-415d-9e52-7e89a104200e": {"__data__": {"id_": "c9f62f5c-2694-415d-9e52-7e89a104200e", "embedding": null, "metadata": {"page_label": "124", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "da72300b-4e2b-4241-a120-d4662bc74b74", "node_type": "4", "metadata": {"page_label": "124", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8ff8a31e3028c413fde1276c3f389757f4616593bb85c2607052168d13885550", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "fa01bcd0-4d9c-4284-a5b8-8b51ab7dc459", "node_type": "1", "metadata": {"page_label": "123", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e45e6c77d9a6e030878faf505e6046e5071b8664cf06fe97d981339599ce6b05", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5b992369-863a-4e61-9fdb-bf963b9a9416", "node_type": "1", "metadata": {}, "hash": "fa81f23efa2b9c3e0b529d36316d383d2c85e93aa0a3a628b3b3ca7040f4cc40", "class_name": "RelatedNodeInfo"}}, "hash": "08d21ea92e2aa764a551653ddc6c3dc50a48581f7d024964bacbbd84d720cb47", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 20 Table 5.9 Cont.  \nTwo weeks \nafter ART \ninitiation  \u25cf Review and reinforce the messages delivered at enrolment; confirm the patient\u2019s \nunderstanding of key messages  \n\u25cf Review ART dosing, timing and reminders  \n\u25cf Explore any barriers to adherence  \n\u25cf Review support systems  \n\u25cf Revisit benefits of disclosure, the disclosure plan and progress in aPNS  \n\u25cf Document the session in the patient\u2019s chart  \nFour weeks \nafter ART \ninitiation, \nand further \nfollow -up \nvisits  \u25cf Review and reinforce the messages delivered in previous sessions; confirm the \npatient\u2019s understanding of key messages  \n\u25cf Review ART dosing, timing and reminders  \n\u25cf Explore any barriers to adherence  \n\u25cf Review support systems  \n\u25cf Revisit benefits of disclosure the disclosure plan,  and progress in aPNS  \n\u25cf Document the session in the patient\u2019s chart  \n \n5.3 Adherence Monitoring, Counselling and Support During the First 3 Months \nof ART  \n5.3.1 Adherence Monitoring  \nOnce ART has been initiated, adherence should be assessed non-judgmentally by a trained \nprovider during each visit (Table 5.10).  The objectives of this assessment are to evaluate and \nreinforce the patient\u2019s adherence to ART, to elicit any barriers to the same, and to develop a plan \nwith the patient/caregiver to address any of the barriers identified. These may include incorrect \nknowledge of HIV infection and ART, unsupportive psychosocial factors, difficult home or school \nenvironment, substance use and poor motivation for taking medication. Patients/caregivers ne ed \nto be counselled on the importance of being honest about their adherence in order for the \nhealthcare team to serve them better.  \nAdherence monitoring requires a combination of interventions. At every clinical visit, the MMAS -\n4 should be administered as w ell as pill counts. MMAS -8 should be administered any time a \nhealthcare worker suspects adherence problem (e.g., patients with suspected or confirmed \ntreatment failure; patient who misses an appointment).", "start_char_idx": 3, "end_char_idx": 2055, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5b992369-863a-4e61-9fdb-bf963b9a9416": {"__data__": {"id_": "5b992369-863a-4e61-9fdb-bf963b9a9416", "embedding": null, "metadata": {"page_label": "125", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "68fae719-e46f-4e70-8b0b-547eca8099ca", "node_type": "4", "metadata": {"page_label": "125", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ffaa423be5666e201c31a9a28f2107180e18a9a1228907cb4d05c8cf90aa9ab2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "c9f62f5c-2694-415d-9e52-7e89a104200e", "node_type": "1", "metadata": {"page_label": "124", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "08d21ea92e2aa764a551653ddc6c3dc50a48581f7d024964bacbbd84d720cb47", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7486fd88-7ac4-4675-b046-961811c46390", "node_type": "1", "metadata": {}, "hash": "6ba682c9ab9d4eb1a1a9fec81505f487b290c058d6baca47e2667f7299ccb90a", "class_name": "RelatedNodeInfo"}}, "hash": "fa81f23efa2b9c3e0b529d36316d383d2c85e93aa0a3a628b3b3ca7040f4cc40", "text": "Adherence Preparation, Monitoring and Support  \n5 - 21 Table 5.10: Adherence Monitoring Strategies  \nAdher ence \nMonitoring \nStrategy  Technique  Frequency  \nSubjective (self -reported adherence)  \nMorisky \nMedication \nAdherence Scale -4 Use Table 5.11 to assess adherence using a \nstandardized questionnaire, and take action \nas required  Every patient, every visit  \nMorisky \nMedication \nAdherence Scale -8 Use Table 5.12 to assess adherence using a \nstandardized questionnaire, and take action \nas required  Any time a healthcare worker \nsuspects adherence problems \n(e.g., patients with suspected or \nconfirmed treatment failure; \npatient who misses an \nappointment)  \nAdherence \nMonitoring \nStrategy  Technique  Frequency  \nObjective  \n \n \n \nPill counts  Ask the patient to bring all their pills with \nthem to follow -up visits. Calculate how many \npills should be remaining based on the \nprevious prescription date and amount \nprescribed, and compare to how many pills \nare actually remaining. Excess pills are \nassumed to be missed doses. Use Table 5.13 to \ncalculate adherence rate and take action as \nrequired  \u25cf At every visit until confirmed \nviral suppression  \n\u25cf Any time a healthcare worker \nsuspects adherence problems  \n \nPharmacy refill \nrecords  Compare drug pick -up date with expected \ndate of pick -up (based on number of pills \ndispensed at last visit). If drug pick -up date is \nlater than expected, it is assumed the patient \nis missing doses equivalent to the number of \ndays late  \u25cf At every drug pick -up \n\u25cf Any time a healthcare worker \nsuspects adherence problems  \nViral load  Follow the viral load monitoring algorithm \n(Figure 6.6). Undetectable VL is the best \nconfirmation of adequate adherence  \u25cf Age 0 -24 years: at 3 months after \nART initiation and then every 6 \nmonths  \n\u25cf Age \u2265 25 years: at month 3 after \nART initiation and month 12 \nthen annually  \n\u25cf For pregnant and breastfeeding \nwomen: at fir st ANC visit if \nalready on ART, or 3 months \nafter ART initiation if starting \nART during pregnancy, and then \nevery 6 months", "start_char_idx": 3, "end_char_idx": 2068, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7486fd88-7ac4-4675-b046-961811c46390": {"__data__": {"id_": "7486fd88-7ac4-4675-b046-961811c46390", "embedding": null, "metadata": {"page_label": "126", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "9d157dd4-5728-44ac-b1a4-4d4414c15544", "node_type": "4", "metadata": {"page_label": "126", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5fc716c56101bc3c9893876e8fe7db12419122cd9b59d70e7cbff9d048ce2337", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5b992369-863a-4e61-9fdb-bf963b9a9416", "node_type": "1", "metadata": {"page_label": "125", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fa81f23efa2b9c3e0b529d36316d383d2c85e93aa0a3a628b3b3ca7040f4cc40", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "87446390-acfc-46ea-ba64-93499cc28f41", "node_type": "1", "metadata": {}, "hash": "94618b2fb7c0efcafd1d2922e648f89f05b67abb430296694a0bdf30035f9163", "class_name": "RelatedNodeInfo"}}, "hash": "6ba682c9ab9d4eb1a1a9fec81505f487b290c058d6baca47e2667f7299ccb90a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 22 Table 5:10 Cont.  \n \n \nHome visit  Observe where and how a patient stores and takes \ntheir medications and assess if they have extra \nmedications because of missed doses. Home visits \nmay also provide a better understanding of a \npatient\u2019s living situation and specific barriers to \nadherence. Unscheduled home visits may be more \nrevealing, but should only be conducted if the  patient \nconsente d to home visits previously (preferably at \nthe time of enrolment or initiation)  For patients with suspected or \nconfirmed treatment failure, \npatients who default from care, \nor any time the MDT feels a \nhome visit will contribute to \npatient management  \n \nAccurately assessing adherence requires clinicians to develop a collaborative and non -\njudgmental relationship with patients.  This is best done when one provider follows an \nindividual patient longitudinally. The key to asking patients about their adherence is not in the \nspecifics of the tool used but in taking the time to ask about adherence regularly and doing so in \nan open and truly inquisitive manner. Otherwise, many patients will simply state what they \nbelieve the clinician wants to hear: perfe ct adherence.  \nEvery provider in each ART service delivery point should receive training and gain confidence in \nassessing adherence and providing adherence support and counselling to the majority of patients \nwho do not have significant barriers to adherence . However, patients with significant adherence \nchallenges and multiple barriers to adherence should be referred to providers with additional \ntraining and time to offer dedicated and enhanced adherence support and counselling. Involving \nexperienced colleagu es at the same health facility should be done as soon as a concern is \nidentified, and the patient should be discussed by the MDT to generate as many solutions as \npossible. Consultation with Mental Health Teams or regional or national mentors may be require d \nfor complex situations.", "start_char_idx": 3, "end_char_idx": 2037, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "87446390-acfc-46ea-ba64-93499cc28f41": {"__data__": {"id_": "87446390-acfc-46ea-ba64-93499cc28f41", "embedding": null, "metadata": {"page_label": "127", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "502385a4-0d00-46ad-ba48-d921bb474f9d", "node_type": "4", "metadata": {"page_label": "127", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1ce98340568e3e3a6b7793969c034f1f596cb6489c37a98b571b50afcb4b14f0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7486fd88-7ac4-4675-b046-961811c46390", "node_type": "1", "metadata": {"page_label": "126", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6ba682c9ab9d4eb1a1a9fec81505f487b290c058d6baca47e2667f7299ccb90a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "434e6cb2-401f-45f9-96e0-6171cad2a21c", "node_type": "1", "metadata": {}, "hash": "e0f6a346caaf0d820157919fbc40148f16d322ff23b9a410bb7802d9cedd9655", "class_name": "RelatedNodeInfo"}}, "hash": "94618b2fb7c0efcafd1d2922e648f89f05b67abb430296694a0bdf30035f9163", "text": "Adherence Preparation, Monitoring and Support  \n5 - 23 Table 5.11: Morisky Medication Adherence Scale (MMAS -4) \nMMAS -4: Ask the patient each question below. Circle the corresponding score for each response. \nAfter completion of all questions, add up all the points that you have circle d for the total score.  \nQuestion  Yes No \n1. Do you ever forget to take your medicine?  1 0 \n2. Are you careless at times about taking your medicine?  1 0 \n3. Sometimes if you feel worse when you take the medicine, do you stop taking it?  1 0 \n4. When you feel better do you sometimes stop taking your medicine?  1  0 \nTotal Score (sum of all items)   \nInterpretation of MMAS -4 Score  \nMMAS -4 \nScore  Adherence \nRating  Action Required  \n0 Good  Continue with routine monitoring, counselling and support  \n \n \n1-2  \n \nInadequate  \u25cf Discuss as an MDT  \n\u25cf Assign a case manager  \n\u25cf Assess for and address barriers to adherence (Table 5.15)  \n\u25cf Engage treatment supporter in adherence counselling sessions  \n\u25cf Follow up in 2 -4 weeks  \n \n \n3-4  \n \nPoor  \u25cf Discuss as an MDT  \n\u25cf Assign a case manager  \n\u25cf Assess for and address barriers to adherence (Table 5.15)  \n\u25cf Engage treatment supporter in adherence counselling sessions  \n\u25cf Implement DOTs  \n\u25cf Follow up in 1 -2 weeks", "start_char_idx": 3, "end_char_idx": 1264, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "434e6cb2-401f-45f9-96e0-6171cad2a21c": {"__data__": {"id_": "434e6cb2-401f-45f9-96e0-6171cad2a21c", "embedding": null, "metadata": {"page_label": "128", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ce2943ad-1dfe-49e6-ba45-70f2905130a4", "node_type": "4", "metadata": {"page_label": "128", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7bdb724aa4dce426444af82dd399314d894306ae11c77fe1055769714a9fd7c3", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "87446390-acfc-46ea-ba64-93499cc28f41", "node_type": "1", "metadata": {"page_label": "127", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "94618b2fb7c0efcafd1d2922e648f89f05b67abb430296694a0bdf30035f9163", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "32ca64ee-46b2-4d94-bdaf-eea90d19e483", "node_type": "1", "metadata": {}, "hash": "99f715adb340e3bfb96b29836427e0a521f16e5c23e5a0a46657c2188a8ca5e1", "class_name": "RelatedNodeInfo"}}, "hash": "e0f6a346caaf0d820157919fbc40148f16d322ff23b9a410bb7802d9cedd9655", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 24 Table 5.12: Morisky Medication Adherence Scale (MMAS -8) \nMMAS -8: Ask the patient each question below. Circle the corresponding score for each \nresponse. After completion of all questions, add up all the points that you have circled for the \ntotal score.  \nQuestion  Yes No \n1. Do you ever forget to take your medicine?  1 0 \n2. Are you careless at times about taking your medicine?  1 0 \n3. Sometimes if you feel worse when you take the medicine, do you stop taking it?  1 0 \n4. When you feel better do you sometimes stop taking your medicine?  1 0 \n5. Did you take your medicine yesterday?  0 1 \n6. When you feel like your symptoms are under control, do you sometimes stop \ntaking your medicine?   \n1  \n0 \n7. Taking medication every day is a real inconvenience for some people. Do you ever \nfeel under pressure about sticking to your treatment plan?   \n1  \n0 \n8. How often do you have difficulty remembering to take all your medications? \n(Please circle the correct number)  \n  A. Never/Rarely  \n  B. Once in a while  \n  C. Sometimes  \n  D. Usually  \n  E. All the time  Points: A. 0  \nB. \u00bc C. \u00bd D. \u00be \nE. 1 \nTotal Score (sum of all items)  \nInterpretation of MMAS -8 Score  \nMMAS -8 Score  Adherence Rating  Action Required  \n0 Good  Continue with routine monitoring, counselling and support  \n \n \n1-2  \n \nInadequate  \u25cf Discuss as an MDT  \n\u25cf Assign a case manager  \n\u25cf Assess for and address barriers to adherence (Table 5.15)  \n\u25cf Engage treatment supporter in adherence counselling \nsessions  \n\u25cf Follow up in 2 -4 weeks  \n \n \n \n3-8  \n \n \nPoor  \u25cf Discuss as an MDT  \n\u25cf Assign a case manager  \n\u25cf Assess for and address barriers to adherence (Table 5.15)  \n\u25cf Engage treatment supporter in adherence counselling \nsessions  \n\u25cf Implement DOTs  \n\u25cf Follow up in 1 -2 weeks", "start_char_idx": 3, "end_char_idx": 1830, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "32ca64ee-46b2-4d94-bdaf-eea90d19e483": {"__data__": {"id_": "32ca64ee-46b2-4d94-bdaf-eea90d19e483", "embedding": null, "metadata": {"page_label": "129", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "de7d242e-f564-4dfc-8762-6b7ca16938ed", "node_type": "4", "metadata": {"page_label": "129", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e0f99c7714c159ed3de57fd17cdbfdafb016d5cb9dba28bc7de62528e8201aff", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "434e6cb2-401f-45f9-96e0-6171cad2a21c", "node_type": "1", "metadata": {"page_label": "128", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e0f6a346caaf0d820157919fbc40148f16d322ff23b9a410bb7802d9cedd9655", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d36ad2c8-3deb-4211-96eb-f0d4d862ce3f", "node_type": "1", "metadata": {}, "hash": "80198aa00a16b8772d760f14fcc4ec0632310fecf1a26da65124fcce6a2b5827", "class_name": "RelatedNodeInfo"}}, "hash": "99f715adb340e3bfb96b29836427e0a521f16e5c23e5a0a46657c2188a8ca5e1", "text": "Adherence Preparation, Monitoring and Support  \n5 - 25 Table 5.13: Adherence Rate Based on Pill Counts  \nMissed Doses per Month  % Of \nMedications \nTaken  Adherence  \nRating  Action Required (see Table 5.10 for \nmore details)  For once -\ndaily \nregimen  For BD  \nregimen  \n1 dose  1-3 doses  \u2265 95%  Good  Continue with routine monitoring, \ncounselling and support  \n2-4 doses  4-8 doses  85-94%  Inadequate  \u25cf Discuss as an MDT  \n\u25cf Assign a case manager  \n\u25cf Assess for and address barriers to \nadherence (Table 5.15)  \n\u25cf Engage treatment supporter in \nadherence counselling sessions  \n\u25cf Follow up in 2 -4 weeks  \n\u2265 5 doses  \u2265 9 doses  < 85%  Poor  \u25cf Discuss as an MDT  \n\u25cf Assign a case manager  \n\u25cf Assess for and address barriers to \nadherence (Table 5.15)  \n\u25cf Engage treatment supporter in \nadherence counselling sessions  \n\u25cf Implement DOTs  \n\u25cf Follow up in 1 -2 weeks  \n \n5.3.2 Adherence Counselling and Support During the First 3 Months of ART  \nAll patients recently initiated on ART need careful adherence monitoring and support to \nensure they achieve virological suppression.  This is particularly important in the context of \nrapid ART initiation. The intensity of counselling and support are dependent on the patients\u2019 level \nof adherence as assessed by the methods described i n section 5.2.1.  \nTable 5.14 summarizes adherence counselling and support for patients from the time of ART \ninitiation until the 3 -month viral load results are available. For patients who have inadequate or \npoor adherence, Table 5.15 describes the assessmen t for barriers to adherence.", "start_char_idx": 3, "end_char_idx": 1580, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d36ad2c8-3deb-4211-96eb-f0d4d862ce3f": {"__data__": {"id_": "d36ad2c8-3deb-4211-96eb-f0d4d862ce3f", "embedding": null, "metadata": {"page_label": "130", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e0cd46f5-c1ae-47d5-9d47-2540161e6126", "node_type": "4", "metadata": {"page_label": "130", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "85e325569d0129cf12f4e4551f21488b3be2c83d82efc6929037a7d8da8d59d0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "32ca64ee-46b2-4d94-bdaf-eea90d19e483", "node_type": "1", "metadata": {"page_label": "129", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "99f715adb340e3bfb96b29836427e0a521f16e5c23e5a0a46657c2188a8ca5e1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e51a4e3a-d69f-4bc5-84dd-2a6cbac8b6e2", "node_type": "1", "metadata": {}, "hash": "6f4e4e02d60f9d3a655a00ba40638f297363f04b8324232d38a8315a248ad86f", "class_name": "RelatedNodeInfo"}}, "hash": "80198aa00a16b8772d760f14fcc4ec0632310fecf1a26da65124fcce6a2b5827", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 26 Table 5.14: Adherence Counselling and Support During the First 3 Months of ART  \nNo adherence concerns (based on adherence assessment and healthcare team opinion)  \nCounselling: Group or \nIndividual, at every visit (can be \ndone by any member of the \nhealthcare team, including the \nclinician)  \u25cf Review patient/caregiver HIV knowledge (Table 5.2, Annex 8) \nand address any gaps  \n\u25cf Review patient/caregiver understanding of ART \nadministration (dosing, timing, frequency) and address any \ngaps  \n\u25cf Elicit any concerns the patient/caregiver has about ART, other \nmedications, visit schedule, or health. Address any concerns or \nengage another care team member who can address them  \n\u25cf Explore any major recent or expected changes in the \npatient\u2019s/caregiver \u2019s life or daily routine that could disrupt \nadherence  \n\u25cf Update patient locator and contact information  \nSupport  \u25cf Encourage the patient/caregiver to continue with the support \nsystems discussed and implemented already  \n\u25cf Encourage introduction of additional standard support \nsystems (Table 5.3), including supporting disclosure as needed  \nInadequate or poor adherence (based on adherence assessment or healthcare team opinion)  \nCounselling: Individual, at \nevery visit until adherence is \ngood (preferably by someone \ntrained on adherence \ncounselling)  \u25cf Assess for and address potential barriers to adherence \n(Table  5.15)  \n\u25cf Review patient/caregiver HIV knowledge (Table 5.2, Annex 8) \nand address any gaps  \n\u25cf Review patient/caregiver understanding of ART administration \n(dosing, timing, frequency) and address any gaps  \n\u25cf Elicit any concerns the patient/caregiver has about ART, other \nmedications, visit schedule, or health. Address any concerns or \nengage another care team member who can addr ess them  \n\u25cf Explore any major recent or expected changes in the \npatient\u2019s/caregiver\u2019s life or daily routine that could disrupt \nadherence  \n\u25cf Update patient locator and contact information  \nSupport  \u25cf Review effectiveness of support systems they already have in \nplace  \n\u25cf Encourage introduction of additional standard and enhanced \nsupport systems (Table 5.3), including supporting disclosure as \nneeded, assigning a case manager and considering DOTs", "start_char_idx": 3, "end_char_idx": 2290, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e51a4e3a-d69f-4bc5-84dd-2a6cbac8b6e2": {"__data__": {"id_": "e51a4e3a-d69f-4bc5-84dd-2a6cbac8b6e2", "embedding": null, "metadata": {"page_label": "131", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1e78686f-8ba1-487b-94b9-38ae0a0c0438", "node_type": "4", "metadata": {"page_label": "131", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "865615891efc61711fde637272ba3e47d2dc566efac230fc27d4e602354aa0e4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d36ad2c8-3deb-4211-96eb-f0d4d862ce3f", "node_type": "1", "metadata": {"page_label": "130", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "80198aa00a16b8772d760f14fcc4ec0632310fecf1a26da65124fcce6a2b5827", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "252c6e79-943c-439b-9ec5-aa6423d1cc9a", "node_type": "1", "metadata": {}, "hash": "78d05f13ba1a10be13364280618f421cfdf3f4f7c12a1babd746b2f5e509dc27", "class_name": "RelatedNodeInfo"}}, "hash": "6f4e4e02d60f9d3a655a00ba40638f297363f04b8324232d38a8315a248ad86f", "text": "Adherence Preparation, Monitoring and Support  \n5 - 27 Table 5.15: Assessment for Barriers to Adherence  \nTheme  Assessment  \nAwareness of  \nHIV status  \u25cf Has the patient/caregiver accepted HIV status?  \n\u25cf For children/adolescents: is age -appropriate disclosure underway/complete?  \n \n \nUnderstanding  \nof HIV infection \nand ART  \u25cf How HIV affects the body and risk of transmission to sexual partners and \nchildren during pregnancy and breastfeeding  \n\u25cf ART and how it works  \n\u25cf Understanding of side effects and what to do in case of side effects  \no \u201cHave you experienced any side effect since your last visit? Has this \naffected the way you take your medicine?\u201d  \n\u25cf Benefits of adherence  \n\u25cf Consequences of non -adherence including drug resistance and treatment \nfailure  \n \nDaily routine  \u25cf Review the patient\u2019s/caregiver\u2019s daily routine: \u201cTell me about your typical day\u201d  \n\u25cf Review how the patient takes medicine or how the caregiver administers it  \no \u201cPlease tell me how you take each of your medicines?\u201d  \no \u201cHow does taking your medicine fit into your daily routine?\u201d  \n\u25cf If the patient\u2019s/caregiver\u2019s daily routine conflicts with medication schedule, \nwork with t hem to find a new medication schedule that will be more \nappropriate  \n\u25cf Remind the patient/caregiver to take/give missed or delayed doses as soon as \nhe/she remembers (up to 12 hours late if on a once -daily regimen, or up to 6 \nhours late if on a twice - daily re gimen). The next dose should be taken at the \nusual time  \n\u25cf \u201cWhat do you do in case of visits or travel?\u201d  \n\u25cf Remind the patient/caregiver to plan travel well, pack sufficient medicine; but \nshould their medication get finished before they return, advise them to vi sit the \nclosest ART centre and show their appointment card to get a refill  \n\u25cf For orphans it is critical to assess who the primary caregiver is and their \ncommitment", "start_char_idx": 3, "end_char_idx": 1878, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "252c6e79-943c-439b-9ec5-aa6423d1cc9a": {"__data__": {"id_": "252c6e79-943c-439b-9ec5-aa6423d1cc9a", "embedding": null, "metadata": {"page_label": "132", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "87f95af1-273f-4f8b-8f43-99dd6ab16c1d", "node_type": "4", "metadata": {"page_label": "132", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a45e6982efd54220dc64c24728b6ec664e14f75488047f2232efbdc60f009dea", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e51a4e3a-d69f-4bc5-84dd-2a6cbac8b6e2", "node_type": "1", "metadata": {"page_label": "131", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6f4e4e02d60f9d3a655a00ba40638f297363f04b8324232d38a8315a248ad86f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a9117e0e-e05b-4934-8219-6f1db80ced92", "node_type": "1", "metadata": {}, "hash": "d414075606e45a7c78789f5672945da0f9c5358f6be1b8d55a9036fb6192bf17", "class_name": "RelatedNodeInfo"}}, "hash": "78d05f13ba1a10be13364280618f421cfdf3f4f7c12a1babd746b2f5e509dc27", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 28 Table 5.15 Cont.  \n \n \nPsychosocial \ncircumstance  Home environment:  \n\u25cf \u201cWho do you live with?\u201d  \n\u25cf \u201cWho is aware of your HIV status? Are there people in your life with whom you\u2019ve \ndiscussed your HIV status and ART use?\u201d  \no Discuss the usefulness of enlisting the support of family members, friends \nor a treatment supporter/buddy in reminding them to take medication (for \nchildren/adolescents, this includes teachers and/or supportive peers at \nschool); offer assisted disclosure  \no Encourage the patient to identify and bring a treatment supporter during \nthe next visit  \n\u25cf Support system (treatment buddy, psychos ocial support groups, etc.)  \n\u25cf Any recent losses, grief  \n\u25cf Changes in relationships with family members/friends  \n\u25cf Screen the patient/caregiver for alcohol and substance abuse (Tables 4.15 and \n4.16)  \no Discuss impact on ability to remember to take medication  \no Explore m otivation to stop and offer support/referral  \no Encourage limiting use and planning ahead so as not to forget to take \nmedication  \n\u25cf Screen for intimate partner violence (Section 4.2.1)  \n\u25cf Stigma and discrimination  \no \u201cDoes it bother you people might find out about your HIV status?\u201d  \no \u201cDo you feel that people treat you differently when they know your HIV \nstatus?\u201d  \n\u25cf Discuss if stigma is interfering with taking medication on time or with keeping \nclinic appointments  \n\u25cf Beliefs: has the patient tried faith healing? Has th e patient ever stopped using \nmedication because of religious beliefs?  \nMental Health  \nScreening  \u25cf Screen patient/caregiver for depression using the PHQ -9 (Table 4.14) and \nmanage/refer as required  \n\u25cf Screen for other psychiatric conditions such as anxiety, post -traumatic stress \ndisorder or psychosis, or refer to a mental health worker for assessment  \nReferrals  \u25cf Establish if the patient has been referred to other services (including nutrition, \npsychosocial support services, other medical clinics, substance use treatment, \netc.)  \n\u25cf Did he/she attend the appointments? What was his/her experience? Do the \nreferrals need to be re -organized?", "start_char_idx": 3, "end_char_idx": 2157, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a9117e0e-e05b-4934-8219-6f1db80ced92": {"__data__": {"id_": "a9117e0e-e05b-4934-8219-6f1db80ced92", "embedding": null, "metadata": {"page_label": "133", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5f99e060-a63a-41ac-a624-2c3001f43fb9", "node_type": "4", "metadata": {"page_label": "133", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9a61a036980afdfdeb611785c2c6316d6d2de8277351950f017479925688809d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "252c6e79-943c-439b-9ec5-aa6423d1cc9a", "node_type": "1", "metadata": {"page_label": "132", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "78d05f13ba1a10be13364280618f421cfdf3f4f7c12a1babd746b2f5e509dc27", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d55043e0-fc84-431d-8457-410d5eb9b004", "node_type": "1", "metadata": {}, "hash": "da3b0a518201b690667e7852c4192f4c468aee503396b2e5b0f6f3628c8ecda8", "class_name": "RelatedNodeInfo"}}, "hash": "d414075606e45a7c78789f5672945da0f9c5358f6be1b8d55a9036fb6192bf17", "text": "Adherence Preparation, Monitoring and Support  \n5 - 29 5.4 Adherence Monitoring, Counselling and Support for Patients with  \nSuppressed Viral Load < 200 copies/ml  \nOnce a patient has confirmed viral suppression (with VL < 50 copies/ml or below the Lower \nDetection Limit (LDL)) this is confirmation of adequate adherence to ART. The patient can be \nreassured that they will do well if they continue to adhere. Ho wever, all patients are at risk of new \nor worsening barriers to adherence, so adherence monitoring, counselling and support should \ncontinue despite viral suppression, but at a lower intensity and frequency unless concerns are \nidentified (Table 5.16). These  patients should also be educated on and assessed for qualification \nas \u201cstable patient\u201d services such as less frequent facility visits, fast -track or community -based ART \ndistribution, etc. (Table 3.5).  \nTable 5.16: Adherence Counselling and Support for Pati ents with Viral Load < 50 copies/ml  \nNo adherence concerns (based on adherence assessment or healthcare team opinion)  \nCounselling: Group or \nindividual, every visit \n(can be done by any \nmember of the \nhealthcare team, \nincluding the clinician)  \u2022 Elicit any concerns the patient/caregiver has about ART, other \nmedications, visit schedule, or health. Address any concerns or engage \nanother care team member who can address them  \n\u2022 Explore any major recent or expected changes in the \npatient\u2019s/caregiver\u2019s life or daily  routine that could disrupt adherence  \n\u2022 Update patient locator and contact information  \nSupport  \u2022 Encourage the patient/caregiver to continue with the support systems \nthat are in place already  \nInadequate or poor adherence (based on adherence assessment or healthcare team opinion)  \nCounselling: Individual, \nat every visit until \nadherence is good \n(preferably by someone \ntrained on adherence \ncounselling)  \u2022 Assess for and address potential barriers to adherence (Table \n5.15)  \n\u2022 Review patient/caregiver HIV knowledge (Table 5.2, Annex 8) and \naddress any gaps  \n\u2022 Review patient/caregiver understanding of ART administration \n(dosing, timing, frequency) and address any gaps  \n\u2022 Elicit any concerns the patient/caregiver has about ART, other \nmedicatio ns, visit schedule, or health. Address any concerns or engage \nanother care team member who can address them  \n\u2022 Explore any major recent or expected changes in the \npatient\u2019s/caregiver\u2019s life or daily routine that could disrupt adherence  \n\u2022 Update patient locator and contact information  \nSupport  \u2022 Review effectiveness of support systems the patient already has in \nplace  \n\u2022 Encourage introduction of additional standard and enhanced support \nsystems (Table 5.3), including supporting disclosure as needed, \nassigning a case manager and considering DOTs", "start_char_idx": 3, "end_char_idx": 2792, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d55043e0-fc84-431d-8457-410d5eb9b004": {"__data__": {"id_": "d55043e0-fc84-431d-8457-410d5eb9b004", "embedding": null, "metadata": {"page_label": "134", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a7a00d35-2e8a-4dcc-815e-3d4a09b67001", "node_type": "4", "metadata": {"page_label": "134", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0133898f6d11cdabe74b9c7842bf0f026a6eadf1e0db627a731276f83c33ee6a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a9117e0e-e05b-4934-8219-6f1db80ced92", "node_type": "1", "metadata": {"page_label": "133", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d414075606e45a7c78789f5672945da0f9c5358f6be1b8d55a9036fb6192bf17", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "11430923-fb2e-48b9-865a-ed68518916ea", "node_type": "1", "metadata": {}, "hash": "eeccf25f274e9a4dbe9ee61cd88237133fb6be2ac9966f66ad3bddd6bf1eef3d", "class_name": "RelatedNodeInfo"}}, "hash": "da3b0a518201b690667e7852c4192f4c468aee503396b2e5b0f6f3628c8ecda8", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 30 Table 5.17 Viral Load Monitoring Cut -Offs  \nClinical \nDefinition  Category  Lab Value  Interpretation  Guidance  \n\u2022 Suppressed  \u2022 LDL  \n \n \n\u2022 Low Risk \nLLV  \u2022 <50 \nCopies/ml  \n \n\u2022 50 \u2013 199 \nCopies/ml.  \u2022 Treatment Goal  \n \n \n\u2022 Stable Client, \nUntransmissible  \u2022 Continue Management  \n \n \n\u2022 Continue management, \nremind client of \ntreatment goal  \n\u2022 Enroll  in DSD  \n \n\u2022 Unsuppressed  \u2022 High Risk \nLLV  \u2022 200 -999 \nCopies/ml \u2022 Increased risk \nof progression \nto treatment \nfailure  \u2022 Step down from DSD, \ninstitute EAC, repeat VL \nafter 3 months of \nexcellent adherence  \n \n\u2022 Suspected \nTreatment \nFailure  \u2022 \u22651000 \nCopies/ml  \u2022 Client at \nincreased risk \nof morbidity \nand mortality  \u2022 Enroll Client in \nspecialized clinic if \navailable  \n\u2022 Conduct EAC  \n\u2022 Refer to VL algorithm  \n \n \n5.5 Adherence Monitoring, Counselling and Support for Patients with \nUnsuppressed Viral Load \u2265 200 copies/ml  \nTreatment failure should be suspected whenever a patient has been on ART for at least 3 months \nand has: a viral load \u2265 200 copies/ml; a decline in CD4 count or; a ny new or worsening clinical \ncondition. Treatment failure is confirmed as per the viral load monitoring algorithm (Figure 6.6). \nPoor adherence is often the most important factor in developing treatment failure, though there \ncan be other causes. Adherence m ust be thoroughly assessed and all issues must be addressed \nbefore switching patients to the next line of ART. Do not change regimens until the reason/s \nfor treatment failure have been identified and addressed, and a repeat VL is \u2265 1,000 \ncopies/ml after 3 months of excellent adherence . For patients with high -risk  persistent low -\nlevel viremia (VL 200 - 999 copies/ml after additional assessment and intervention), consult the \nRegional or National HIV Clinical TWG (Uliza Hotline 0726 460 000; \nhttps://nh csc.nascop.org/clinicalform ).", "start_char_idx": 3, "end_char_idx": 1930, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "11430923-fb2e-48b9-865a-ed68518916ea": {"__data__": {"id_": "11430923-fb2e-48b9-865a-ed68518916ea", "embedding": null, "metadata": {"page_label": "135", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "869d0abc-bedf-475c-96e0-f4e6cbc3edec", "node_type": "4", "metadata": {"page_label": "135", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "49bc4cee5774f455f1db96dd93e58f9d44582ab39d4e368a2904685c076d937d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d55043e0-fc84-431d-8457-410d5eb9b004", "node_type": "1", "metadata": {"page_label": "134", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "da3b0a518201b690667e7852c4192f4c468aee503396b2e5b0f6f3628c8ecda8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bb803592-1397-4da8-a96f-3984b863731e", "node_type": "1", "metadata": {}, "hash": "1837fe6837ef2064f07a655208d7210eaad44e3d95c8dbd207c9f255a79ad277", "class_name": "RelatedNodeInfo"}}, "hash": "eeccf25f274e9a4dbe9ee61cd88237133fb6be2ac9966f66ad3bddd6bf1eef3d", "text": "Adherence Preparation, Monitoring and Support  \n5 - 31 5.5.1 Enhanced Adherence Assessments  \nAs soon as treatment failure is suspected the patient/caregiver should be discussed by the facility \nmulti -disciplinary team to develop a plan for assessing barriers to adherence (includin g \nscheduling a home visit), and assessing other potential causes of treatment failure (e.g., \ninadequate dosing/dose adjustments, drug -drug interactions, drug -food interactions, impaired \nabsorption e.g., chronic severe diarrhoea).  \nAll patients with suspecte d or confirmed treatment failure should have a thorough assessment of \npotential barriers to adherence (Table 5.15).  \nIf the patient has a caregiver, treatment buddy, and/or spouse/partner who is enrolled in HIV \ncare, that person\u2019s file should also be review ed to confirm their most recent viral load results and \nadherence.  \n5.5.2 Enhanced Adherence Counselling  \nAdherence assessment and enhanced adherence counselling should begin as soon as a detectable \nviral load ( \u2265 200 copies/ml) is received, preferably within 2 weeks.  \nThe goal of Enhanced Adherence Counselling is to assess possible barriers to adherence in a non -\njudgmental way and to help the patient construct an adherence plan with concrete objectives. It \nis important not to focus solely on k nowledge of HIV and ART but also to review psychological, \nemotional, and socio -economic factors that may contribute to poor adherence. In addition, \nexploring the patient\u2019s motivation for taking medication often highlights reasons for poor \nadherence.  \nAt lea st three sessions of Enhanced Adherence Counselling, spaced 2 -4 weeks apart, are \nrecommended as the minimum number of sessions, but additional sessions can be added as \nneeded (Table 5.1 8). If the adherence is evaluated as adequate, a repeat viral load is d one after \nthree months of excellent adherence, and another Enhanced Adherence Counselling session is \nconducted to discuss the viral load results. A detailed content guide for Enhanced Adherence \nCounselling is provided in Annex 9.  \nIt is preferable to have t he patient go through all adherence counselling sessions with the same \ncounsellor in order to provide continuity, and that the session is documented to ensure follow -up \nof all issues identified.  \nIf adequate adherence cannot be achieved then consult with a senior clinician, discuss as an MDT, \nor consult the Regional or National TWG.", "start_char_idx": 3, "end_char_idx": 2444, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bb803592-1397-4da8-a96f-3984b863731e": {"__data__": {"id_": "bb803592-1397-4da8-a96f-3984b863731e", "embedding": null, "metadata": {"page_label": "136", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8858a28f-c93f-4ba5-9026-e4141f676042", "node_type": "4", "metadata": {"page_label": "136", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a443854bb57993dc548019ac782ebc00a58f43c1efcd8a793d6dadb50e4ef103", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "11430923-fb2e-48b9-865a-ed68518916ea", "node_type": "1", "metadata": {"page_label": "135", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "eeccf25f274e9a4dbe9ee61cd88237133fb6be2ac9966f66ad3bddd6bf1eef3d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5c1a7b3a-ffe0-439f-a817-9698e74fbd39", "node_type": "1", "metadata": {}, "hash": "27514f3480c1b645ea94b372f39da5bf807d60e20f3684101251aa44bbb73225", "class_name": "RelatedNodeInfo"}}, "hash": "1837fe6837ef2064f07a655208d7210eaad44e3d95c8dbd207c9f255a79ad277", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 32 Table 5.1 8: Components of Enhanced Adherence Counselling Sessions (Annex 9A for detailed \ncontent guide)  \nEnhanced Adherence Counselling Sessions: Overview  \n \nSession 1  \u2022 Review understanding of viral load (VL) and discuss why the patient\u2019s VL is \nhigh  \n\u2022 Review common cognitive, behavioral, emotional and socio -economic barriers \nto adherence  \no Stigma and non -disclosure  \no Loss or grief  \no Treatment literacy  \no Medications: dosage, timing, storage  \no Side effects  \no Discuss risk reduction (e.g., for substance abuse)  \no Motivation  \no Mental health screening (screen for depression using PHQ -9, Table 4.14)  \no Discuss patient\u2019s support systems  \n\u25cf Assist patient to develop adherence plan to address the ide ntified issues  \n \nSession 2  \u25cf Review adherence plan from the first session and discuss any challenges  \n\u25cf Identify other possible gaps and issues emerging  \n\u25cf Assist patient to modify the adherence plan to address the identified issues  \n \n \nSession 3  \u25cf Review adherence plan from the first and second session and discuss any \nchallenges  \n\u25cf Identify other possible gaps and issues emerging  \n\u25cf Assist patient to modify the adherence plan to address the identified issues  \n\u25cf Decision on repeat VL based on current adherence  \no If the adherence is good: plan repeat VL testing after three months of good \nadherence and explain possible ways forward, emphasizing role of the \npatient and the health facility  \no If adherence challenges persist: consult with a senior clinician, discuss as \nan MD T, or consult the Regional or National TWG before repeating the VL  \n \nSession to \nDiscuss \nRepeat Viral \nLoad Results  \u25cf Discuss result of the second VL test  \n\u25cf Plan the way forward:  \no If VL now < 200 copies/ml: continue current regimen with ongoing \nenhanced adherence; repeat VL after 6 months  \no If VL \u2265 1,000: prepare patient for change of regimen (Figure 5.2)  \no If VL is 200 -999 copies/ml: perform another assessment for causes for \nviremia and address any issues identified; repeat viral load after an \nadditional 3 months of excellent adherence", "start_char_idx": 3, "end_char_idx": 2152, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5c1a7b3a-ffe0-439f-a817-9698e74fbd39": {"__data__": {"id_": "5c1a7b3a-ffe0-439f-a817-9698e74fbd39", "embedding": null, "metadata": {"page_label": "137", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6787bcc5-c3ef-4aa4-9112-3ba3611354a7", "node_type": "4", "metadata": {"page_label": "137", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "917af2bd62ef5da54ac32a471cac568fca9cf501177d5a9696cc25f3cdcdd30a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bb803592-1397-4da8-a96f-3984b863731e", "node_type": "1", "metadata": {"page_label": "136", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1837fe6837ef2064f07a655208d7210eaad44e3d95c8dbd207c9f255a79ad277", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d8370c24-3bf7-4a1d-808d-e626ee2c8fcc", "node_type": "1", "metadata": {}, "hash": "a8fc031188e7513b6bb79d599ebbc8bbc0a63ff23aa23e2ae044eca3bcaa2368", "class_name": "RelatedNodeInfo"}}, "hash": "27514f3480c1b645ea94b372f39da5bf807d60e20f3684101251aa44bbb73225", "text": "Adherence Preparation, Monitoring and Support  \n5 - 33 Table 5.1 8 Cont.  \nOther Enhanced Adherence Support Interventions (for patients failing or at high -risk of failing \ntreatment)  \nCase \nmanagement  \u2022 Assign a case manager to all children and adolescents (those not achieving \noptimum treatment outcomes); pregnant women, orphans, patients with alcohol \nand substance abuse, patients with mental illness, patients with suspected or \nconfirmed treatment failure, and any patients who the healthcare team feels has \npoor adheren ce or is at high risk of defaulting from care  \n\u2022 The case manager is the link between the patient and the MDT  \n\u2022 Roles  of the case managers include:  \no Coordinating multidisciplinary management for patients under case \nmanagement  \no Following up on appointment -keeping for their patients  \no Organizing patient reminders (SMS, calling the day before) and other support \nsystems  \no Ensuring appropriate defaulter tracing  \no Coordinating home visits to their patients  \nDirectly \nobserved \ntherapy  \u2022 Patients with suspected treatment failure should have DOTs to ensure good \nadherence before a viral load is repeated to confirm treatment failure  \n\u2022 DOTs involve a healthcare provider, family member, treatment supporter or any \ntrained peer observing the patient ingesting th eir prescribed ART on a daily basis  \n\u2022 DOTs can be tapered off once the patient adopts consistent adherence -enhancing \nbehaviours  and barriers to adherence are overcome  \nHome visits  \u2022 Observe where and how a patient stores and takes their medications, and assess if \nthey have extra medications because of missed doses  \n\u2022 Home visits may also provide a better understanding of a patient\u2019s living situation \nand specific barriers to adherence  \n\u2022 Unscheduled home visits may be more revealing, but should only be conducted if \nthe patient consented to home visits previously (preferably at the time of enrolment  \nor initiation)  \nMonthly \u201chigh \nviral load\u201d \nclinics  \u2022 Patients with suspected treatment failure should be booked for dedicated monthly \nhigh viral load clinics  \n\u2022 Children and adolescents in school who are unable to attend clinic monthly may \nattend dedicated monthly clinics during mid -term and school holidays (at least \nevery 6 weeks)  \n\u2022 Comprehensive clinical and psychosocial evaluation should be conducted at e ach \nvisit, appropriate investigations done and any opportunistic infections treated  \n\u2022 Enhanced adherence counseling sessions should be conducted at each visit  \n\u2022 Support groups for patients with viremia can be timed with \u201chigh viral load\u201d clinic \ndays  \nSpecial \nsupport \ngroups  \u2022 For health facilities with several patients who are failing treatment or who are on \n2nd line ART, special support groups can be established so these patients can work \nthrough their adherence challenges together  \n\u2022 Community support groups can also be engaged and linked to the facility for \nsupporting patients with adherence challenges", "start_char_idx": 3, "end_char_idx": 2985, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d8370c24-3bf7-4a1d-808d-e626ee2c8fcc": {"__data__": {"id_": "d8370c24-3bf7-4a1d-808d-e626ee2c8fcc", "embedding": null, "metadata": {"page_label": "138", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8c6fa3b6-2dd8-4ffa-ab3d-b476301a484d", "node_type": "4", "metadata": {"page_label": "138", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3abe9f5ea5fff583e6cdb1f7ba0822657bae176a31b0ddad5c8b40cad0f056f0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5c1a7b3a-ffe0-439f-a817-9698e74fbd39", "node_type": "1", "metadata": {"page_label": "137", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "27514f3480c1b645ea94b372f39da5bf807d60e20f3684101251aa44bbb73225", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a25411ad-458e-4adc-8dcb-f2081a9dc29a", "node_type": "1", "metadata": {}, "hash": "cc44a15006d92df5dec61dadc0aacbb18a66cfc9c347874fa1c478d05343de89", "class_name": "RelatedNodeInfo"}}, "hash": "a8fc031188e7513b6bb79d599ebbc8bbc0a63ff23aa23e2ae044eca3bcaa2368", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 34 Adherence support systems will need to be adapted to patients\u2019 specific needs and the context \n(Table 5.1 8). Special attention needs to be given to children, a dolescents, pregnant and \nbreastfeeding women, patients with mental health disorders and substance users.  \n5.6 Treatment Preparation for 2nd Line or 3rd Line ART  \nAfter confirming treatment failure and making the decision to start 2nd line or 3rd line ART (ba sed \non discussion as an MDT, and in consultation with the Regional or National HIV Clinical TWG), the \npatient requires targeted counselling and education to prepare them for the new regimen and to \nsupport ongoing adherence (Figure 5.2).  \nReview patient file\nAssess patient  s \nknowledge and \nunderstanding\nProvide patient education\nConstruct adherence plan\nEnsure monthly \ncounselling follow -up \nsessionsEnsure a monthly follow -up counselling session during \nclinic visits for the first 6months after initiating the new \nregimen\n\u2022 Follow up on problems identified during the previous \nsessions\n\u2022 Assess patient  s adherence and explore any reasons for \npoor adherence. Identify strategies to overcome these \nbarriers\nRepeat VL after 3 months on new regimen\n\u2022 If VL undetectable: adherence counselling every \n3months\n\u2022 If VL is detectable: discuss as MDT and consult Clinical \nTWG\u2022 Confirm patient  s willingness to start new regimen\n\u2022 Ensure that the patient understands the treatment plan \n(drug regimen, dosing schedule, dietary restrictions, \npotential side effects, what to do when missing doses or \nexperiencing side effects)\n\u2022 Prepare for situations that could impair good \nadherence, and encourage disclosure of poor adherence\n\u2022 Plan sessions with the pharmacist on medication \nadherence, and nutritionist on nutritional aspects\u2022 Strengthen key messages on HIV and viral load\n\u2022 Provide information on 2nd/3rd line ART: more complex \nto take (more pills, twice -a-day dosing), very limited \noptions if this fails\n\u2022 Provide simple take -home IEC materials on 2nd  or 3rd  \nline ART management\u2022 HIV, viral load and ART\n\u2022 The importance of good adherence and potential \nproblems of non -adherence\n\u2022 Reasons for switching to 2nd or 3rd line ART: treatment \nfailure with repeated high viral load\u2022 Review the patient file and all problems identified \nduring Enhanced Adherence Counselling sessions\n\u2022 Confirm all the barriers to adherence have been \naddressed during Enhanced Adherence Counselling, if \nnot \u2013 address remaining barriers before considering \nchanging regimens\n \n \nFigure 5.2: Adherence Counselling and Education for Patients Preparing to Initiate 2nd Line or \n3rd Line ART", "start_char_idx": 3, "end_char_idx": 2678, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a25411ad-458e-4adc-8dcb-f2081a9dc29a": {"__data__": {"id_": "a25411ad-458e-4adc-8dcb-f2081a9dc29a", "embedding": null, "metadata": {"page_label": "139", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "25171e07-2718-4357-afff-eef710bc5890", "node_type": "4", "metadata": {"page_label": "139", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fde7fd25b9fc12b8c4377ed3a18141fb1a951aa140bb47f918ed4f232ac84eb8", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d8370c24-3bf7-4a1d-808d-e626ee2c8fcc", "node_type": "1", "metadata": {"page_label": "138", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a8fc031188e7513b6bb79d599ebbc8bbc0a63ff23aa23e2ae044eca3bcaa2368", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "782233bd-8681-463a-a590-533a14ee1ab5", "node_type": "1", "metadata": {}, "hash": "824635b98134b8b7f6ff81df0f3319f818a518c9c7f6e2d871dc8440503cc233", "class_name": "RelatedNodeInfo"}}, "hash": "cc44a15006d92df5dec61dadc0aacbb18a66cfc9c347874fa1c478d05343de89", "text": "Adherence Preparation, Monitoring and Support  \n5 - 35 5.7 Identifying, Tracing, and Supporting Patients who Default from Care  \nEvery service delivery point that is providing ARVs for patients (whether ART, PEP, or PrEP) must \nhave a functional system for identifying patients who miss appointments and for taking action \nwithin 24 hours of a missed appointment (Figure 5.3).  \nEnter date of next appointment/TCA for each patient into the \nappointment diary\n\u2022 As patients arrive at the service delivery point their name should be \nchecked off in the appointment diary for that day\n\u2022 All patients who had appointments booked for the day but did not \nattend clinic should be recorded in the patient follow -up register\n\u2022 Patient/caregiver should be called within 24 hours of missed \nappointment\n\u2022 If no response, treatment buddy should be called\n\u2022 Several attempts at phone tracing should be made if no response \ninitially\n\u2022 Update the patient follow -up register with phone call findings\nPatient does not return \nwithin time agreed upon \nduring phone call, but still \nable to reach by phonePatient returns to clinic \nwithin 7 days, or returns \non date agreed during \nphone callUnable to reach by phone, \nand does not return to \nclinic within 7 daysPatient dead, transferred \nout, or declines further \ncontact: update patient \nrecords/ registers with \noutcome\nReturns to clinic\n\u2022 Assess for and address potential barriers to adherence \n(Table 5.14) \n\u2022 Review patient/caregiver HIV knowledge (Table 5.1, \nAnnex 6) and address any gaps\n\u2022 Elicit any concerns the patient/caregiver has about ART, \nother medications, visit schedule, or health. Address any \nconcerns or engage another care team member who can \naddress them\n\u2022 Explore any major recent or expected changes in the \npatient s/caregiver  s life or daily routine that could disrupt \nadherence\n\u2022 Review effectiveness of facility and community support \nsystems the patient already has in place\n\u2022 Encourage introduction of additional standard  and \nenhanced support systems (Table 5.2), including \nsupporting disclosure as needed, assigning a case manager \nand considering DOTs\n\u2022 Review ART Readiness Assessment Form for re -initiation \nof ART\u2022 Prioritized home visit, based on\no Patient type (pregnant and \nbreastfeeding women, child, co -\nmorbidity)\no Proximity to clinic\n\u2022 Complete the home visit form\n\u2022 Update the patient follow -up register with \nhome visit findings\n\u2022 Update appointment diary if agrees to \nreturn to clinic\nUnable to trace or does not return to clinic on \nscheduled appointment date\n\u2022 Discuss as MDT and develop follow -up/ \nmanagement plan\n\u2022 Update patient records/registers with \noutcome\n \nFigure 5.3: Ident ifying, Tracing and Supporting Patients who Default from Care", "start_char_idx": 3, "end_char_idx": 2749, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "782233bd-8681-463a-a590-533a14ee1ab5": {"__data__": {"id_": "782233bd-8681-463a-a590-533a14ee1ab5", "embedding": null, "metadata": {"page_label": "140", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "228a0999-6474-4e72-a750-9c59285108fe", "node_type": "4", "metadata": {"page_label": "140", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ee6d1967c932765f00a5ecf315f43334d897439ea98794856d74923ec9495ce5", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a25411ad-458e-4adc-8dcb-f2081a9dc29a", "node_type": "1", "metadata": {"page_label": "139", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cc44a15006d92df5dec61dadc0aacbb18a66cfc9c347874fa1c478d05343de89", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e00307f4-fc20-4775-a344-bfe058a8a7ff", "node_type": "1", "metadata": {}, "hash": "2532f71cad7f0fde63c27f2a51bc543116ea54f0a4f082bb22f7ba4c1e02d268", "class_name": "RelatedNodeInfo"}}, "hash": "824635b98134b8b7f6ff81df0f3319f818a518c9c7f6e2d871dc8440503cc233", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n5 - 36", "start_char_idx": 3, "end_char_idx": 63, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e00307f4-fc20-4775-a344-bfe058a8a7ff": {"__data__": {"id_": "e00307f4-fc20-4775-a344-bfe058a8a7ff", "embedding": null, "metadata": {"page_label": "141", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1544e7a3-92ac-4cd9-b8a5-19e8dcd1dbdb", "node_type": "4", "metadata": {"page_label": "141", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "157c302758d6354b0948eaaf00a29a54c0a2bf94cc5d686ac46dcc36e8b68b44", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "782233bd-8681-463a-a590-533a14ee1ab5", "node_type": "1", "metadata": {"page_label": "140", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "824635b98134b8b7f6ff81df0f3319f818a518c9c7f6e2d871dc8440503cc233", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a63eb1a5-cb93-4055-9bdc-c4cabc04b902", "node_type": "1", "metadata": {}, "hash": "7aefbb81a7b307a4c86c4851e53ac664fc06e39c2f31c3c0c49dff21649eb3dd", "class_name": "RelatedNodeInfo"}}, "hash": "2532f71cad7f0fde63c27f2a51bc543116ea54f0a4f082bb22f7ba4c1e02d268", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 1  \n6. Antiretroviral Therapy in Infants, Children, \nAdolescents, and Adults  \nART, while very effective in managing HIV disease, does not cure HIV infection. The goal of ART is \nto suppress viral replication with the aim of reducing the  patient\u2019s VL to undetectable levels. \nUninterrupted ART with ongoing strict adherence will help maintain undetectable VL levels \nthereby preventing damage to the body\u2019s immune system, reducing AIDS -related morbidity and \nmortality and the risk of sexual and vertical transmission of HIV.  \n6.1 Eligibility for ART  \nAll individuals with confirmed HIV infection are eligible for ART irrespective of CD4 \ncount, WHO clinical stage, age, pregnancy or breastfeeding status, co -infection status, \nrisk group, or any other cri teria.  \n6.2 Timing of ART Initiation  \nART should be started in all patients as soon as possible, preferably within 2 weeks of \nconfirmation of HIV status, and even on the same day as testing positive for HIV if they are ready.  \nART Readiness Criteria (Table 5.4) can be used to help determine any issues that need to be \naddressed around the time of ART initiation. Same -day ART initiation (on the same day as testing \nHIV-positive) has additional benefits for HIV prevention (e.g., for pregnant and breastfee ding \nwomen, and the HIV positive partner in a discordant relationship), and is associated with \nimproved retention, viral suppression, and survival. Special considerations for timing of ART \ninitiation are listed in Table 6.1.", "start_char_idx": 3, "end_char_idx": 1581, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a63eb1a5-cb93-4055-9bdc-c4cabc04b902": {"__data__": {"id_": "a63eb1a5-cb93-4055-9bdc-c4cabc04b902", "embedding": null, "metadata": {"page_label": "142", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "7486df76-209d-40ef-a7e8-1f129ab17f4b", "node_type": "4", "metadata": {"page_label": "142", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "84aeb531ebcec57848a7bd8bd764d46c6355235d85a3643e0ac721c32336bc75", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e00307f4-fc20-4775-a344-bfe058a8a7ff", "node_type": "1", "metadata": {"page_label": "141", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2532f71cad7f0fde63c27f2a51bc543116ea54f0a4f082bb22f7ba4c1e02d268", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8aebfab4-da37-4c9e-986e-334a268f076b", "node_type": "1", "metadata": {}, "hash": "fbecf7f0e7d94ac642f4c41fad1534ef2ef05ce42db122f815d0a4c2a3791671", "class_name": "RelatedNodeInfo"}}, "hash": "7aefbb81a7b307a4c86c4851e53ac664fc06e39c2f31c3c0c49dff21649eb3dd", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 2 Table 6.1: Special Considerat ions for Timing of ART Initiation  \nPopulation  Timing of ART Initiation  Additional Notes  \nPregnant and \nbreastfeeding \nwomen  Support ART initiation on the \nsame day as testing positive for \nHIV Intensive adherence counselling, \nsupport and close follow -up \nrequired because of limited time for \npatient preparation  \nInfants (< 12 months \nold)  Support ART initiation on the \nsame day as testing positive for \nHIV. Treatment should \ncommence following a first \npositive PCR test. ALWAYS take a \nsample for a confirmatory PCR \ntest as soon as the first positive \nPCR result is received, but do not \ndelay ART initiation for the \nsecond PCR result  Intensive adherence counselling, \nsupport and close follow -up \nrequired because of limited time for \ncaregiver preparation  \nPatients with strong \nmotivation to start \nART immediately  Support ART initiation as soon as \nthe patient feels ready, preferably \non the same day as testing \npositive for HIV  Intensive adherence counselling, \nsupport and close follow -up \nrequired because of limited time for \npatient preparation  \nPatients with newly \ndiagnosed TB  Start anti -TB treatment \nimmediately and initiate ART as \nsoon as anti -TB medications are \ntolerated, preferably within 2 \nweeks. For TB meningitis delay \nART for 4 to 8 weeks  Monitor closely for IRIS (Annex 16)  \nPatients with \ncryptococcal \nmeningitis  Defer ART until after completing \n5 weeks of CM treatment  Monitor closely for IRIS (Annex 16)  \n \nPatients for whom \nadherence will be \nparticularly \nchallenging  Start ART as soon as possible \nwhile implementing additional \nsupport systems (e.g., optional \nenrolment of a PWID into a MAT \nprogram; psychiatric treatment \nfor a patient with mental illness; \nenrolment into an OVC program \nfor orphans etc.)  A case manager should be assigned \nto all patients with complex \nadherence challenges  \nAll other patients  Start ART as soon as possible, \npreferably within 2 weeks, \nand even on the same day as \ntesting positive for HIV if they \nare ready  Continued adherence monitoring \nand support is recommended after \nART initiation for all patients", "start_char_idx": 3, "end_char_idx": 2214, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8aebfab4-da37-4c9e-986e-334a268f076b": {"__data__": {"id_": "8aebfab4-da37-4c9e-986e-334a268f076b", "embedding": null, "metadata": {"page_label": "143", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "69ebabd8-2d2b-4fc1-9cb0-3828a8791e3b", "node_type": "4", "metadata": {"page_label": "143", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ba9e93fa502f56de6366ce5c630411ff5dfdd16ae7b84f8f3f24cf54f9a6755b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a63eb1a5-cb93-4055-9bdc-c4cabc04b902", "node_type": "1", "metadata": {"page_label": "142", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7aefbb81a7b307a4c86c4851e53ac664fc06e39c2f31c3c0c49dff21649eb3dd", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8f56cb2c-e382-413c-8832-1195a697e407", "node_type": "1", "metadata": {}, "hash": "746c6c459d0b05dfab8a62c519243b528b36c205e788a8889a72beb5f3718492", "class_name": "RelatedNodeInfo"}}, "hash": "fbecf7f0e7d94ac642f4c41fad1534ef2ef05ce42db122f815d0a4c2a3791671", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 3 6.3 First -Line ART for Infants, Children, Adolescents and Adults (including \nPregnant and Breastfeeding Women)  \nThe recommendations below apply to patients who are starting ART for the first time. Preferred \nand alternative first line regimens are shown in Tables  6.2 and 6.3. ARVs for infant prophylaxis \nare presented in the PMTCT chapter in Tables 7.3 to 7.6.  \nAll patients must have their weight documented at every visit. Children and adolescents \nless than 15 years must have correct weight -based dosing of ARVs conf irmed at every visit.  \nInfants and children depend on their caregivers for adherence to medication. Caregivers should \nbe adequately prepared for their role of administering ARVs to infants and children, including \naddressing anticipated challenges such as dr ug palatability. It can be helpful for more than one \ncaregiver to be informed about a child\u2019s HIV status and receive instruction on administration of \nART.  \nCaregivers should always be shown and then asked to demonstrate how to measure and \nadminister ARVs.  This should be done both at the time of prescribing the ART (by the clinician) \nand at the time of dispensing the ART. Clinicians should ensure that the caregiver accompanying \na child for clinical review is the same caregiver responsible for day -to-day ART a dministration.  \nTable 6.2: Preferred First -line ART Regimens and Dosing for Children, Adolescents and \nAdults 1 \nAge  Weight  Preferred \nRegimen  Dosing2 (correct weight -based dosing must \nbe confirmed at every visit)  \nBirth to 4 \nweeks  Any  AZT + 3TC + NVP3 Refer to Annex 10 for weight -based dosing  \n> 4 weeks to \n< 15 years  < 30 kg  ABC + 3TC + DTG4 Refer to Annex 10 for weight -based dosing  \n\u2265 30 kg  TDF + 3TC + \nDTG5,6 TDF/3TC/DTG (300/300/50mg): 1 tab once \ndaily  \n\u2265 15 years  Any  TDF + 3TC + \nDTG5,6 TDF/3TC/DTG (300/300/50mg): 1 tab once \ndaily  \n1 Patients currently on first -line regimens that are not included in the indicated preferred (Table 6.2) \nor alternative (Table 6.3) regimens should be considered for regimen optimization as per Section \n6.5.1  \n2 See Annex 10 for weight -based dosing of all single -drug and fixed -dose combination formulations  \n3 Infants who initiate ART at less than 4 weeks of age should initiate on AZT+3TC+NVP irrespective of \nprevious ART exposure; metabolism of other ARVs is not well known for this age group. As soon as \nthese infants become 4 weeks old, they should switch to ABC/3TC+DTG (dosing included in Annex \n10). Consult the Regional or National HIV Clinical TWG (Uliza Hotline 0726 460 000, \nulizanascop@gmail.com) in case of pre -term infants  \n4 Once adolescents reach 30 kg, if virally suppressed they should be considered for transition as per \nFigure 6.2  \n5 TAF may become the preferred NRTI once fixed -dose combinations are available  \n6 DTG/3TC dual therapy may be considered for HBV -negative pa tients once fixed -dose combinations \nare available", "start_char_idx": 3, "end_char_idx": 3021, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8f56cb2c-e382-413c-8832-1195a697e407": {"__data__": {"id_": "8f56cb2c-e382-413c-8832-1195a697e407", "embedding": null, "metadata": {"page_label": "144", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1865ede3-f08b-429f-b842-9253f6e4e6b8", "node_type": "4", "metadata": {"page_label": "144", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "127cec8feafa71ce48831d925da845d113c10fb69d2689c50da7aeb71a6ab0e0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8aebfab4-da37-4c9e-986e-334a268f076b", "node_type": "1", "metadata": {"page_label": "143", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fbecf7f0e7d94ac642f4c41fad1534ef2ef05ce42db122f815d0a4c2a3791671", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "56c7e676-d96b-4c21-9ea4-947f2f2a7b24", "node_type": "1", "metadata": {}, "hash": "02df6d38485303d54a0b99ffe8331d9e193728d9f06c56ee14991e305fb4d04d", "class_name": "RelatedNodeInfo"}}, "hash": "746c6c459d0b05dfab8a62c519243b528b36c205e788a8889a72beb5f3718492", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 4 Table 6.3: Use of Alternative ARVs in First -Line Regimens 1 \nAge  Weight  Scenario and ARV \nAffected  Alternative ARV to Use  \nBirth to 4 \nweeks   \nAny  NVP: Develops \nhypersensitivity reaction  Use RAL granules or LPV/r granules \n(over 2 weeks of age) or defer ART until \n4 weeks of age, then start ABC+3TC+DTG  \nAZT: Infant Hb < 9.5 g/dL  Defer ART until 4 weeks of age, then \nstart ABC+3TC+DTG  \n> 4 weeks \nto < 15 \nyears   \n \n< 30 kg  ABC: Develops ABC \nhypersensitivity reaction2 Use AZT (if Hb \u2265 9.5 g/dL); if Hb < 9.5 \ng/dL consults Regional or National HIV \nClinical TWG (call Uliza Hotline 0726 \n460 000; ulizanascop@gmail.com)  \nDTG: Unable to tolerate  Use LPV/r at standard weight -based BD \ndosing, if 4-in-1 available this is \npreferred  \nDTG: Currently on \nrifampicin -containing \nanti -TB \nmedications  Increase DTG dosing frequency to twice \ndaily for duration of rifampicin -\ncontaining TB treatment and for an \nadditional 2 weeks after TB treatment is \ncompleted, then revert to once daily \ndosing3 \n \n \n \n\u2265 30 kg  \n \n TDF: Impaired renal \nfunction (CrCl \u2264 50 \nml/min)  Use ABC4,5 or TAF (once available)  \nDTG: Unable to tolerate  Use EFV (for PWID use ATV/r)  \nDTG: Currently on \nrifampicin -containing \nanti -TB \nmedications  Give TDF/3TC/DTG FDC morning + DTG \n50mg evening for duration of rifampicin -\ncontaining TB treatment and for an \nadditional 2 weeks after TB treatment is \ncompleted, then revert to TDF/3TC/DTG \nFDC OD 3 \n\u2265 15 years  Any  TDF: Impaired renal \nfunction (CrCl \u2264 50 \nml/min)  Use ABC4,5 or TAF (once available)  \nDTG: Unable to tolerate  Use EFV (for PWID use ATV/r)  \nDTG: Currently on \nrifampicin -containing \nanti -TB \nmedications  Give TDF/3TC/DTG FDC morning + DTG \n50mg evening for duration of rifampicin -\ncontaining TB treatment and for an \nadditional 2 weeks after TB treatment is \ncompleted, then revert to TDF/3TC/DTG \nFDC OD 3", "start_char_idx": 3, "end_char_idx": 1947, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "56c7e676-d96b-4c21-9ea4-947f2f2a7b24": {"__data__": {"id_": "56c7e676-d96b-4c21-9ea4-947f2f2a7b24", "embedding": null, "metadata": {"page_label": "145", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "87067352-300a-45e1-9441-ac1a296c0301", "node_type": "4", "metadata": {"page_label": "145", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "61c389cc0c204cff208116f9c3293a77f908888660e5591f63822f971c860f13", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8f56cb2c-e382-413c-8832-1195a697e407", "node_type": "1", "metadata": {"page_label": "144", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "746c6c459d0b05dfab8a62c519243b528b36c205e788a8889a72beb5f3718492", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "455fda8a-08cb-48fc-8ba1-ac2d5f09cc25", "node_type": "1", "metadata": {}, "hash": "fd976fb8cfe79472d5f5bc38710da30bcad08dc0755043468135afef5e919a28", "class_name": "RelatedNodeInfo"}}, "hash": "02df6d38485303d54a0b99ffe8331d9e193728d9f06c56ee14991e305fb4d04d", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 5 Table 6.3 Cont.  \n1 For other scenarios that are not covered in this table, discuss as an MDT and consult the Regional or \nNational HIV Clinical TWG (Uliza Hotline 0726 460 000; https://nhcsc.nascop.org/clinicalform ) \n2 ABC hypersensitivity reaction (AHR) is rare in the Kenyan population. Table 6.9 provides the \ndefinition and management of AHR  \n3 The additional 2 weeks of higher -dose DTG is to counter the ongoing liver enzyme induction effect \nof rifampicin, which continues for a short period after TB treatment is completed  \n4 TAF may become the preferred NRTI once fixed -dose combinations are available  \n5 DTG/3TC dual therapy may be considered for HBV -negative patients once fixed -dose combinations \nare available  \n6.4 Dosing and Administration of Dolutegravir (DTG)  \nDTG is preferred in first line ART (in combination with other ARVs) for children, adolescents and \nadults. DTG is well tolerated, highly efficacious, has a high genetic barrier to resistance and fewer \ndrug -drug interactions.  \nTable 6.4: Dosing and Administration of  Dolutegravir  \nRecommended Dosing of DTG  \n\u25cf < 20 kg body weight: Use weight -based dosing with dispersible 10mg DTG tablets as per Annex 10  \n\u25cf \u2265 20 kg body weight: DTG 50 mg film -coated tablet once daily, preferably as a morning dose. It is also \navailable as part of FDC. Those unable to swallow the film coated tablets whole refer to Annex 10  \n\u25cf For patients taking rifampicin: Increase DTG dosing frequency to twice daily for duration of \nrifampicin -containing TB treatment and for an additional 2 weeks after TB treatment is completed, \nthen revert to once daily. (The additional 2 weeks of higher -dose DTG is to counter the ongoing liver \nenzyme induction effect of rifampicin, which continues for a short period after TB treatment is \ncompleted)  \n\u25cf For patients w ith suspected or confirmed INSTI resistance (e.g., patients with prior history of failing a \nRAL -based regimen): use DTG twice daily  \n\u25cf DTG can be taken with or without food  \nCommon Side Effects of DTG  \n\u25cf The most common side effects of DTG are headache, nausea and diarrhea. These side effects usually \nresolve after continued use for 1 -2 weeks. It is critical to inform patients / caregivers about these \npotential side effects and their temporary nature, and encourage them to continue their ART and \nconsult a HCW if concerned.  \n\u25cf Some patients on DTG are more likely to develop insomnia. This may be reduced by taking DTG as a \nmorning dose, or by taking DTG with a low -fat meal or on an empty stomach.  \n\u25cf DTG may cause a small rise in serum creatinine levels bu t this does NOT represent a true decline in \nrenal function.  \n\u25cf Integrase inhibitors, including DTG, are associated with increased weight gain. Counsel patients about \nhealthy eating and physical activity and the benefits of maintaining a healthy weight.  \n\u25cf All ad verse events should be reported through the national pharmacovigilance mechanism. \n(http://www.pv.pharmacyboardkenya.org/ )", "start_char_idx": 3, "end_char_idx": 3080, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "455fda8a-08cb-48fc-8ba1-ac2d5f09cc25": {"__data__": {"id_": "455fda8a-08cb-48fc-8ba1-ac2d5f09cc25", "embedding": null, "metadata": {"page_label": "146", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f3dda054-e7b7-406e-ad3e-0f882fba1ac6", "node_type": "4", "metadata": {"page_label": "146", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cd2fb421dd9793ab4af3c60d5a3aa0f704b8c549dcf2cac89a79c1449944cb4d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "56c7e676-d96b-4c21-9ea4-947f2f2a7b24", "node_type": "1", "metadata": {"page_label": "145", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "02df6d38485303d54a0b99ffe8331d9e193728d9f06c56ee14991e305fb4d04d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "831c2d14-08f9-4ffd-88bd-15d61dd2f8c5", "node_type": "1", "metadata": {}, "hash": "3944c0a4e5eb826d939dc4caa472553eb62d116ec57159748d2326dfeede014a", "class_name": "RelatedNodeInfo"}}, "hash": "fd976fb8cfe79472d5f5bc38710da30bcad08dc0755043468135afef5e919a28", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 6 Table 6.4 Cont.  \nPregnancy Safety of DTG  \n\u25cf DTG is safe during pregnancy and breastfeeding. Pregnancy intention should be discussed with all \nwomen initiating ART regardless of regimen. Women who do not wish to become pregnant should be \noffered appropriate family planning counseling and methods.  \nImportant Drug Interactions with DTG  \n\u25cf Rifampicin  \no Rifampicin lowers DTG levels: increase DTG to 50 mg twice daily for patients on rifampicin who \nare > 20 kg in body weight. Children <20 kg taking DTG who require rifampicin should increase \ntheir weight -appropriate DTG dose to twice daily.  \no There are no significant drug interactions between DTG and other currently used anti -TB \nmedications (including for MDR -TB) \n\u25cf Mineral supplements, including: antacids containing calcium, zinc, magnesium or aluminum; iron \nsupplements; prenatal vitamins (which contain iron and calcium)  \no These supplements decrease the absorption of DTG: administer DTG at least 2 hours before or 6 \nhours after taking any of these supplements  \no Dose separation is not required for calcium and iron supplements (including prenatal vitamins) if \nDTG is taken with a meal  \no It is critical to educate patients about this important drug interact ion because many patients get \nthese supplements and antacids over -the-counter without informing their healthcare provider  \n\u25cf Carbamazepine, phenobarbital, phenytoin  \no These anticonvulsants decrease DTG levels: use a different anticonvulsant if available  \no If DTG must be co -administered with these drugs then increase to DTG to twice daily, although \nthere is little data to guide this  \no If valproic acid is available this can be used with DTG without dose adjustment  \n\u25cf Metformin  \no DTG increases levels of metformin; the levels of DTG are not affected: use a lower dose of \nmetformin (often 50% of usual dose) and monitor glycemic control. Use a maximum daily dose of \nmetformin 1 g  \n\u25cf Other drug -drug interactions with DTG  \no See Annex 13C", "start_char_idx": 3, "end_char_idx": 2058, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "831c2d14-08f9-4ffd-88bd-15d61dd2f8c5": {"__data__": {"id_": "831c2d14-08f9-4ffd-88bd-15d61dd2f8c5", "embedding": null, "metadata": {"page_label": "147", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0c7bc54d-4634-4884-96f3-3b5e396c1a71", "node_type": "4", "metadata": {"page_label": "147", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cf6986e610338079159c2ea61e3bd387fd1b4cb912de5c97a4fd5af9e452e175", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "455fda8a-08cb-48fc-8ba1-ac2d5f09cc25", "node_type": "1", "metadata": {"page_label": "146", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fd976fb8cfe79472d5f5bc38710da30bcad08dc0755043468135afef5e919a28", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7f084ea8-6092-48c0-a89a-2d462d1c66cd", "node_type": "1", "metadata": {}, "hash": "3322c4c701711eebd0ff468d4aa82e036c3339ca0d2f92905417ee08384759d3", "class_name": "RelatedNodeInfo"}}, "hash": "3944c0a4e5eb826d939dc4caa472553eb62d116ec57159748d2326dfeede014a", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 7 6.5 Monitoring and Changing ART  \nThe objectives of clinical and laboratory monitoring during ART are to identify and treat inter -\ncurrent illnesses, assess for and manage adverse drug reactions, and evaluate response to \ntreatment. Routine laboratory monitoring recommendations are described in Table 3.5; however, \nadditional investigations should be ordered whenever there is clinical suspicion for which a \nlaboratory test result may alter patient management.  \nIndications for changing ART include optimizing therapy for patients who have undetectable viral \nload, managing adverse drug reactions or toxicity, drug -drug interactions, co -morbidities and \ntreatment failure.  \n6.5.1 Optimizing Therapy for Patients who have suppressed viral load on First Line \nART  \nPatients who are virally suppressed o n first line ART may benefit from regimen optimization even \nif they are currently tolerating their regimen well and have no drug -drug interactions requiring a \nchange. Regimen modifications may be done for age/weight transitions among children and \nadolescen ts <15 years and to simplify a regimen, prevent long -term toxicity and improve cost -\neffectiveness. Dolutegravir has been shown to have superior tolerability and efficacy compared to \nefavirenz and lopinavir and is now preferred as part of first line ART for  children, adolescents and \nadults. While most adults in Kenya have switched over to a DTG -containing regimen, proactive \nswitching of children is now also recommended with the availability of a pediatric dispersible \ndolutegravir tablet.  \nChildren and adolesc ents with suppressed viral load on first line ART and not on the \nrecommended first line regimen as per Table 6.2 should be considered for optimization as \nper Figures 6.1 and 6.2, such as when children grow and enter a new weight band.  This also \nincludes PL HIV who recently initiated non -standard therapy (less than 3 months ago, before the \nfirst VL is due). Decisions on regimen modification should be made following discussion with the \npatient/caregiver.  \nAlways discuss the possibility of new side effects when changing to a new ARV,  particularly \nside effects common to all ARVs (headache, nausea, diarrhea) and any side effects specific to the \nnew ARV. Reassure patients that most side effects resolve with continued use after 1 -2 weeks.", "start_char_idx": 3, "end_char_idx": 2429, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7f084ea8-6092-48c0-a89a-2d462d1c66cd": {"__data__": {"id_": "7f084ea8-6092-48c0-a89a-2d462d1c66cd", "embedding": null, "metadata": {"page_label": "148", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f8b1f015-551c-4579-8b3a-765d49eb89b4", "node_type": "4", "metadata": {"page_label": "148", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "801f6237e434d455d44a359013cea73a2e4496bb0334344832326ba67c6eadd7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "831c2d14-08f9-4ffd-88bd-15d61dd2f8c5", "node_type": "1", "metadata": {"page_label": "147", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3944c0a4e5eb826d939dc4caa472553eb62d116ec57159748d2326dfeede014a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b1b372dd-3b44-4a93-bf9e-b51f3f985549", "node_type": "1", "metadata": {}, "hash": "f6756ab2596fa7db48d96571e96684792fe65d3d2f3ce37939ad827d8ef975bf", "class_name": "RelatedNodeInfo"}}, "hash": "3322c4c701711eebd0ff468d4aa82e036c3339ca0d2f92905417ee08384759d3", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 8 \nChildren weighing < 30  kg on a first line ART regimen OTHER than ABC/3TC + DTG\nVL within last 6 months < \n200 copies/ml (LDL)\nNo VL result within last 6 \nmonths\nVL within last 6 months   \n200 copies/ml\nCollect sample for VL\nVL   200 copies/ml\n\u2022 Switch to ABC/3TC + DTG using the \nweight -based dosing from Annex 10A -B\n\u2022 Schedule clinical appointment at 2 weeks \nafter regimen change to review \nadherence, side effects and any other \nconcerns\n\u2022 Repeat VL 3 months after regimen \nmodification followed by routine viral \nload monitoring\n\u2022 Switch regimen while assessing for reasons for viremia and \nproviding enhanced adherence counselling\n\u2022 If current regimen contains ABC: Switch to \nAZT/3TC + DTG\n\u2022 If current regimen contains AZT: Switch to \nABC/3TC + DTG\n\u2022 Use the weight -based dosing from Annex 10A -B\n\u2022 For all patients on PI/r or DTG containing regimens: \nsummarize case for TWG and take sample for DRT  \u2013 do not \nwait for DRT results for making the regimen modification\n\u2022 Schedule clinical appointment at 2 weeks after regimen \nchange to review adherence, side effects and any other \nconcerns\n\u2022 Repeat VL 3 months after regimen modification\n\u2022 If VL still   200  copies/ml then consult the \nregional or national TWG\n\u2022 If VL now < 200  copies/ml then continue routine \nviral load monitoring\nOn ART for < 3 months\n On ART for     months\nVL < 200 copies/ml  (LDL) \nFigure 6.1: Optimizing ART Regimens for Children and adolescents <15 years Weighing < 30 kg \non First Line ART", "start_char_idx": 3, "end_char_idx": 1544, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b1b372dd-3b44-4a93-bf9e-b51f3f985549": {"__data__": {"id_": "b1b372dd-3b44-4a93-bf9e-b51f3f985549", "embedding": null, "metadata": {"page_label": "149", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5f489d29-067d-46c1-a87d-31bf4bf5ca83", "node_type": "4", "metadata": {"page_label": "149", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b2418c0565a3a3ed9b444eeb34b7ee4252b20c4be6bd1e39dcf12f800db98712", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7f084ea8-6092-48c0-a89a-2d462d1c66cd", "node_type": "1", "metadata": {"page_label": "148", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3322c4c701711eebd0ff468d4aa82e036c3339ca0d2f92905417ee08384759d3", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b8d0f815-1a16-4564-be08-9b5a64c67868", "node_type": "1", "metadata": {}, "hash": "8d215678956f1d83830165c6b2f6e02bc6ef4e68cbef31872d103fe072299bd3", "class_name": "RelatedNodeInfo"}}, "hash": "f6756ab2596fa7db48d96571e96684792fe65d3d2f3ce37939ad827d8ef975bf", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 9 \nChildren and adolescents weighing      kg or       years old on a first line ART regimen OTHER \nthan TDF/3TC/DTG\nVL within last 6 months \n< 200 copies/ml (LDL)\nNo VL result within last 6 \nmonths\nVL within last 6 months   \n200  copies/ml\nCollect sample for VL\nVL       copies/ml\n\u2022 Switch to TDF/3TC/DTG (300/300/\n50mg) 1 tab once daily\n\u2022 Schedule clinical appointment at 2 weeks \nafter regimen change to review \nadherence, side effects and any other \nconcerns\n\u2022 Repeat VL 3 months after regimen \nmodification followed by routine viral \nload monitoring\n\u2022 Switch regimen while assessing for reasons for viremia \nand providing enhanced adherence counselling\n\u2022 Switch to TDF/3TC/DTG (300/300/50mg) 1 tab once \ndaily\n\u2022 For all patients on PI/r or DTG containing regimens: \nsummarize case for TWG and take sample for DRT  \u2013 do \nnot wait for DRT results for making the regimen \nmodification\n\u2022 Schedule clinical appointment at 2 weeks after regimen \nchange to review adherence, side effects and any other \nconcerns\n\u2022 Repeat VL 3 months after regimen modification\n\u2022 If VL still       copies/ml then consult the \nregional or national TWG\n\u2022 If VL now < 200 copies/ml then continue routine \nviral load monitoring\nOn ART for < 3 months\n On ART for     months\nVL < 200 copies/ml (LDL) \nFigure 6.2: Optimizing ART Regimens for Children and Adolescents Weighing \u2265 30 kg or \u2265 15 years \nold on First Line ART  \n6.5.2 Changing ARVs Due to Adverse Drug Reactions  \nPatients starting ART should be educated on the potential side effects of ART and all ot her \nprescribed medication.  ADRs can have a significant impact on patient adherence and must be \nidentified early and managed aggressively. All ADRs should be reported to the Pharmacy and \nPoisons Board using existing pharmacovigilance tools \n(http://www.pv.pharmacyboardkenya.org/ ). Pharmacovigilance is particularly important for \nmonitoring ADRs associated with any new ARVs that enter the national supply chain, as rare \nADRs may appear in routine care, whi ch were not observed in the highly selected patients \nparticipating in clinical trials.  \nThe most common significant ADRs associated with ARVs that may require a drug substitution \nare summarized in Table 6.5. General principles for managing ADRs are outlined  in Figure 6.3. \nManaging specific ADRs is described in Tables 6.6 to 6.9.", "start_char_idx": 3, "end_char_idx": 2413, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b8d0f815-1a16-4564-be08-9b5a64c67868": {"__data__": {"id_": "b8d0f815-1a16-4564-be08-9b5a64c67868", "embedding": null, "metadata": {"page_label": "150", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b1d1ff1c-13fa-4b12-b5bb-859729436658", "node_type": "4", "metadata": {"page_label": "150", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "99f7ef825360ef3f65567238cccaa5ca4268a17709cb3750e4decce9429bbbe4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b1b372dd-3b44-4a93-bf9e-b51f3f985549", "node_type": "1", "metadata": {"page_label": "149", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f6756ab2596fa7db48d96571e96684792fe65d3d2f3ce37939ad827d8ef975bf", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "99f91826-7f3e-44c6-8ad6-3c3058681e3c", "node_type": "1", "metadata": {}, "hash": "e95b9d66e08a7c4b3bb311cc88d8d96dc43a84e92b46bc76d96fac690a97128b", "class_name": "RelatedNodeInfo"}}, "hash": "8d215678956f1d83830165c6b2f6e02bc6ef4e68cbef31872d103fe072299bd3", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 10  Table 6.5: Common Significant Adverse Drug Reactions  \nARV \nAgent   Adverse Drug Reaction   High Risk Situations/Comments  \n NRTIs  \n  ABC  ABC hypersensitivity \nreaction (see Table 6.9)  Do not re -challenge  \n \n \n \nAZT  Anaemia, neutropenia  \n(See Table 6.7)  Risk factors: CD4 count < 200 cells/mm3; BMI < 18.5 (or \nbody weight < 50 kg); anaemia at baseline; concurrent use \nof other drugs with similar ADR (cotrimoxazole, \ngancyclovir, ribavirin)  \nLactic acidosis  Risk factors: Pregnancy; obesity  \nLipoatrophy  Risk factors: Low CD4 count  \nTDF  Renal dysfunction  \n(See Figure 6.5)  Risk factors: Underlying renal disease; age > 60 years; BMI \n< 18.5 (or body weight < 50 kg); diabetes; hypertension; \nconcomitant PI use or nephrotoxic drug  \nAvoid in patients with CrCl< 50ml/minute unless no \nsuitable alternative such as required to treat HIV/HBV co -\ninfection if TAF is not available  \nTAF  Weight gain  Risk factors: women; concomitant use of INSTIs  \nProvide advice on healthy eating and physical activity to \nmaintain a healthy weight (Table 4.9)  \nNNRTIs  \nAll \nNNRTIs  Rash  \n(NVP>>EFV>ETR)  Manage rash as per Table 4.4 \n \nEFV  CNS side -effects  Risk factors: Pre -existing psychiatric disorder  \nGynaecomastia  Switch from EFV to an alternative, and consult if \ngynecomastia does not improve  \nNVP  Hepatotoxicity  \n(See Table 6.8)  N/A.  \nPIs \nAll PIs \nboosted \nwith  \nRTV  GI intolerance \n(LPV/r>DRV/r>ATV/r)  Consult for recommendation on alternative regimen (R -\nTWG or Uliza Hotline 0726 460 000, \nhttps://nhcsc.nascop.org/clinicalform ) \nDyslipidaemia \n(LPV/r>DRV/r>ATV/r)  Risk factors: Obesity; sedentary lifestyle; diet high in \nsaturated fats and cholesterol  \nATV/r  Hyperbilirubinemia  This only requires drug substitution if cosmetic effect of \njaundice is likely to interfere with patient adherence  \nDRV/r  Rash/hypersensitivity  Risk factors: sulfa allergy  \nINSTIs  \nAll \nINSTIs  Weight gain  Risk factors: women; concomitant use of TAF  \nProvide advice on healthy eating and physical activity to \nmaintain a healthy weight  \nRash/hypersensitivity  Consult (Uliza Hotline 0726 460 000, \nhttps://nhcsc.nascop.org/clinicalform ) \n DTG   Insomnia   Give in the morning; if no improvement then try giving \nwith low fat meal or on empty stomach", "start_char_idx": 3, "end_char_idx": 2342, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "99f91826-7f3e-44c6-8ad6-3c3058681e3c": {"__data__": {"id_": "99f91826-7f3e-44c6-8ad6-3c3058681e3c", "embedding": null, "metadata": {"page_label": "151", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "db645132-94d8-49ff-a5ab-ff619cb3457c", "node_type": "4", "metadata": {"page_label": "151", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "52a9e8ac81163eda30b5fab3a63b19dedc68423b0932cebd1a5863cd7db51f1a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b8d0f815-1a16-4564-be08-9b5a64c67868", "node_type": "1", "metadata": {"page_label": "150", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8d215678956f1d83830165c6b2f6e02bc6ef4e68cbef31872d103fe072299bd3", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "027743ad-32ad-420d-8167-08310ee38951", "node_type": "1", "metadata": {}, "hash": "5e8d5ef076ec6964301a1d6f616d1d2ced3ddd412c856357181feb600bab5271", "class_name": "RelatedNodeInfo"}}, "hash": "e95b9d66e08a7c4b3bb311cc88d8d96dc43a84e92b46bc76d96fac690a97128b", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 11  \nAlternative explanations for toxicity must be excluded before concluding a reaction is secondary to an ARV.\nConsider other medications and herbal remedies and diseases including opportunistic infections, immune \nreconstitution inflammatory syndrome (IRIS), or other illnesses\n2. Evaluate concurrent medications & any concurrent new \nor pre -existing condition Establish whether adverse \nevent is due to:  \n\u2022 other drugs or drug -drug interaction\n\u2022 other medical condition\n\u2022 Inter -current illness or IRIS\nAdverse Drug Reaction \nidentifiedPresentation due to other \nmedical condition\n3.  Determine seriousness of adverse event Manage condition, continue ART\nLife-threatening  \n(Grade 4) Severe\n(Grade 3) Moderate \n(Grade 2)Mild \n(Grade 1)\nImmediately discontinue\nALL drugs, including ARVs  \nand manage the medical \nevent. The patient often \nrequires hospitalization \nWhen the patient is stabilised, \nreintroduce ARVs using a \nmodified regimen (substitute \nthe offending drug) *Substitute the offending \ndrug without \ndiscontinuing ART *. \nMonitor the patient \ncloselyContinue ARVs as long as \nfeasible,  offer \nsymptomatic relief if \nappropriate. If no \nimprovement consider \nsingle drug substitution*Continue ARVs, offer \nsymptomatic relief (if \nappropriate)\nPatients identified with ADR, review the patient progress at every clinic visit and \ndocument their outcomes \nReport suspected/confirmed adverse drug events by filling the Pharmacovigilance\nform or online at www.pv.pharmacykenya.org1. Patient/caregiver \nreports  possible \nadverse eventHistory or clinical \nassessment suggest \nadverse eventLab tests indicate \npossible problem \nrelated to ART\n1. At every clinic  visit the patient on ART should be monitored clinically for toxicities using history \n(history of symptoms that suggest toxicity) and physical examination (relevant signs). Patients should be asked \nspecifically about ADR known to be associated with their current ART. laboratory assessment may be \nused to confirm specific  \n2.  Evaluate concurrent medications and establish whether the toxicity is attributable to an ARV, or to a non-ARV \nmedication taken at the same time. Consider  other disease processes concurrent infectious processes or \n3.  All toxicities should be graded. Manage the adverse event according to \n* Follow single-drug substitution algorithm (Figu re \n \nFigure 6.3: General Principles for Managing Adverse Drug Reactions", "start_char_idx": 3, "end_char_idx": 2499, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "027743ad-32ad-420d-8167-08310ee38951": {"__data__": {"id_": "027743ad-32ad-420d-8167-08310ee38951", "embedding": null, "metadata": {"page_label": "152", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "16e6e770-0a57-40a4-a9e6-14a5ed8d2828", "node_type": "4", "metadata": {"page_label": "152", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ebfa603ba6f90c5491fa51bfb2c5498f12a94c4befe66144908e24053af109e2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "99f91826-7f3e-44c6-8ad6-3c3058681e3c", "node_type": "1", "metadata": {"page_label": "151", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e95b9d66e08a7c4b3bb311cc88d8d96dc43a84e92b46bc76d96fac690a97128b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "45a442fe-5fbc-43dc-a6c2-1558b8864a8f", "node_type": "1", "metadata": {}, "hash": "aa72076f1060495bc4091df67ee6555e4ee640a89deb17d822d8a449050ee85c", "class_name": "RelatedNodeInfo"}}, "hash": "5e8d5ef076ec6964301a1d6f616d1d2ced3ddd412c856357181feb600bab5271", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 12  \nPatients with specific reason for stopping an ARV  1\nVL within last 6 months < \n200 copies/ml\nNo VL result within last 6 \nmonths 1\nVL within last 6 months   \n200 copies/ml\nCollect sample for VL\nVL       copies/ml\n\u2022 Proceed with single drug substitution\n\u2022 Schedule clinical appointment at 2 weeks after regimen change \nto review adherence, side effects and any other concerns\n\u2022 Repeat VL 3 months after regimen modification followed by \nroutine viral load monitoring\n\u2022 Do NOT  change the current regimen unless \nimmediate change required for clinical reasons1\n\u2022 Follow viral load monitoring algorithm (Figure 6.6)\nOn ART for < 3 months\n On ART for     months\nVL < 200 copies/ml \n1 If an ARV must be changed for clinical reasons (adverse \ndrug reaction; drug -drug interaction; co -morbidity; etc) \nbefore viral load results available, Urgently consult Uliza \nHotline (0726 460 000) or Regional or National TWG\n \nFigure 6.4: Managing Single Drug Substitutions for ART", "start_char_idx": 3, "end_char_idx": 1031, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "45a442fe-5fbc-43dc-a6c2-1558b8864a8f": {"__data__": {"id_": "45a442fe-5fbc-43dc-a6c2-1558b8864a8f", "embedding": null, "metadata": {"page_label": "153", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "7a20962c-efc0-463b-91d3-7e425221faf3", "node_type": "4", "metadata": {"page_label": "153", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "202d364654a729d01ce4dbe06497cc228c3d29e2ec58e576c81c511953164c58", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "027743ad-32ad-420d-8167-08310ee38951", "node_type": "1", "metadata": {"page_label": "152", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5e8d5ef076ec6964301a1d6f616d1d2ced3ddd412c856357181feb600bab5271", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "00ab73c4-074d-4505-9e82-e0347187e226", "node_type": "1", "metadata": {}, "hash": "cab6e29658f5ca2d52e409013d4932b93660688c612318a42fb3b001a4d1d5c5", "class_name": "RelatedNodeInfo"}}, "hash": "aa72076f1060495bc4091df67ee6555e4ee640a89deb17d822d8a449050ee85c", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 13 \nAt every clinic visit, assess for risk of kidney disease:\n\u2022  Age > 60 years\n\u2022  Concurrent HIV associated diseases (such as TB and other OIs)\n\u2022  Concurrent diabetes, hypertension, viral hepatitis\n\u2022  Concomitant use of nephrotoxic drugs (e.g. aminoglycosides, \namphotericin and boosted PIs)\n\u2022  Wasting, low BMI\n\u2022  CD4 count < 200 cells/mm3\nIf any risk factor present\nObtain a dip stick urinalysis and serum creatinine and calculate \ncreatinine clearance (CrCl in ml/min, see Annex 15)1\n4,5CrCl   29\nAVOID: if there is no \nsuitable alternative; give \nTDF 300 mg every 72 \nhours, monitor CrCl \nmonthly 2CrCl    90 \nTDF 300 mg OD: re -\nassess creatinine and CrCl \nat 1 month, 3 months and \nbi-annually thereafter if \nnormal3CrCl = 50 -89\nTDF 300 mg OD, monitor \nmore closely for decline in \nrenal function (monthly \nduring the first year, and 3 \nmonthly thereafter if CrCl \nremains stable4,5CrCl = 30 -49\nAVOID: if there is no \nsuitable alternative; give \nTDF 300 mg every 48 \nhours, monitor closely \nwith monthly CrCl for the \nfirst year, and 3 monthly \nthereafter if stable\n1 DTG may cause a small rise in serum creatinine levels but this does NOT represent a true decline in renal function\n2 Obtain biannual serum Cr and CrCl in patients at risk of renal disease and a CrCl      ml/min\n3 Patients with a CrCl      ml/min do not require TDF dose adjustment.\n4 Avoid the use of TDF in patients with CrCl < 50ml/min unless in HIV/HBV coinfection (in which case TAF or TDF should \nbe used). If HBV  negative and on first line ART, substitute TDF with  ABC, TAF or DTG + 3TC dual therapy. If prior ART \ntreatment failure or any other scenario consult the Regional or National HIV Clinical TWG (Uliza Hotline 0726 460 000).  \n5 3TC also requires dose adjustment once CrCl < 50 ml/min\n* For patients with decreased renal function, assess for other causes of renal impairment and refer to physician for review \nFigure 6.5: Managing TDF -Associated Kidney Toxicity", "start_char_idx": 3, "end_char_idx": 2035, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "00ab73c4-074d-4505-9e82-e0347187e226": {"__data__": {"id_": "00ab73c4-074d-4505-9e82-e0347187e226", "embedding": null, "metadata": {"page_label": "154", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0db6c699-190b-4cca-bec0-9110e76a40f6", "node_type": "4", "metadata": {"page_label": "154", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c1e637ff9464b91443a0d16a197090e90f416549a1cbfceec1e801aa8bebe217", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "45a442fe-5fbc-43dc-a6c2-1558b8864a8f", "node_type": "1", "metadata": {"page_label": "153", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "aa72076f1060495bc4091df67ee6555e4ee640a89deb17d822d8a449050ee85c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f9f05376-207d-4029-a984-e82d58daa15c", "node_type": "1", "metadata": {}, "hash": "d27da6df0c994cbb4f2202d51d3ae18eacd9be9635d01009c5abf7af885c5e0d", "class_name": "RelatedNodeInfo"}}, "hash": "cab6e29658f5ca2d52e409013d4932b93660688c612318a42fb3b001a4d1d5c5", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 14 Table 6.6: ARV, CTX and Fluconazole Adjustments in Renal and Hepatic Impairment1 \nDrug  CrCl (ml/min)  Haemodialysis  Liver impairment  \n15 - 50 <15  \n \nABC   \nNo change  Reduce adult dose to 200 mg BD for \nmoderate to severe liver impairment. \nAVOID in severe hepatic impairment  \nAZT  No change  300 mg/day  300 mg/day  Reduce dose by 50% or double \ninterval of administration in \nmoderate to severe impairment  \nTDF2 AVOID unless \nHBV+2 AVOID unless \nHBV+2 300 mg every 7 \ndays  No change  \nTAF  No change  AVOID unless \nHBV+2 No dose adjustment - \nAdminister after \ndialysis  No change  \n3TC  150 mg OD  150 mg OD  75 mg OD  No change  \nLPV  No change  No change, use with caution in \nmoderate to severe impairment  RTV  \nATV  \nDRV  \nRAL  No change  \n No change in mild to moderate \nimpairment. Use with caution in \nsevere impairment  DTG  \nEFV  No change  \n Use with caution in mild to moderate \nliver impairment. AVOID in severe \nimpairment  \nNVP  No change  AVOID  \nETV  No change  Use with caution in severe liver \nimpairment  \nCTX  If CrCl > 30 ml/min then no dose adjustment \nrequired; if 15 -30 ml/min then use 50% of normal \nrecommended dose; if CrCl < 15 ml/min then CTX \nshould be avoided  Use with caution in mild to moderate \nliver impairment. AVOID in severe \nimpairment  \nFluconazole  If CrCl \u2264 50 ml/min then use 50% of normal \nrecommended dose (no dose adjustment required \nfor CrCl > 50 ml/min)  Use with caution  \n1 Patients with evidence of renal or hepatic impairment should have access to regular monitoring of renal \nand liver function  \n2 TDF and renal impairment:  \n\u25cf In acute kidney injury (AKI), interrupt TDF administration until the cause of AKI is established and \ncorrected.  \n\u25cf Avoid the use of TDF in patients with CrCl < 50ml/min unless in HIV/HBV coinfection (in which case \nTAF or TDF should be used). For patients wit h HBV co -infection, the benefit of TDF or TAF for treating \nHBV often outweighs the risks of renal impairment, so more severe levels of renal impairment are \ntolerated. See Table 9.3 for TDF and TAF dose adjustments for patients with HBV/HIV co -infection. \nThese patients should be managed in consultation with an experienced clinician  \n\u25cf If HBV negative and on first line ART, substitute TDF with ABC, TAF or DTG + 3TC dual therapy, \nfollowing the single drug substitution algorithm (Figure 6.4). If prior ART treatmen t failure or any other \nscenario consult the Regional or National HIV Clinical TWG (Uliza Hotline 0726 460 000; \nhttps://nhcsc.nascop.org/clinicalform )", "start_char_idx": 3, "end_char_idx": 2597, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f9f05376-207d-4029-a984-e82d58daa15c": {"__data__": {"id_": "f9f05376-207d-4029-a984-e82d58daa15c", "embedding": null, "metadata": {"page_label": "155", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c0c3d598-aeff-4258-a882-bb32afc7dc02", "node_type": "4", "metadata": {"page_label": "155", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1bf92ca599972894c8662afaa0b7c3fd5614ac145be5a090815ee28f9586e688", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "00ab73c4-074d-4505-9e82-e0347187e226", "node_type": "1", "metadata": {"page_label": "154", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cab6e29658f5ca2d52e409013d4932b93660688c612318a42fb3b001a4d1d5c5", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "184c8854-413a-41c4-8de6-5486d1d1ee0a", "node_type": "1", "metadata": {}, "hash": "f069f136ad15c0791068579686dc74a4fed78277b3e426b20838f11ee742f201", "class_name": "RelatedNodeInfo"}}, "hash": "d27da6df0c994cbb4f2202d51d3ae18eacd9be9635d01009c5abf7af885c5e0d", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 15 Table 6.7: Management of AZT -Associated Bone Marrow Suppression  \nTest  Result  Action  \n \nHb (g/dL)  > 8.5 (and decrease \nfrom pre -AZT \nbaseline)  Retain AZT, repeat Hb at week 1, 2, 4 and 12 (if accessing \nfollow -up Hb is difficult then consider substituting to an \nalternative ARV immediately)  \n\u2264 8.5  Switch from AZT to an alternative ARV  \n \nNeutrophils  \n(x 109/L) 1.0 \u2013 1.5 (and decrease \nfrom pre -AZT baseline, \nif available)  If receiving cotrimoxazole consider withholding unless \nessential. Retain AZT, repeat at week 1, 2, 4 and 12 (if \naccessing follow -up neutrophils is difficult then \nconsider s witching to an alternative ARV immediately)  \n\u2264 1.0  Switch from AZT to an alternative ARV  \nNote:  \n\u25cf Patients with baseline Hb of < 9.5 g/dL should not be initiated on AZT; patients who develop \nanaemia while on AZT should be managed as per this table  \n\u25cf AZT -associated bone marrow suppression occurs early in the course of treatment, usually within \n3 months of initiating ART  \n\u25cf All patients with anaemia and/or neutropenia, whether on AZT or not, should be evaluated for \nother likely causes of anaemia/neutropenia and managed appropriately  \n \nTable 6.8: Management of Drug -Related Hepatotoxicity  \nALT  <2.5 x Upper Limit of Normal (ULN)  2.5 \u2013 5 x ULN  > 5 x ULN  \nAction  Retain regimen, repeat in 2 weeks  Retain regimen, \nrepeat in 1 week  Discontinue offending drug/s  \nConsult senior clinician for \nnext step  \nNote: All patients with acute increase in liver enzymes should be evaluated for other likely causes of \nhepatitis/hepatotoxicity and managed appropriately", "start_char_idx": 3, "end_char_idx": 1680, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "184c8854-413a-41c4-8de6-5486d1d1ee0a": {"__data__": {"id_": "184c8854-413a-41c4-8de6-5486d1d1ee0a", "embedding": null, "metadata": {"page_label": "156", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6f95169e-4a47-4ce1-8500-e2b23138be2e", "node_type": "4", "metadata": {"page_label": "156", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "84dabe91b5692a71cc6b53d2b1199a9b48f9f69cc1201ed7c43e0ab90f04cff0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f9f05376-207d-4029-a984-e82d58daa15c", "node_type": "1", "metadata": {"page_label": "155", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d27da6df0c994cbb4f2202d51d3ae18eacd9be9635d01009c5abf7af885c5e0d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "59a0c680-11ee-4eae-8e17-f8b8c8b56849", "node_type": "1", "metadata": {}, "hash": "c18025e7dc40c70f12d726b189615658aae9d248a4dbea7d0857f2bfe31cf88a", "class_name": "RelatedNodeInfo"}}, "hash": "f069f136ad15c0791068579686dc74a4fed78277b3e426b20838f11ee742f201", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 16 Table 6.9: Diagnosis and Management of Abacavir Hypersensitivity Reaction  \nDiagnosis  \nWithin 3 weeks of initiating an ABC -containing regimen , patient develops any 2 of the following \nsymptom groups concurrently  \n\u2022 Fever  \n\u2022 Erythematous and/or pruritic rash  \n\u2022 Respiratory symptoms (shortness of breath and/or sore throat and/or cough)  \n\u2022 GI symptoms: nausea and/or vomiting and/or diarrhea  \n\u2022 Extreme fatigue and/or body pain preventing normal activities  \nAND: there is not a more likely alternative explanation for the symptoms  \nManagement  \n\u2022 Stop ABC immediately and substitute with an alternative ARV  \n\u2022 Patient must NEVER be re -challenged with ABC \u2013 a single dose could result in a fatal \nhypersensitivity reaction  \n\u2022 Clearly mark file and educate patient about avoiding ABC in future  \n\u2022 Issue an Adverse Event alert card  \nNote:  \n\u2022 ABC hypersensitivity reaction is rare in our population: always consider other more likely possible \ndiagnoses  \n\u2022 Symptoms generally get worse within hours after each dose of ABC  \n \n \n6.5.3 Changing ARVs Due to Drug -Drug Interactions  \nPatients must be asked about other medications (including non -prescription and herbal \nmedicine) they are taking at every visit. Some common drugs have specific drug -drug interactions \nthat may require dose adjustment or substitution o f the ARV or the other interacting drugs. \nCommon medications that interact with specific ARVs include: rifampicin, rifabutin, antacids, \nmultivitamin/mineral supplements, methadone, several anti -fungal, anti -convulsant, calcium -\nchannel blockers, some anti -depressants, some statins, and some anti -malarial. Annex 13 \nprovides common drug -drug interactions and management recommendations. It is \nrecommended practice to check for interactions whenever a new medicine is started.", "start_char_idx": 3, "end_char_idx": 1880, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "59a0c680-11ee-4eae-8e17-f8b8c8b56849": {"__data__": {"id_": "59a0c680-11ee-4eae-8e17-f8b8c8b56849", "embedding": null, "metadata": {"page_label": "157", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2116e637-706b-4def-9874-ae4caa3782d0", "node_type": "4", "metadata": {"page_label": "157", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0ce1c0b0faeea804df6c1676308cb0025410fa1d50eb506db42e3575178add28", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "184c8854-413a-41c4-8de6-5486d1d1ee0a", "node_type": "1", "metadata": {"page_label": "156", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f069f136ad15c0791068579686dc74a4fed78277b3e426b20838f11ee742f201", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9c985ff1-b216-4b66-bce5-051031168e5b", "node_type": "1", "metadata": {}, "hash": "3d8b94624b2525210e4e96272336b8736046706b75c67984ad908bd470faa9c9", "class_name": "RelatedNodeInfo"}}, "hash": "c18025e7dc40c70f12d726b189615658aae9d248a4dbea7d0857f2bfe31cf88a", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 17 6.5.4 Changing ARVs Due to Treatmen t Failure  \nViral load is the test of choice for monitoring response to ART and identifying treatment failure. \nFirst VL should be performed 3 months after ART initiation for all PLHIV.   \nTreatment failure should be suspected when a new or recurrent HIV -associ ated condition \nindicating severe immunodeficiency (WHO stage III or IV condition) develops after at least 6 \nmonths on ART. Treatment failure should always be confirmed with VL testing.  \nFrequency of routine VL monitoring for specific populations is:  \n\u25cf Age 0-24 years old: at 3 months after ART initiation and then every 6 months  \n\u25cf Age \u2265 25 years old: at 3 months after ART initiation, then at month 12 and then \nannually  \n\u25cf Pregnant or breastfeeding: at confirmation of pregnancy (if already on ART) or 3 \nmonths after ART initiation (if ART initiated during pregnancy/ breastfeeding), and \nthen every 6 months until cessation of breastfeeding  \n\u25cf Before making any drug substitution (if no VL results from the prior 6 months)  \n\u25cf Three months after any regimen modification (includin g single -drug substitutions), \nand then as per population group  \n\u25cf For any patient with a detectable VL follow the viral load monitoring algorithm \n(Figure 6.6)  \n \nInterpreting Viral Load Results and Defining Treatment Failure (Figure 6.6)  \nThe goal for ART is t o achieve sustained viral suppression defined as below the Lower Detection \nLimit (LDL), < 50 copies/ml is considered as suppressed.  See Table 5.17  \nPersistent low -level viremia (PLLV) is defined as having between 200 -999 copies/ml on \ntwo consecutive measures.  These patients are at increased risk of progression to treatment \nfailure, development of resistance and death and therefore require a similar case management \napproach as patients with VL \u2265 1,000 copies/ml, and consultation with the Re gional or National \nHIV Clinical TWG (Uliza Hotline 0726 460 000; https://nhcsc.nascop.org/clinicalform ).  \nTreatment failure is suspected when a patient has a high VL \u2265 1,000 copies/ml after at least \n3 months of using ART.  Treatment failure is only confirmed when VL is \u2265 1,000 copies/ml after \nassessing for and addressing poor adherence or other reasons for high VL, and then repeating VL \nafter at least 3 months of enhanced adherence to allow for viral re -suppression.", "start_char_idx": 3, "end_char_idx": 2421, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9c985ff1-b216-4b66-bce5-051031168e5b": {"__data__": {"id_": "9c985ff1-b216-4b66-bce5-051031168e5b", "embedding": null, "metadata": {"page_label": "158", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "fba1789c-2a02-47a4-a740-8f7932dd07d2", "node_type": "4", "metadata": {"page_label": "158", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e3c521fad3c5bc567be6125d0c4a91b1dea3ba4c5a53d34dedb95016b7ddcdb8", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "59a0c680-11ee-4eae-8e17-f8b8c8b56849", "node_type": "1", "metadata": {"page_label": "157", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c18025e7dc40c70f12d726b189615658aae9d248a4dbea7d0857f2bfe31cf88a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b917d356-b723-4e9f-b8d0-af531dbe6b49", "node_type": "1", "metadata": {}, "hash": "c03a5314d1cc991fe664f2836c12d89b4f1700cbb550a993a35351728ed80da4", "class_name": "RelatedNodeInfo"}}, "hash": "3d8b94624b2525210e4e96272336b8736046706b75c67984ad908bd470faa9c9", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 18 \nSchedule for routine viral load testing1 \n\u2022 Age 0 -24 years old: at month 3, then every 6 months \n\u2022 Age      years old: at month 3, then month 12 and then annually \n\u2022 Pregnant or breastfeeding: at confirmation of pregnancy (if already on ART) or 3 months after ART initiation (if ART initiate d during \npregnancy/breastfeeding), and then every 6 months until complete cessation of breastfeeding \n\u2022 Before any drug substitution (if no VL result available from the prior 6 months) \n\u2022 Three months after any regimen modification (including single -drug substitutions) \nVL < 200 copies/ml\n VL 200 \u2013 999 copies/ml\n VL         copies/ml\nIncreased risk of progression to \ntreatment failure\nSuspected treatment \nfailure\n\u2022 Discuss patient in MDT \n\u2022 Assign a case manager \n\u2022 Assess for and address likely causes of non -adherence2 \n\u2022 Provide enhanced adherence support/intervention as appropriate (Section \n5.4 of guidelines for enhanced adherence protocol) \n\u2022 Assess for other causes of viremia and manage as needed3 \n\u2022 Support daily witnessed ingestion by treatment buddy or healthcare worker\n\u2022 After 3 months of excellent adherence, repeat VL \nVL < 200 copies/ml (LDL)\nVL 200 \u2013 999 copies/ml\nVL         copies/ml\n\u2022 Continue ART regimen\n\u2022 Routine adherence \ncounselling and monitoring\n\u2022 Routine VL monitoring\n\u2022 Reassess adherence and other \ncauses of viremia2,3\n\u2022 Repeat VL after another 3 months of \nexcellent adherence\nConfirms treatment failure: \n\u2022 Begin treatment preparation for new regimen and \ncontinue failing regimen until adherence \npreparation completed \n\u2022 Continue enhanced adherence support \n\u2022 Take sample for CD4 count and assess for and \nmanage any OIs \n\u2022 If failing a DTG or PI based regimen a DRT is \nrecommended in consult ation with the  regional or \nNational HIV Clinical TWG or call Uliza Hotline \n       (0726 460 000)  \n\u2022 Schedule clinical appointment at 2 weeks after \nregimen change to review adherence, side effects \nand any other concerns \n\u2022 Repeat VL 3 months after regimen modification \nConsult Regional or National HIV \nClinical TWG or call Uliza Hotline \n(0726 460 000)\nVL 200 \u2013 999 copies/ml\n1. As part of treatment preparation, patients should be informed that \nviral load is the recommended method of monitoring ART. VL results \nshould always be discussed with patients, even when they are \nundetectable. Goals of treatment and definition of success should be \ndiscussed and adherence messaging reinforced \n2. Common causes of poor adherence include: stigma, non -disclosure, \ntravel, toxicities, alcohol or drug use, mental health disorder, religious \nbeliefs, inadequate treatment preparation, chaotic lifestyle, lack of \nsupport systems, and poor patient -provider relationship \n3. Other common causes of treatment failure (beyond adherence) \ninclude: inadequate dosing/dose adjustments, drug -drug \ninteractions, drug -food interactions, impaired absorption (e.g. \nchronic severe diarrhoea)  \n Figure 6.6: Viral Load Monitoring of Patients on ART (1st Line or 2nd Line)", "start_char_idx": 3, "end_char_idx": 3064, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b917d356-b723-4e9f-b8d0-af531dbe6b49": {"__data__": {"id_": "b917d356-b723-4e9f-b8d0-af531dbe6b49", "embedding": null, "metadata": {"page_label": "159", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0a64f2ce-2269-4732-b8fc-7b415f3992b4", "node_type": "4", "metadata": {"page_label": "159", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d2dd36af25090e70ebee9161d21e6dd00036edb095088c636df20fd33ed976cc", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9c985ff1-b216-4b66-bce5-051031168e5b", "node_type": "1", "metadata": {"page_label": "158", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3d8b94624b2525210e4e96272336b8736046706b75c67984ad908bd470faa9c9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f0cf3add-2787-491c-98d4-611d56ab8b0f", "node_type": "1", "metadata": {}, "hash": "73d1ba2b608d0abc0ad2768cdf9601935dbd86d1dc61f7c301f91479358f4947", "class_name": "RelatedNodeInfo"}}, "hash": "c03a5314d1cc991fe664f2836c12d89b4f1700cbb550a993a35351728ed80da4", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 19 Non -adherence is the most frequent cause of treatment failure. As per the viral load \nmonitoring algorithm, adherence issues must be addressed BEFORE confirming \ntreatment failure.  \nDaily witnessed ingestion by a treatment buddy or healthcare worker is recommended to confirm \nexcellent adherence before repeating the VL. All adherence issues must be resolved before \nswitching to a new regimen otherwise the patient will quickly fail the n ew regimen as well, and \nsoon run out of viable ART options. An exception to this may be when the regimen itself is \nthe primary cause of poor adherence  (e.g., side effects from one of the ARVs are not \nmanageable such as severe diarrhea with LPV/r that does not improve with symptom \nmanagement), in which case the regimen may need to be modified to allow for perfect adherence. \nThis should be done in consultation with the Regional or National HIV Clinical TWG.  \nChapter 5 provides detailed guidance on adherence pr eparation, assessment, and support.  \nTable 6.10: Recommended Second -line ART Regimens in Infants, Children, Adolescents and \nAdults, excluding TB/HIV co -infection 1 \nWeight/scenario  First -line ART  Second -line ART  \n \n< 30 kg  ABC (or AZT) + 3TC + DTG  DRT -based second -line2,3  \nABC + 3TC + LPV/r  Take sample for DRT and change to AZT + \n3TC + DTG while awaiting DRT results; \nmodify based on DRT results if indicated  \nAZT + 3TC + LPV/r  Take sample for DRT and change to ABC \n+ 3TC + DTG while awaiting DRT results; \nmodify based on DRT results if indicated  \nABC + 3TC + EFV  AZT + 3TC + DTG  \nAZT + 3TC + EFV  ABC + 3TC + DTG  \n \n\u2265 30 kg or \u2265 15 \nyears old  TDF (or ABC) + 3TC + DTG (or PI/r)  DRT -based second -line2 \nTDF (or ABC) + 3TC + EFV  TDF + 3TC +  DTG  \nAZT + 3TC + EFV  TDF + 3TC + DTG  \nPregnant and \nBreastfeeding \nwomen  TDF (or ABC) + 3TC + DTG  Take sample for DRT and change to TDF \n+ 3TC + ATV/r while awaiting DRT \nresults; modify based on DRT results if \nindicated  \nTDF (or ABC) + 3TC + PI/r  Take sample for DRT and change to TDF \n+ 3TC + DTG while awaiting DRT results; \nmodify based on DRT results if indicated  \nTDF (or ABC) + 3TC + EFV  TDF + 3TC + DTG  \nAZT + 3TC + EFV  TDF + 3TC + DTG  \nHIV/HBV Co -\ninfection  Always maintain TDF in order to treat the HBV as well as HIV  \nTB/HIV Co -\ninfection  Refer to Table 8.8: Recommended ART Regimens for Patients who Develop TB \nwhile Failing  1st Line ART", "start_char_idx": 3, "end_char_idx": 2487, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f0cf3add-2787-491c-98d4-611d56ab8b0f": {"__data__": {"id_": "f0cf3add-2787-491c-98d4-611d56ab8b0f", "embedding": null, "metadata": {"page_label": "160", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3702f53c-42aa-4e0c-b0fe-baf1c5a1b529", "node_type": "4", "metadata": {"page_label": "160", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0a499a3756e0d1bdea0f9196eb9826d77de79f07f7636cda50a1ee6e8f7ce8c1", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b917d356-b723-4e9f-b8d0-af531dbe6b49", "node_type": "1", "metadata": {"page_label": "159", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c03a5314d1cc991fe664f2836c12d89b4f1700cbb550a993a35351728ed80da4", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d340061b-406b-4de5-baee-15e4daa434ef", "node_type": "1", "metadata": {}, "hash": "814caecc5dda02be0df710c22bd2c4c3d7176207e7391b937abedc1d8ec48cb4", "class_name": "RelatedNodeInfo"}}, "hash": "73d1ba2b608d0abc0ad2768cdf9601935dbd86d1dc61f7c301f91479358f4947", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 20 Table 6.10 Cont.  \n1. If any drug in the recommended 2nd line regimen is contraindicated or previously not tolerated, \nconsult the Regional or National HIV Clinical TWG (Uliza Hotline 0726 460 000; \nhttps://nhcsc.nascop.org/clinicalform ). Such patients may require DRT to select agents for the \nsecond -line ART. Add itional drugs may be recommended on a case -by-case basis, including DRV/r, \nATV/r, RAL, or ETR  \n2. Patients failing DTG -based or PI -based first -line regimens should have a Drug Resistance Test \n(DRT) ordered as soon as treatment failure is confirmed. The patient  summary and DRT results \nshould be sent to the Regional or National HIV Clinical TWG \n(https://nhcsc.nascop.org/clinicalform ) or call Uliza Hotline (0726 460 000) to determine the \nmost suitable second -line regimen for the patient. The DRT results will be us ed to determine if \nthere is true DTG or PI failure or if there is an underlying problem with non -adherence. Daily \nwitnessed ingestion is recommended prior to performing DRT  \nImportant Considerations for First -line Treatment Failure in Children  \n\u25cf Second -line ART in infants and children is more complex to manage. These children and \ntheir caregivers should undergo thorough clinical and psychosocial assessment to rule \nout inter -current illness or non -adherence as the reason for a high viral load  \n\u25cf All c hildren failing first -line should be discussed in the MDT and preferably with an \nexperienced ART provider prior to change of ART to second -line. However, this should \nnot cause undue delay in switching a failing regimen  \n\u25cf The choices for infants and children failing an alternative first -line regimen are limited \nand may need to be discussed with the Regional or National HIV Clinical TWG. Some of \nthese children will require HIV DRT to determine the most suitable second -line regimen  \nImportant considerations for s econd -line ART Treatment Failure  \n\u25cf Patients failing second -line ART have limited options. ARVs used to construct a third -line \nregimen are often more expensive, will have increased pill burden and more side effects. \nThese factors will exacerbate pre -existing poor adherence  \n\u25cf Second -line treatment failure should be confirmed by viral load testing following the \nviral load monitoring algorithm (Figure 6.6)  \no After the first detectable VL ( \uf065 50 copies/ml), assess for and address all causes of \npoor adherence, and assess for all other possible causes of viremia.  \no These patients should be discussed at an MDT session. Repeat the VL after 3 months \nof excellent adherence (preferably with daily witn essed ingestion of the ARVs by a \ntreatment buddy, relative, CHV, etc.).  \no If the second VL is still \uf065 50 copies/ml then continue the failing second -line regimen \nwhile reassessing adherence and other causes of viremia, implementing adherence \nsupport systems as needed, and then repeat the VL after another 3 months.  \no If viremia continues then consult the Regional or National HIV Clinical TWG (Uliza \nHotline 0726 460 000; https://nhcsc.nascop.org/clinicalform ) using the national \ncase summary form (Annex 9B). These patients will likely require DRT in order for \nthe TWG to design the most suitable third -line regimen  \n\u25cf Patients failing second -line ART require thorough assessment for barriers to adherence \nand ongoing enhanced adherence support including  \no Assigning a case manager  \no More frequent adherence counselling by a trained counsellor  \no Assessment and treatment of mental health and substance use disorders  \no Provision of adherence support such as modified directly observed therapy, a \ntreatment supporter, hom e visits etc.", "start_char_idx": 3, "end_char_idx": 3734, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d340061b-406b-4de5-baee-15e4daa434ef": {"__data__": {"id_": "d340061b-406b-4de5-baee-15e4daa434ef", "embedding": null, "metadata": {"page_label": "161", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "943f1925-785f-40ed-a9ec-c9c790606dc6", "node_type": "4", "metadata": {"page_label": "161", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0946486467b16bd5d245fad80b71f6fad330e515f5a30f3dea8987b2a263b309", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f0cf3add-2787-491c-98d4-611d56ab8b0f", "node_type": "1", "metadata": {"page_label": "160", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "73d1ba2b608d0abc0ad2768cdf9601935dbd86d1dc61f7c301f91479358f4947", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3d17c1b9-2140-4735-a397-4535152e12fd", "node_type": "1", "metadata": {}, "hash": "f94dde5459c69dd9e10db0de27eb0b1780085bd46bbf960aecae6e4e5099db71", "class_name": "RelatedNodeInfo"}}, "hash": "814caecc5dda02be0df710c22bd2c4c3d7176207e7391b937abedc1d8ec48cb4", "text": "Antiretroviral Therapy in Infants, Children, Adolescents, and Adults  \n6 - 21 Table 6.11: Possible Third -line ART in Children, Adolescents and Adults  \n Possible 3rd Line Regimen  Comment  \n \nChildren  DTG + 3TC + DRV/r  Third line ART selection is based on DRT \nresults  \nNote that the Regional or National \nHIV Clinical TWG may recommend \nreusing some of the ARVs the \npatient has already failed, even \nwhen resistance is present  DTG + AZT + 3TC + DRV/r  \nDTG + ABC (or TDF) + 3TC + DRV/r  \nETV + 3TC + DRV/r  \nAdults  DTG + 3TC + DRV/r  \nDTG + AZT + 3TC + DRV/r  \nDTG + TDF + 3TC + DRV/r  \nDTG + TDF (or AZT) + 3TC  \nETV + 3TC + DRV/r", "start_char_idx": 3, "end_char_idx": 642, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3d17c1b9-2140-4735-a397-4535152e12fd": {"__data__": {"id_": "3d17c1b9-2140-4735-a397-4535152e12fd", "embedding": null, "metadata": {"page_label": "162", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "d68ed21a-a708-404c-a410-08332cdc4e36", "node_type": "4", "metadata": {"page_label": "162", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8d8f7151943ef13f0312e88baf68aa4af9f119963e871a98e8f9b13d312fdc1e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d340061b-406b-4de5-baee-15e4daa434ef", "node_type": "1", "metadata": {"page_label": "161", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "814caecc5dda02be0df710c22bd2c4c3d7176207e7391b937abedc1d8ec48cb4", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "733c0fde-5108-420f-97e2-86fd3c853e9c", "node_type": "1", "metadata": {}, "hash": "57852476ce498b4ebce348c168f765dffe8ff713f5e7feabe3dfa597fc67f2af", "class_name": "RelatedNodeInfo"}}, "hash": "f94dde5459c69dd9e10db0de27eb0b1780085bd46bbf960aecae6e4e5099db71", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n6 - 22", "start_char_idx": 3, "end_char_idx": 63, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "733c0fde-5108-420f-97e2-86fd3c853e9c": {"__data__": {"id_": "733c0fde-5108-420f-97e2-86fd3c853e9c", "embedding": null, "metadata": {"page_label": "163", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "45f458ac-ae83-4870-b5c8-7b121c09da30", "node_type": "4", "metadata": {"page_label": "163", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "92dd552dc0f29715de6d0c8cc23ea448cc26b794f5a9bc2aaa39cda1e5a19cec", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3d17c1b9-2140-4735-a397-4535152e12fd", "node_type": "1", "metadata": {"page_label": "162", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f94dde5459c69dd9e10db0de27eb0b1780085bd46bbf960aecae6e4e5099db71", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5da1a971-f734-4994-976e-e6d5f978895d", "node_type": "1", "metadata": {}, "hash": "f664399f97be74ddceb82115d478480c6898de1720e8cdf0055277ebd82e5a36", "class_name": "RelatedNodeInfo"}}, "hash": "57852476ce498b4ebce348c168f765dffe8ff713f5e7feabe3dfa597fc67f2af", "text": "Prevention of Mother to Child Transmission of HIV/Syphilis/Hepatitis B  \n  7 - 1  \n7. Prevention of Mother to Child Transmission of \nHIV/Syphilis/Hepatitis B  \nRoutine antenatal care (ANC) offers an important opportunity to provide high quality combined \nHIV prevention throug h targeted health education and counselling; HIV testing for the woman, \npartners and family members; linkage to HIV prevention and treatment; and to discuss and plan \nfor future conception and contraception needs. Prevention of mother -to-child transmission of HIV \n(PMTCT)/Syphilis/Hepatitis B should be offered as part of a comprehensive package of fully \nintegrated, routine antenatal care interventions (Table 7.1).  \nTable 7.1: Essential Package of Antenatal Care  \nIntervention  Recommendation/Description  \n \nGroup & \nIndividual \nEducation  Include information on importance of at least 8  ANC visits, details of ANC services \n(including health checks and treatment of any illness, medical tests including HIV, \nsyphilis testing and hepatitis B, monitoring of maternal and fetal wellbeing, etc.), \nnutrition, personal care, recognizing and responding to danger signs during \npregnancy, birth preparedness including skilled birth attendance, post -natal care \nincluding immunization, family pla nning and maternal and infant nutrition, HIV \nprevention and treatment (HTS, preventing new infections during pregnancy \nincluding PrEP where appropriate, ART for those who are HIV positive, monitoring of \nART and ARV prophylaxis and follow -up for HEIs) and t riple elimination (preventing \nHIV/ syphilis/hepatitis B transmission from mother to child).  \nCounselling  \u25cf Pre-conception \u2013 Women in reproductive age who are known to be HIV positive \nshould have pregnancy intention assessment visit at every visit. If they desire to \nbecome pregnant, pregnancy should be planned i.e., attain viral load suppression, \nimmune reconsti tution and have Iron and Folic Acid Supplementation (IFAS) \nadministered prior to conception.  \n\u25cf Women who are newly diagnosed with HIV and/or newly initiating ART require \nmore intensive adherence counseling and HIV education, which may include a case \nmanager  and/or mentor mother  \n\u25cf Birth preparedness: support the pregnant woman and her partner to develop an \nindividual birth plan that includes place of delivery with skilled attendants, \nemergency transport, birth companionship and readiness for infant care  \n\u25cf Pregnan cy danger signs: offer information on returning to ANC as soon as possible \nin case they develop fever, lower abdominal pain, severe headache, swollen feet, \nconvulsions and per vaginal bleeding.  \n\u25cf Maternal, infant and young child nutrition (MIYCN): All pregn ant women should \nreceive information on proper nutrition during pregnancy and breastfeeding, safe \ninfant feeding and optimal nutrition practices. Promote exclusive breastfeeding for \nthe first 6 months irrespective of HIV status, followed by complementary f eeding \n(Table 7.7). During pregnancy, provide iron, folate and multivitamins; monitor for \nanemia, advise on adequate caloric intake (HIV positive women require an \nadditional 10% of recommended daily allowance (RDA))", "start_char_idx": 3, "end_char_idx": 3183, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5da1a971-f734-4994-976e-e6d5f978895d": {"__data__": {"id_": "5da1a971-f734-4994-976e-e6d5f978895d", "embedding": null, "metadata": {"page_label": "164", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "bce4450b-0983-48da-ac4a-e501875482bb", "node_type": "4", "metadata": {"page_label": "164", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "19c430ee3a37e56cb17a1fcd55ff700cfadfe4b3b6f6112dc223f4b1ed81b13a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "733c0fde-5108-420f-97e2-86fd3c853e9c", "node_type": "1", "metadata": {"page_label": "163", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "57852476ce498b4ebce348c168f765dffe8ff713f5e7feabe3dfa597fc67f2af", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9f4fc877-b0a1-458c-bd2e-c3bb4967ffb6", "node_type": "1", "metadata": {}, "hash": "13e93a4db09dcdf5f808519bdc70284b8b9dfcd3ac0463ed89040653143e0121", "class_name": "RelatedNodeInfo"}}, "hash": "f664399f97be74ddceb82115d478480c6898de1720e8cdf0055277ebd82e5a36", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n7 - 2 Table 7.1 Cont.  \nCounselling  \u25cf HIV testing services  \no All pregnant women (unless known HIV positive) should be counselled and \ntested for HIV, syphilis and Hepatitis B during their first ANC visit and if \nnegative, repeat HIV and syphilis testing in the third trimester.  \no All pre gnant and breastfeeding mothers with continued HIV risk (Key \npopulations) should be counseled and tested for HIV every 3 months until post -\ncessation of breastfeeding.  \no Pregnant and breastfeeding mothers should be educated and offered a self -test \nkit for th eir sexual partner(s)  \no At Labour and delivery, HIV testing should be done for all women with \nunknown HIV status or that previously tested negative, even if tested during \nthe third trimester  \no All breastfeeding mothers (unless known HIV positive) should be co unselled \nand tested at the 6 -week infant immunization visit. The HIV test (if negative) \nshould be repeated every 6 months until complete cessation of breastfeeding. \nNote:  key population mothers (FSWs and PWIDs) get retested every 3 months \n(Table 2.5)  \no Women should be counselled about the schedule for repeat HIV testing in \npregnancy and postnatally as part of routine ANC and postnatal education  \no All pregnant and breastfeeding women who are not tested, opt -out or decline \nHIV, Syphilis or Hepatitis testing during the first contact should be offered \ncounselling and testing in subsequent visits with appropriate linkage and \nreferral for prevention, care and support services. Daily Witnessed Ingestion \n(DWI) is advised to support Viral suppression for newly initi ated clients and \nthose whose regimens are being switched. This is to support viral suppression \namong women with high viral load.  \no All HIV positive pregnant and breastfeeding women enrolled into care should \nreceive counselling and support (including assiste d disclosure), case \nmanagement linkage and follow -up for comprehensive treatment and \nprevention (including lifelong ART)  \no All Syphilis and Hepatitis B positive clients should be given appropriate care as \ndefined in Table 7.3 \u201ctriple elimination\u201d.  \no All partn ers of pregnant and breastfeeding women should be offered HIV \ntesting and counselling and all biological children if the mother is HIV positive  \n\u25cf All pregnant and breastfeeding women should receive information on risk \nreduction, including PrEP where appropri ate \n\u25cf Post -partum contraception: counsel on contraception methods and help patient \ndevelop a plan for effective contraception from 6 -weeks post -partum to avoid \nunplanned pregnancies", "start_char_idx": 3, "end_char_idx": 2646, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9f4fc877-b0a1-458c-bd2e-c3bb4967ffb6": {"__data__": {"id_": "9f4fc877-b0a1-458c-bd2e-c3bb4967ffb6", "embedding": null, "metadata": {"page_label": "165", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "48e9c06c-8cd5-4e9d-9530-6547d417d28f", "node_type": "4", "metadata": {"page_label": "165", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2c675fd1d90c9a1adaac1c4f494c39123704b87dfbf7e9e0853ba27caf74a9af", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5da1a971-f734-4994-976e-e6d5f978895d", "node_type": "1", "metadata": {"page_label": "164", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f664399f97be74ddceb82115d478480c6898de1720e8cdf0055277ebd82e5a36", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1aef3e13-fb6d-44a2-9e3c-fd87454c82db", "node_type": "1", "metadata": {}, "hash": "229b99ced45f28fd318d3163830248af8b89c8afd7d725189ed87883f5194157", "class_name": "RelatedNodeInfo"}}, "hash": "13e93a4db09dcdf5f808519bdc70284b8b9dfcd3ac0463ed89040653143e0121", "text": "Prevention of Mother to Child Transmission of HIV/Syphilis/Hepatitis B  \n  7 - 3 7.1 Antiretroviral Therapy for HIV -positive Pregnant and Breastfeeding \nWomen and Infant Prophylaxis  \nThe goal of ART for HIV positive pregnant women is two -fold: to restore and maintain the \nmother\u2019s immune function and therefore general health, and secondly, to prevent transmission \nof HIV in utero, at labour and delivery and during breastfeeding. To achieve this goal, the mother \nmust take effective antiretroviral therapy to achieve viral suppression.  Table 7.2 summarizes \nrecommendations for use of ART for HIV positive pregnant women.  \nTable 7.2: Summary of Use of A RT for HIV Positive Pregnant and Breastfeeding Women  \nOverall recommendations  \nWhen to start  ART should be initiated in all pregnant and breastfeeding women living with HIV, \nregardless of gestation, WHO clinical stage and at any CD4 cell count and continued \nlifelong. ART should be started, ideally, on same day as HIV diagnosis after \nreadiness asse ssment with ongoing enhanced adherence support including \ncommunity -based case management and support.  \nWhat to start with \n(first -line ART)  TDF/3TC/DTG  \nInfant \nprophylaxis  \u25cf AZT+NVP for 6 weeks, NVP should be continued until 6 weeks after complete \ncessation of breastfeeding  \nFor more comprehensive information Refer to Table 7.3  \nMonitoring       Viral load  monitoring during pregnancy and breast -feeding (Figure 6.6)  \n\u25cf Whenever possible, use same -day point -of-care methods for viral load \ntesting of pregnant and breastfeeding women to expedite the return of \nresults and clinical decision -making. If this is not available, viral load \nspecimens and results for pregnant and breastfeeding women should be \ngiven priority across the laboratory referral process  (including specimen \ncollection, testing and return of results).  \n\u25cf For pregnant and breastfeeding women newly initiated on ART, obtain VL 3 \nmonths after initiation, and then every 6 months until complete cessation of \nbreastfeeding  \n\u25cf For HIV positive women already on ART at the time of confirming pregnancy \nor breastfeeding, obtain a VL irrespective of when prior VL was done, and \nthen every 6 months until complete cessation of breastfeeding  \n\u25cf For pregnant or breastfeeding women with a VL \u2265 50 copies/ml: assess for \nand address potential reasons for viremia, including intensifying adherence \nsupport, repeat the VL after 3 months of excellent adherence, including \ndaily witnessed ingestion, where feasible and appropriate  \no If the repeat VL is 200 - 999 copies/ml consul t the Regional or National \nHIV Clinical TWG  \no If the repeat VL is \u2265 1,000 copies/ml, change to an effective regimen. \nRefer to Table 6.10  \no If the repeat VL is < 200 copies/ml (LDL) then continue routine \nmonitoring", "start_char_idx": 3, "end_char_idx": 2811, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1aef3e13-fb6d-44a2-9e3c-fd87454c82db": {"__data__": {"id_": "1aef3e13-fb6d-44a2-9e3c-fd87454c82db", "embedding": null, "metadata": {"page_label": "166", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "afe12146-d210-46eb-9f96-79fd8127493d", "node_type": "4", "metadata": {"page_label": "166", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0ebcfb94e1fabf54b54c8809b71fd166629a5f97ec6d59110d52a17042997232", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9f4fc877-b0a1-458c-bd2e-c3bb4967ffb6", "node_type": "1", "metadata": {"page_label": "165", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "13e93a4db09dcdf5f808519bdc70284b8b9dfcd3ac0463ed89040653143e0121", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "177d3723-b62e-4541-8230-a6997d06c1f7", "node_type": "1", "metadata": {}, "hash": "1ed3fbffc54bbf1861ef1137731f06a633661271998cbe177319b6ae953d7422", "class_name": "RelatedNodeInfo"}}, "hash": "229b99ced45f28fd318d3163830248af8b89c8afd7d725189ed87883f5194157", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n7 - 4 Table 7.2 Cont.  \nScenario  \nPre-conception planning \nfor women already on \nART (not yet pregnant)  Maintain ART  \nCarry out a VL test if not done in the prior six months to confirm viral \nsuppression (Figure 6.6)  \nRefer to Table 4.8 for pre -conception care for women on ART who desire \npregnancy, including laboratory screening, TT immunization, folate, etc.  \nOn ART at the time of \nconfirming \npregnancy/breastfeeding  Maintain ART.  \nCarry out a VL at first identification of pregnancy, irrespective of when a \nprior viral load was done, to confirm viral suppression (Figure 6.6)  \nManage the baby as HEI (Figure 2.1 for EID, and Table 7.3 for infant \nprophylaxis)  \nNot on ART at the time of \nconfirming pregnancy  Prepare the patient and start on ART as soon as possible.  \nART initiation should occur preferably on the same day HIV infection is \nconfirmed. Perform VL 3 months after ART initiation.  \nPregnant and breastfeeding women with a history of treatment \ninterruption returning to care should have reasons for interruption \nassessed and preferentially re -started on a DTG -containing regimen \nunless the reason for interruption was DTG intolerance or failure. Viral \nload monitoring in this case should be done after 3 months of initiation \nand 6 months thereafter until cessation of breastfeeding . Additional \nadherence support should be made available.  \nNot on ART during \nlabour and delivery  Start on ART during labour.  \nAfter delivery, continue treatment preparation and adherence support and \ncontinue ART  \nManage the baby as HEI (Figure 2.1 for EID, a nd Table 7.3 for infant \nprophylaxis)  \nNot on ART during \npost -\npartum/breastfeeding  Prepare (readiness assessment) and start on ART as soon as possible \npreferably on the same day HIV infection is confirmed.  \nManage the baby as HEI (Figure 2.1 for EID, and Table 7.3 for infant \nprophylaxis). Adherence support for both mother and infant, con sider \ndaily witnessed ingestion (DWI) support.  \nManaging labour and \ndelivery  Minimize vaginal examinations, use aseptic techniques to conduct delivery, \navoid artificial rupture of membranes, monitor labour and avoid prolonged \nlabour by use of the partograph, avoid unnecessary genital tract trauma  \nNote that certain patient groups e.g., recent HIV infections, pregnant adolescent girls and young \nwomen, women with previous children with HIV infection, patients with high viral load at time of \npregnancy  confirmation, patients with poor social support systems, patients with history of \ndefault from care and those with active co -morbidities etc. may require additional adherence and \npsychosocial support", "start_char_idx": 3, "end_char_idx": 2708, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "177d3723-b62e-4541-8230-a6997d06c1f7": {"__data__": {"id_": "177d3723-b62e-4541-8230-a6997d06c1f7", "embedding": null, "metadata": {"page_label": "167", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "40716143-1060-4caf-bbf3-d47e14578a19", "node_type": "4", "metadata": {"page_label": "167", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "60ef00bb466da90ac6b382ec97976afc4e8d03c61aca76a520bd36e2f43cc6ee", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1aef3e13-fb6d-44a2-9e3c-fd87454c82db", "node_type": "1", "metadata": {"page_label": "166", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "229b99ced45f28fd318d3163830248af8b89c8afd7d725189ed87883f5194157", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "155e612d-f318-4fc2-9e6c-542c695cd373", "node_type": "1", "metadata": {}, "hash": "d42192d5d88626f5411e967b90ca53b843766a8840ca86b7d22ee67cfd6172c7", "class_name": "RelatedNodeInfo"}}, "hash": "1ed3fbffc54bbf1861ef1137731f06a633661271998cbe177319b6ae953d7422", "text": "Prevention of Mother to Child Transmission of HIV/Syphilis/Hepatitis B  \n  7 - 5 7.2. Syphilis elimination for Pregnant and Breastfeed ing Women and Infant \nTreatment  \nThe country has adopted triple elimination of HIV, Syphilis and Hepatitis B among pregnant and \nbreastfeeding women. It is recommended that all pregnant women attending ANC and not aware \nof their HIV status require a dual HIV syphilis test during their first trimester and a second HIV \nSyphilis test in the 3rd trimester if the initial test was negative.   \nAll women who test positive for syphilis at any point during pregnancy and breastfeeding should \nbe treated with the appropria te regimen. (Table 7.3). All babies born of mothers who test positive \nfor syphilis are suspected to be exposed to syphilis and should also be treated with the correct \nregimen (Table 7.3). Ensure to perform contact tracing for all the sexual contacts and en sure they \nare treated for syphilis.  \nSymptoms of congenital syphilis may not become apparent for several weeks or months after \nbirth.  \n7.3. Hepatitis B elimination for Pregnant and Breastfeeding Women and Infant \nProphylaxis  \nRequires routine testing of pregnant women to identify women in need of antiviral treatment for \ntheir own health and additional interventions to reduce Mother to Child Transmission of viral \nhepatitis B.  \nRegular screening should be done by incorporation of viral hepatitis screening as  part of the ANC \nprofile. This is recommended for Hepatitis B & C which pose a big risk to both the mother and \nfetus.  \nFor pregnant and breastfeeding women who are found to be positive for HBsAg, offer appropriate \ntreatment options of ARVs containing TDF/3TC or FTC containing regimens. This treatment also \nacts as prophylaxis for HBV transmission from mother to child. All pregnant and breastfeeding \nwomen without evidence of hepatitis B infection (HBsAg negative) should be vaccinated against \nhepatitis B. (Chapter 9).  \nHIV positive infants without evidence of infection should be vaccinated against Hepatitis B.  \nInfants born of mothers who test positive for HBsAG should be treated using Hepatitis B \nImmunoglobulin (Table 7.3).  \nRefer to Chapter 9 f or management of HIV/HBV coinfection.", "start_char_idx": 3, "end_char_idx": 2240, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "155e612d-f318-4fc2-9e6c-542c695cd373": {"__data__": {"id_": "155e612d-f318-4fc2-9e6c-542c695cd373", "embedding": null, "metadata": {"page_label": "168", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "4b4a0bc5-89ea-4f2d-b935-123a4893cf46", "node_type": "4", "metadata": {"page_label": "168", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "bf5873c5a332a9abe048793d9bcf3d7d87b2327438309d7c8514b5055abcfab7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "177d3723-b62e-4541-8230-a6997d06c1f7", "node_type": "1", "metadata": {"page_label": "167", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1ed3fbffc54bbf1861ef1137731f06a633661271998cbe177319b6ae953d7422", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "0017d9ed-1f8f-4b41-8d6c-99e0d461db1c", "node_type": "1", "metadata": {}, "hash": "a23aad50a3feec4b2f0588e6b69d9571eaf27bd5868115fe67e8e2f3713823a1", "class_name": "RelatedNodeInfo"}}, "hash": "d42192d5d88626f5411e967b90ca53b843766a8840ca86b7d22ee67cfd6172c7", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n7 - 6 Table 7.3: ARV Prophylaxis for HIV -Exposed Infants  \nInfant Scenario  Infant Prophylaxis  Maternal Scenarios  \nHIV Exposed \nInfant  \u25cf Infant prophylaxis  \no AZT+NVP for 6 weeks, NVP + cotrimoxazole should be \ncontinued until 6 weeks after complete cessation of \nbreastfeeding  \no Infant prophylaxis can be discontinued after a minimum \nof 12 weeks on NVP if the child is not breastfeeding (death \nof mother or separation with mother)  \no The infant prophylaxis regimen applies to all infants \nirrespective of age when identifying HIV exposure (e.g., \nmother diagnosed HIV -positive in the  postpartum  period)  \n\u25cf DBS or whole blood for PCR at 6 weeks or first contact, \nfollowing EID algorithm (Figure 2.1)  \n\u25cf Birth testing (Figure 2.2) may be conducted in sites \nwhere point of care has been implemented and when \nmedically indicated  If mother not on ART, initiate \nART as soon as possible \n(preferably same day)  \nIf mother is on ART for \u2265 3 \nmonths and the VL is \u2265 50 \ncopies/ml, intensify adherence, \nrepeat the VL  \n \nIf VL <50 copies/ml, continue \ncurrent regimen  \nFollow Viral load algorithm \nFigure 6.6  \nTRIPLE ELIMINATION  \nCONDITION in \nmother  INFANT MANAGEMENT  MATERNAL MANAGEMENT  \nSyphilis -VDRL \nor diagnosed \nwith Dual kit  Crystalline Penicillin 50,000 IU/kg BD (if <7 days) or TDS if \n(>7 days old) for a total of 10 days.  Penicillin G 2.4 MU IM Stat or \nCeftriaxone 1gm IM daily for 8 -10 \ndays in case of penicillin allergy.  \nCongenital \nsyphilis    \nHepatitis B \u2013 \nHbsAg test  Hepatitis B immunoglobulin 0.5ml IM within 12 hours after \nbirth. Hepatitis B vaccine 0.5ml three doses at birth, 1 month \nand 6 months.  Refer to viral hepatitis \nmanagement guidelines  \nNote: If child has contraindication or unable to tolerate NVP or AZT then give the tolerated drug up to complete \ncessation of breastfeeding. If the infant is on AZT prophylaxis, give up to a minimum of 12 we eks or until maternal viral \nload is suppressed. In situations where neither AZT nor NVP are tolerated 3TC may be used as a third option if available.  \nHIV exposed infants with TB infection, infant prophylaxis should include AZT plus 3TC fixed dose (60/30 mg ). For 12 \nweeks or until maternal viral load is suppressed (3 -5.9 \u2013 1 tab BD, 6 -9.9kg 1.5tab BD, 10 -13.9 kg 2 tabs BD).  For more \ndetails, refer to Annex 10 A.  \nAfter TB treatment, revert to NVP until 6 weeks post cessation of breastfeeding,  \nHB monitoring should be done to all HEIs on AZT prophylaxis as per the recommendations (Table 6.7: management of \nAZT associated bone marrow suppression)  \nGroups considered higher risk for mother to child transmission who may need additional adherence and \npsych ological support include:  \n\u25cf All new HIV positives irrespective of time identified  \n\u25cf HIV positive adolescent Girls and Young Women (AGYW) <19 yrs. including OVC  \n\u25cf VL >200 copies/ml  \n\u25cf Clients with stigma, declining treatment, poor adherence   \n\u25cf PMTCT client with previous HIV infected infant  \n\u25cf Client with active comorbidities - DM, OIs, malnourished (low MUAC), mental health etc.  \n\u25cf Clients who sero -convert during ANC/PNC follow up  \n\u25cf Poor socio -economic and family support structures   \n\u25cf Those who drop of f ART  \n\u25cf Key population \u2013 FSW, PWID  \nAlcohol use and brewers/sellers", "start_char_idx": 3, "end_char_idx": 3335, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "0017d9ed-1f8f-4b41-8d6c-99e0d461db1c": {"__data__": {"id_": "0017d9ed-1f8f-4b41-8d6c-99e0d461db1c", "embedding": null, "metadata": {"page_label": "169", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "7cf22dee-3c91-4f98-9f8a-00d7855f92cd", "node_type": "4", "metadata": {"page_label": "169", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e605726f706318d188793f32add23966d455246a96c19197187456e402433614", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "155e612d-f318-4fc2-9e6c-542c695cd373", "node_type": "1", "metadata": {"page_label": "168", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d42192d5d88626f5411e967b90ca53b843766a8840ca86b7d22ee67cfd6172c7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "41258b7f-aba6-4893-9432-3d2a42999ac6", "node_type": "1", "metadata": {}, "hash": "4f695e28a09c3698b4690886b2eb6f6a70762970e241344ccf2ce60c38302a9d", "class_name": "RelatedNodeInfo"}}, "hash": "a23aad50a3feec4b2f0588e6b69d9571eaf27bd5868115fe67e8e2f3713823a1", "text": "Prevention of Mother to Child Transmission of HIV/Syphilis/Hepatitis B  \n  7 - 7 Table 7.4: Dosing of ARVs for Infant Prophylaxis from Birth to 12 Weeks of Age  \nAge/Weight  Dosing of NVP (10mg/ml) OD  Dosing of AZT (10mg/ml) BD  \nBirth to 6 weeks  \nBirth weight < 2,000 g  2 mg/kg per dose, OD  4 mg/kg per dose, BD  \nBirth weight 2,000 -2,499 g  10 mg (1 ml), OD  10 mg (1 ml), BD  \nBirth weight \u2265 2,500 g  15 mg (1.5 ml), OD  15 mg (1.5 ml), BD  \n> 6 weeks to 12 weeks of age*  \nAny weight  20 mg (2 ml), OD  60 mg (6 ml), BD  \n> 12 weeks (Table 7.5 and 7.6)  \n*Dose adjustment required once child reaches 6 weeks of age  \nIf older infant beyond 6 weeks of age is newly identified as HIV exposed infant, should be given \nAZT+NVP for 6 weeks, NVP + cotrimoxazole should be continued until 6 weeks after complete \ncessation of breastfeeding  \nTable 7.5: NVP Dosing for Infant Prophylaxis beyond 12 Weeks of Age *  \nAge  Dosing of NVP (10mg/ml) Once Daily  \n12 weeks \u2013 6 months  25 mg (2.5 ml), OD  \n7 months \u2013 9 months  30 mg (3 ml), OD  \n10 months \u2013 12 months  40 mg (4 ml), OD  \n> 12 months  Consult the Regional or National HIV Clinical TWG (Uliza \nHotline 0726 460 000; \nhttps://nhcsc.nascop.org/clinicalform ) \n* If child presents to facility late and has to be on AZT and NVP beyond 12 weeks of age \nTable 7.6: AZT Dosing for Infant Prophylaxis beyond 12 Weeks of Age *  \nWeight  Dosing of AZT: (10mg/ml syrup) Twice Daily  \n3.0-5.9 kg  6 ml, BD  \n6.0-9.9 kg  9 ml, BD  \n10.0 -13.9 kg  12 ml, BD  \n14.0 -19.9 kg  15 ml, BD  \n* If child presents to facility late and has to be on AZT and NVP beyond 12 weeks of age  \n7.4 Infant and Young Child Nutrition in the Context of HIV  \n\u25cf Exclusive breastfeeding  involves giving the baby only breast milk with no other liquids \n(including water) or solids for the first six months of life. Giving of vitamins, mineral \nsupplements or medicines are permitted if prescribed.  \n\u25cf Mixed feeding  is giving other liquids and/or foods together with breast milk to infants \nunder 6 months of age and is not recommended.  Mixed feeding during thi s period is \nassociated with significantly higher risk of mother -to-child HIV transmission, diarrhoeal \nand respiratory tract illnesses, among other consequences and should be prevented", "start_char_idx": 3, "end_char_idx": 2276, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "41258b7f-aba6-4893-9432-3d2a42999ac6": {"__data__": {"id_": "41258b7f-aba6-4893-9432-3d2a42999ac6", "embedding": null, "metadata": {"page_label": "170", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "79217702-97a0-4095-9aa1-ccd788e487f8", "node_type": "4", "metadata": {"page_label": "170", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "12806d621ad08dee4b6eab7d427c2edddb676f1e5366195cf6473d17c55797c9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "0017d9ed-1f8f-4b41-8d6c-99e0d461db1c", "node_type": "1", "metadata": {"page_label": "169", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a23aad50a3feec4b2f0588e6b69d9571eaf27bd5868115fe67e8e2f3713823a1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "635e47a7-e8cb-4f14-9661-07fcc9d8fd81", "node_type": "1", "metadata": {}, "hash": "4b9552d2dd218b78bacf612c743ec8033275d5ffb8a1fc65e64ee22438cf234d", "class_name": "RelatedNodeInfo"}}, "hash": "4f695e28a09c3698b4690886b2eb6f6a70762970e241344ccf2ce60c38302a9d", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n7 - 8 \u25cf All infants irrespective of HIV status should be exclusively breastfed f or the first 6 months \nof life, with timely introduction of appropriate complementary foods after 6 months, and \ncontinued breastfeeding up to 24 months or beyond.  \n\u25cf Should mothers be physically separated from their infants (back to work), support them \nto sust ain lactation and to exclusively breastfeed including mentorship on expressing \nbreast milk (refer to current MIYCN Policy)  \n\u25cf All mothers, irrespective of HIV status, should be encouraged and supported to \nexclusively breastfeed for the first six months and co ntinue breastfeeding with \nappropriate complementary feeding after 6 months, for a period of 24 months or beyond. \nBreastfeeding should ONLY stop once a nutritionally adequate and safe diet without \nbreast milk can be sustained.  \n\u25cf HIV positive mothers and HIV p ositive infants should always be on ART and given extra \nattention for adherence support, VL monitoring and optimal retention in care  \n\u25cf Breastfeeding mothers who do not know their HIV status or who previously tested HIV \nnegative should be encouraged to be ret ested for HIV at the 6 -week immunization visit, \nand then every 6 months thereafter until complete cessation of breastfeeding (Table 2.5)  \n\u25cf Access for HIV testing and STI/HIV prevention interventions should be reinforced for \npartners of pregnant and breastfee ding women  \n\u25cf Mothers who are diagnosed with HIV while breastfeeding should immediately start \nappropriate ART, giving extra attention to adherence support, VL monitoring, and optimal \nretention in care. The infant should immediately start ARV prophylaxis and r eceive PCR \ntesting (Table 7.3).  \n\u25cf Mothers who decide to stop breastfeeding at any time should stop gradually within one \nmonth (and only when a nutritionally adequate and safe diet without breast milk can be \nsustained), and HIV positive mothers and HIV positi ve infants should continue with ART. \nContinued breastfeeding is recommended for HIV positive infants for as long as the \nmother is willing and able to do so.  \n\u25cf In special medical circumstances, determined by clinicians, where an infant cannot \nbreastfeed, refe r to current MIYCN Policy and Breast Milk Substitute (BMS) Regulation \nand Control Act, 2012.  \n\u25cf Complimentary feeding means giving other foods to complement breast milk after six \nmonths of exclusive breastfeeding. Complimentary feeds provide additional nutrit ional \nvalue to meet the child\u2019s increasing nutritional needs for growth (Table 7.7). \nFurthermore, complementary feeding helps the child to gradually become accustomed \nto eating family foods while breastfeeding continues to be an important source of \nnutrien ts. It is worth noting that breastfeeding continues to have child growth/survival \nbenefits for up to two years or longer. Emphasis should be made on consuming all the \nseven (7) food groups for children in various meals.  \no Cereal/tubers and roots  \no Beans, pulses and nuts  \no Dairy and dairy products  \no Eggs and Flesh (meat/poultry/insects/organ meat)  \no Vitamin A rich food (orange/yellow fruits) and green vegetables  \no Fats and high sugar foods  \n\u25cf Other fruits and vegetables", "start_char_idx": 3, "end_char_idx": 3259, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "635e47a7-e8cb-4f14-9661-07fcc9d8fd81": {"__data__": {"id_": "635e47a7-e8cb-4f14-9661-07fcc9d8fd81", "embedding": null, "metadata": {"page_label": "171", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "81e5fbd1-277b-4222-ae9b-2fdca1712164", "node_type": "4", "metadata": {"page_label": "171", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "309f400ec4e311e4e64132db69f686a7860f98fbcf80b24eb4cefcc3f4bb4c27", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "41258b7f-aba6-4893-9432-3d2a42999ac6", "node_type": "1", "metadata": {"page_label": "170", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4f695e28a09c3698b4690886b2eb6f6a70762970e241344ccf2ce60c38302a9d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "580ce8dd-d1a7-4b02-8cec-4866d37b932c", "node_type": "1", "metadata": {}, "hash": "2e1d80db80a81242dad515ddfc049722b3eb96d5be95a0e64f763f44e512e5ec", "class_name": "RelatedNodeInfo"}}, "hash": "4b9552d2dd218b78bacf612c743ec8033275d5ffb8a1fc65e64ee22438cf234d", "text": "Prevention of Mother to Child Transmission of HIV/Syphilis/Hepatitis B  \n  7 - 9 Table 7.7: Complementary Foods for Children 6 -24 Months Old  \nFoods to Offer  \nAge  Texture  Frequency  Amount of food per meal  \n6 \nmonths  Start with thick porridge or \nwell mashed foods  \n 2 times per day  2 tablespoons each feed, \nincreasing to 3 tablespoons \nin the 3rd to 4th week  \n7-8 \nmonths  Mashed/pureed family foods  \nBy 8 months can begin \nfinger foods  3 meals per day, plus \nfrequent breastfeeds  \n Increase amount gradually \nto \u00bd of a 250 ml cup  \nUse a separate plate/bowl  \n9-11 \nmonths  Finely chopped or mashed \nfoods, and foods that baby \ncan pick up  3 meals and 1 snack, \nplus frequent \nbreastfeeds  \u00be of a 250 ml cup/bowl  \nUse a separate plate/bowl  \n12-23 \nmonths  Cut food into small, soft \npieces that child can pick up, \nchew and swallow \ncomfortably  3 meals and 2 snacks, \nplus breastfeeds  One 250ml cup/bowl  \nUse a separate plate/bowl  \n24-59 \nmonths  Cut food into small, soft \npieces that child can pick up, \nchew and swallow \ncomfortably  3 meals and 2 snacks, \nplus breastfeeds if still \nbreastfeeding  1 \u00bd - 2 cups of 250ml \ncup/bowl  \nUse a separate plate/bowl", "start_char_idx": 3, "end_char_idx": 1186, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "580ce8dd-d1a7-4b02-8cec-4866d37b932c": {"__data__": {"id_": "580ce8dd-d1a7-4b02-8cec-4866d37b932c", "embedding": null, "metadata": {"page_label": "172", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "375d6175-5a31-446b-aa84-c552c66e67c1", "node_type": "4", "metadata": {"page_label": "172", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b4d8511bf189782ab91738b8be0896059aae4345528e4ec3b33d776080803f68", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "635e47a7-e8cb-4f14-9661-07fcc9d8fd81", "node_type": "1", "metadata": {"page_label": "171", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4b9552d2dd218b78bacf612c743ec8033275d5ffb8a1fc65e64ee22438cf234d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "fcff0ba5-dc13-478c-bc48-a5903398747a", "node_type": "1", "metadata": {}, "hash": "50604090c538fbcbe4df2694bf9527aed1f007255f19daafe3a120e55a02907b", "class_name": "RelatedNodeInfo"}}, "hash": "2e1d80db80a81242dad515ddfc049722b3eb96d5be95a0e64f763f44e512e5ec", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n7 - 10", "start_char_idx": 3, "end_char_idx": 63, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "fcff0ba5-dc13-478c-bc48-a5903398747a": {"__data__": {"id_": "fcff0ba5-dc13-478c-bc48-a5903398747a", "embedding": null, "metadata": {"page_label": "173", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e0ef6558-8e0a-4a8f-957e-17007ddba154", "node_type": "4", "metadata": {"page_label": "173", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "538f4647215d7594f64a59ff67ee6d5bb611a36af62c2594211a663ef03dd78d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "580ce8dd-d1a7-4b02-8cec-4866d37b932c", "node_type": "1", "metadata": {"page_label": "172", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2e1d80db80a81242dad515ddfc049722b3eb96d5be95a0e64f763f44e512e5ec", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3118573c-818d-4fd1-8760-a996b856fbf2", "node_type": "1", "metadata": {}, "hash": "af1edd50f15c29cb4123fd6df0f8094c5c1a1322155d6621d2468e0fd1ba5f0d", "class_name": "RelatedNodeInfo"}}, "hash": "50604090c538fbcbe4df2694bf9527aed1f007255f19daafe3a120e55a02907b", "text": "TB/HIV Co -infection, Prevention and Management  \n8 - 1 \n  \n8. TB/HIV Co -infection, Prevention and \nManagement  \n \nTB is a leading cause of morbidity and mortality among people living with HIV. Reducing this \nburden of illness requires identifying TB early, providing pre -emptive and preventive  treatment \nfor TB, and providing optimal treatment for both HIV and TB. Timely initiation of ART in \ncombination with TB Preventive Therapy are effective ways to reduce the burden of TB in PLHIV.  \nAll PLHIV should receive counselling about the risk of acquir ing TB, strategies for reducing \nexposure to TB, recognizing clinical manifestations of TB and seeking care promptly, the risk of \ntransmission of TB to others and TB preventive therapy to prevent TB disease.  \nHealthcare settings present suitable conditions f or transmission of TB, particularly among \nvulnerable individuals like PLHIV. All healthcare settings should develop and implement TB \ninfection control guidelines to reduce the risk of transmission of TB between patients, visitors \nand staff.  \n8.1 TB Screenin g for PLHIV: Intensified Case Finding (ICF)  \nTB screening and prevention services should be offered at every clinical visit. Symptom -based \nTB screening using the ICF tool MUST be performed at every clinic visit to rule out active TB; \npatients who screen pos itive (presumptive TB cases) must complete definitive diagnostic \npathways (Figure 8.1 and Table 8.1) and patients who screen negative should be evaluated for \nTB preventive therapy (TPT).  \nActive Case Finding (ACF) differs from ICF. ICF refers to TB screenin g among PLHIV, whereas \nActive TB case finding (ACF) refers to special efforts made by the NTP or other partners that go \nbeyond passive TB case finding at health facilities, in which communities or population groups \nthat are underserved or at higher risk of  TB are actively reached for providing access to care, \nincluding screening and testing", "start_char_idx": 2, "end_char_idx": 1953, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3118573c-818d-4fd1-8760-a996b856fbf2": {"__data__": {"id_": "3118573c-818d-4fd1-8760-a996b856fbf2", "embedding": null, "metadata": {"page_label": "174", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1ad47429-8504-46ab-a6be-6ed00c28b572", "node_type": "4", "metadata": {"page_label": "174", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2983bc8a8a69183dd2ada41bbb7c69a2d0feac51c9755065e419b00d18290b70", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "fcff0ba5-dc13-478c-bc48-a5903398747a", "node_type": "1", "metadata": {"page_label": "173", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "50604090c538fbcbe4df2694bf9527aed1f007255f19daafe3a120e55a02907b", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a74113a4-a832-4c4d-a99a-07da40d5992c", "node_type": "1", "metadata": {}, "hash": "3d762c123ccb162210aa1af0e7543cd048943952645a9c8236ef0aca1d4ae1df", "class_name": "RelatedNodeInfo"}}, "hash": "af1edd50f15c29cb4123fd6df0f8094c5c1a1322155d6621d2468e0fd1ba5f0d", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n8 - 2      Intensified Case Finding Screening Questions       \n\u25cf  If \u201cYes\u201d to any question, take a detailed history, examine the patient and do sputum examination \n(sputum smear or GeneXpert)  \n\u25cf If \u201cNo\u201d to questions 1 -5 above, consider TPT eligibility and work up for TB Preventive Therapy and \nrepeat screening on subsequent visits  \n\u25cf Questions 5 and 6 do not apply to adults  \nThe following are the intensified case finding screening questions:  \n\u25cf Cough of any duration (Y/N)  \n\u25cf Fever (Y/N)  \n\u25cf Noticeable weight loss/ Failure to thrive/ Poor weight gain (Y/N)  \n\u25cf Night sweats (Y/N)  \n\u25cf Reduced playfulness/ Lethargy/ Irritability (Y/N)  \n\u25cf Contact with a TB case (Y/ N)", "start_char_idx": 3, "end_char_idx": 735, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a74113a4-a832-4c4d-a99a-07da40d5992c": {"__data__": {"id_": "a74113a4-a832-4c4d-a99a-07da40d5992c", "embedding": null, "metadata": {"page_label": "175", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "83315e43-b179-402f-9e31-b211202fec2e", "node_type": "4", "metadata": {"page_label": "175", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9b122812d972fc9344e0b794cdecfb7872572b83b51e41f87bdfd321b7e8a935", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3118573c-818d-4fd1-8760-a996b856fbf2", "node_type": "1", "metadata": {"page_label": "174", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "af1edd50f15c29cb4123fd6df0f8094c5c1a1322155d6621d2468e0fd1ba5f0d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "84a2b3d2-37b6-414e-8331-9e162c77ca56", "node_type": "1", "metadata": {}, "hash": "b28ded0c5b0799f4d7e9f5e986b9bb17285405695668557ab88898ccc7ec446d", "class_name": "RelatedNodeInfo"}}, "hash": "3d762c123ccb162210aa1af0e7543cd048943952645a9c8236ef0aca1d4ae1df", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 3 \n \nIf yes, to any of the signs and symptoms above the patient requires a clinical review If no to all the signs and symptoms above\nTake a comprehensive history and thorough examination. Decide on classification as a presumptive TB case\nIs the client/patient a presumptive TB case?\nIs a sample available for TB testing? \u2022 Evaluate and manage for other conditions\n\u2022 Consider TB preventive therapy (TPT) as per LTBI guidelines\nIs the GeneXpert available on site?\n\u2022 Consider a CXR3\n\u2022 Consider clinical \ndiagnosis of TB\nIs smear microscopy available on site?\n\u2022 Obtain a sample1 for GeneXpert\n\u2022 TB LAM should be considered for \neligible PLHIV2\no Positive TB LAM test \u2013 initiate \nDS TB treatment. Review once \nGeneXpert results received\no NB: A negative TB LAM test \ndoes not rule out TB\u2022 If yes, collect 2 samples; one for smear microscopy and an additional sample for \nGeneXpert\n\u2022 If smear microscopy is positive, start DS TB treatment and review the patient once \nGeneXpert results as received\n\u2022 TB LAM should be considered for eligible PLHIV2\no Positive TB LAM test \u2013 initiate DS TB treatment. Evaluate once GeneXpert results \nreceived\no NB: A negative TB LAM test does not rule out TB\u2022 If not available, collect and refer sample for \nGeneXpert\n\u2022 TB LAM should be considered for eligible PLHIV2\n\u2022 Positive TB LAM test \u2013 initiate DS TB treatment. \nEvaluate once GeneXpert results received\n\u2022 NB: A negative TB LAM test does not rule out TB\nGene Xpert ResultsDoes the client have any of the following symptoms?\n4. Unintended weight loss\n5. Chest Pain\n6. BMI less than 18.5 or Z score   -21. Cough of any duration\n2. Hotness of Body\n3. Drenching night sweats\nYES NOYES NOYES NOYES NOYES NOis the initial  test  for TB a has no smear  \nSHOULD  BE USED  as sample  is & for \nTB LAM  should  be used  among  PLHIV  as per TB LAM  SHOULD  be used  as an to", "start_char_idx": 2, "end_char_idx": 1905, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "84a2b3d2-37b6-414e-8331-9e162c77ca56": {"__data__": {"id_": "84a2b3d2-37b6-414e-8331-9e162c77ca56", "embedding": null, "metadata": {"page_label": "176", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5c0997f9-f956-4961-8e2e-dbd1f6b2d6e8", "node_type": "4", "metadata": {"page_label": "176", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a68e32768e68e2272a52a8be2ffa7e989e2b06abcdf95414ef6c62c34746be0b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a74113a4-a832-4c4d-a99a-07da40d5992c", "node_type": "1", "metadata": {"page_label": "175", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3d762c123ccb162210aa1af0e7543cd048943952645a9c8236ef0aca1d4ae1df", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e2b92eb9-7293-4323-b195-9bd728428cde", "node_type": "1", "metadata": {}, "hash": "09f3bbb52fe742567cf8cc34e0611ac9bf0b19090b315e9bbda06e05262d2f9e", "class_name": "RelatedNodeInfo"}}, "hash": "b28ded0c5b0799f4d7e9f5e986b9bb17285405695668557ab88898ccc7ec446d", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n8 - 4 \nMTB Detected\nRifampicin Resistance Detected \n(RR)MTB Detected\nRifampicin Resistance not \nDetected (TR)MTB not Detected \n(N)MTB Detected 1\nRifampicin Resistance \ninditerminate (TI)MTB \nDetected \nTrace4Invalid/\nError\n1. Collect another \nsample and repeat \nGeneXpert test.\n2. Treat as per the \nrepeat results1. Collect a sample for FL & SL LPA, \nculture and 1st and 2nd line DST\n2. Conduct baseline work up on DR \nTB treatment\n3. Comprehensive review by a DR \nTB clinical review team.\n4. Start DR TB treatment as per the \nguidelines.Patients at high risk of DR TB \ngroups\n1. Collect a sample of FL & SL \nLPA, culture and 1st and 2nd \nLine DST\n2. Start DS TB treatment while \nawaiting DST results.Patients at low  \nrisk of DR TB \ngroups\n1. Start DS TB \ntreatments.\u2022 If already on TB treatment (smear \npositive, TB LAM positive), continue until \nother diagnostic test results received and \nreviewed even if MTB Not Detected\n\u2022 NTM is likely if smear microscopy was \npositive, and MTB not detected on \nGeneXpert\n- Send a sample for culture for definitive \ndiagnosis of NTM\n- Continue with TB treatment until \nculture results received and reviewed\n\u2022 Evaluate for other respiratory illnesses \ne.g. asthma, pneumonias, COPD, \nbronchiectasis and cancer as other \npossible conditions\n\u2022 Obtain a CXR and review with CXR3 report \nand treat for TB as applicable\n\u2022 Consider EPTB\n\u2022 Refer for further evaluation when a \ndefinitive diagnosis is yet to be found\n\u2022 Consider repeat GeneXpert1. Treat as DS TB\n2. Immediately \ncollect another \nsample and \nrepeat GeneXpert \n(Ultra) test\n3. Collect a sample \nfor FL & SL LPA, \nculture and 1st \nand 2nd line DST\n4. Revise regimen \nbased on DST \nresults.Based on DST results, DR \nTB clinical team to adjust \nregimen as necessary.Revised treatment based on DST \nresults Follow up as per guidelines\n\u2022 Follow up as per DR TB treatment \nguidelines\n\u2022 Mandatory clinical review meetings \nfor Patients\n\u2022 Monthly smears and cultures are \nmandatory during the treatment \nduration.Follow up:\n1. Clinical improvement assessment\n2. Smear microscopy at months 2/3,5,6\n3. If drug resistance is detected, treat \nfor DR TB as per guidelines.DR TB DS TBGene Xpert Results", "start_char_idx": 3, "end_char_idx": 2241, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e2b92eb9-7293-4323-b195-9bd728428cde": {"__data__": {"id_": "e2b92eb9-7293-4323-b195-9bd728428cde", "embedding": null, "metadata": {"page_label": "177", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "02304cb0-b213-4504-9640-19e3b62bd1fa", "node_type": "4", "metadata": {"page_label": "177", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "01ae678599630a6f4d5a1f23adb1068942df3e4ff1ad0e337879a71860390870", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "84a2b3d2-37b6-414e-8331-9e162c77ca56", "node_type": "1", "metadata": {"page_label": "176", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b28ded0c5b0799f4d7e9f5e986b9bb17285405695668557ab88898ccc7ec446d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "b3e2bf4e-85f4-49aa-b2d4-ad05fa95271f", "node_type": "1", "metadata": {}, "hash": "83bb5092adc1172bbc6b2b0b4f37e0411192b03eba38cdcf07cf09cb3810a164", "class_name": "RelatedNodeInfo"}}, "hash": "09f3bbb52fe742567cf8cc34e0611ac9bf0b19090b315e9bbda06e05262d2f9e", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 5 \n \nFootnotes\n1 Samples for GeneXpert, sputum, CSF, Pleural aspirate, \nPeriloneal fluid, synovial fluid, Gastric Aspirate, \nNasopharyngeal aspirate, FNA, Lymph node biopsy, Pus, \nstool\n2 Indications for use of TB -LAM, as an adjunct test to \nGeneXpert:\n\u2022 PLHIV with advanced disease (WHO stage 3 or 4 or \nCD4 count  200 cells/mm3 (or 25% for children \n 5years old) with presumed TB\n\u2022 PLHIV that have any danger signs of severe illness: \nrespiratory rate \u02c330breaths per minute, \ntemperature \u02c339\u00b0C, heart rate\u02c3120beats per minute, \nunable to walk unaided\n\u2022 Currently admitted to hospital\n3 All CHEST X -rays should be reported and the reports \nreviewed by the clinician for definitive management. \nRefer to the CXR algorithm for TB diagnosis\n4 MTB detected Trace \u2013 Results from sample with few \nbacilli (paucibacillary TB).  Rifampicin resistance status.\nHIV Testing, using the HTS algorithm 1, is \nrecommended during TB screening and diagnosis.\nScreening for diabetes is recommended among all \nadult patients with TB disease\nKey\nCBR - Chest X -ray\nDR TB - Drug Resistant TB\nDS TB - Drug Susceptible TB\nDST - Drug Susceptibility \nTesting\nEPTB   - Extra Pulmonary TB\nFL - First LineLPA Line Probe Assay\nMTB Mycobacteria \nTuberculosis\nNTM Non -Tuberculous \nMycobacteria\nTST Tuberculin Skin test\nSL Second lineDR TB risk classification among \npatients\nHigh risk for DR TB*\n1. All previously treated TB \npatients: treatment failures, \nrelapses, treatment after loss to \nfollow up\n2. Contacts  of Drug Resistant TB \npatients\n3. TB patients with a positive \nsmear result at month 2 or \nmonth 5 of TB treatment\n4. Patient who develops TB \nsymptoms while on IPT or has \nhad previous IPT exposure\n5. Healthcare workers with 18 \nsymptoms\n6. Prisoners with TB symptoms\n7. Refugees with TB symptoms\nLow risk for DR TB\nAll presumptive TB cases who are \nNOT  in the high risk group\n*ALL the high risk patients MUST  \nbe prioritized to receive DST, \nGeneXpert, FL and SL LPA, \nculture and FL and SL DST.DS TB follow up and DR TB surveillance\nPOSITIVE SMEAR \nRESULT ATAction\nMonth 2/3 \u2022 Evaluate for adherence, and other causes of delayed conversion\n\u2022 Request for all the following drug susceptibility tests (DST); GeneXpert, FL, LPA and \nSL, LPA, Culture and FL and SL DST\n\u2022 Continue with RHZE for one more month, or longer if DST results not received by then\n\u2022 Adjust treatment regimen based on DST results\n\u2022 Repeat smear microscopy at end of month 3.", "start_char_idx": 2, "end_char_idx": 2494, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "b3e2bf4e-85f4-49aa-b2d4-ad05fa95271f": {"__data__": {"id_": "b3e2bf4e-85f4-49aa-b2d4-ad05fa95271f", "embedding": null, "metadata": {"page_label": "177", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "02304cb0-b213-4504-9640-19e3b62bd1fa", "node_type": "4", "metadata": {"page_label": "177", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "01ae678599630a6f4d5a1f23adb1068942df3e4ff1ad0e337879a71860390870", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e2b92eb9-7293-4323-b195-9bd728428cde", "node_type": "1", "metadata": {"page_label": "177", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "09f3bbb52fe742567cf8cc34e0611ac9bf0b19090b315e9bbda06e05262d2f9e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7cd447f1-75b0-4dcf-8efc-656d336879df", "node_type": "1", "metadata": {}, "hash": "0a97b67e619d75ddd6209915c80ee563e7d78d15f20ed501c268844f7357963a", "class_name": "RelatedNodeInfo"}}, "hash": "83bb5092adc1172bbc6b2b0b4f37e0411192b03eba38cdcf07cf09cb3810a164", "text": "Healthcare workers with 18 \nsymptoms\n6. Prisoners with TB symptoms\n7. Refugees with TB symptoms\nLow risk for DR TB\nAll presumptive TB cases who are \nNOT  in the high risk group\n*ALL the high risk patients MUST  \nbe prioritized to receive DST, \nGeneXpert, FL and SL LPA, \nculture and FL and SL DST.DS TB follow up and DR TB surveillance\nPOSITIVE SMEAR \nRESULT ATAction\nMonth 2/3 \u2022 Evaluate for adherence, and other causes of delayed conversion\n\u2022 Request for all the following drug susceptibility tests (DST); GeneXpert, FL, LPA and \nSL, LPA, Culture and FL and SL DST\n\u2022 Continue with RHZE for one more month, or longer if DST results not received by then\n\u2022 Adjust treatment regimen based on DST results\n\u2022 Repeat smear microscopy at end of month 3. If smear positive continue with RHZE and \nreview DST results and inform the SCTLC immediately\n\u2022 Do not proceed to the continuation phase (RH) without a DST result confirming \nsusceptibility to RH (rifampicin and isoniazid)\nMonth 5 or \nMonth 6\u2022 Declare treatment failure and stop anti -TB treatment\n\u2022 Review by the sub county and county TB clinical review teams\n\u2022 Evaluate for adherence, other causes of delayed conversion and treatment failure\n\u2022 Request for GeneXpert, FL LPA and SL LPA, culture and FL and SL DST\n\u2022 Review DST results and re -initiate treatment based on DST results and other clinical \nfindings\nDS TB follow up and DR TB surveillance\nSmear Positive or \nculture positive \nat months 3 or \nlater\u2022 Evaluate for adherence, and  other causes of delay conversion\n\u2022 Request for the following drug susceptibility tests (DSTI) (GeneXpert, Culture and \nFirst Line (FL) and SL DST, FL LPA and SL LPA) depending on the initial resistance \npattern\no Review by the sub county and county clinical review teams\n\u25aa Evaluate for adherence, other causes of reversion and treatment failure\n\u25aa Review the DST results\no Declare failure if at the end of the extended intensive phase  (refer to DR TB \nguidelines)\no Send a case summary to the national clinical team after review by the county clinical \nteam\n\u2022 Do not proceed to the continuation phase (depending on treatment regimen) without a \nDST result\n\u2022 Declare treatment failure\no Review by the sub county and county clinical review teams\n\u25aa Evaluate for adherence, other causes of reversion and treatment failure\n\u25aa Review the DST results\n\u2022 Send a case summary to the national clinical team after review by the county clinical \nteamMOH/DNTLDP/TBSDXALG/01\nSeptember 2020Smear Positive \nsmears and/or \ncultures during \ncontinuation \nphase \nFigure 8.1: TB diagnosis - GeneXpert Ultra algorithm", "start_char_idx": 1748, "end_char_idx": 4329, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7cd447f1-75b0-4dcf-8efc-656d336879df": {"__data__": {"id_": "7cd447f1-75b0-4dcf-8efc-656d336879df", "embedding": null, "metadata": {"page_label": "178", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "9c113226-b6ee-4196-8266-546443c82575", "node_type": "4", "metadata": {"page_label": "178", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "daec823f46496a780e4fd778055007bf67bf1b58f3237ed0d14b1215ce2cca1a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "b3e2bf4e-85f4-49aa-b2d4-ad05fa95271f", "node_type": "1", "metadata": {"page_label": "177", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "83bb5092adc1172bbc6b2b0b4f37e0411192b03eba38cdcf07cf09cb3810a164", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "45cb9011-76a8-49fb-8a63-ed979fe7aa1a", "node_type": "1", "metadata": {}, "hash": "c389caade8f9a2eac40a6e26fb17d3ee089adb6856de44fe717bfa6369880495", "class_name": "RelatedNodeInfo"}}, "hash": "0a97b67e619d75ddd6209915c80ee563e7d78d15f20ed501c268844f7357963a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 6 Table 8.1: TB Diagnosis in Children <10 Years Old  \nALGORITHM FOR PULMONARY TB DIAGNOSIS IN CHILDREN  \nHistory of \npresenting \nillness  For all children presenting to a health facility ask for the following suggestive \nsymptoms  \n\u25cf Cough  \n\u25cf Fever  \n\u25cf Poor weight gain  \n\u25cf Lethargy or reduced playfulness  \nSuspect TB if the child has two or more of these suggestive symptoms  \nAsk for history of contact with adult/adolescent with chronic cough or TB within the \nlast 2 years  \nClinical \nevaluation  Examine the child and check for:  \n\u25cf Temperature > 37.5o (fever)  \n\u25cf Weight (to confirm poor weight gain, weight loss) \u2013 check growth monitoring \ncurve)  \n\u25cf Respiratory rate (fast breathing)  \n\u25cf Respiratory system examination \u2013 any abnormal findings  \nExamine other systems for abnormal signs suggestive of extra -pulmonary TB#  \nInvesti gation\ns Obtain specimen\u2019 for Xpert MTB/RIF (and culture when indicated**)  \nDo a chest Xray (where available)  \nDo a Mantoux test** (where available)  \nDo a HIV test  \nDo other tests to diagnose extra -pulmonary TB where suspected#  \nDiagnosis  Bacteriologically  \nConfirmed TB:  \nDiagnosis if \nspecimen is \npositive for MTB  Clinical Diagnosis of PTB:  \nChild has two or more of the following suggestive symptoms  \n\u25cf Persistent cough, fever, poor weight gain, lethargy  \nPLUS, two or more of the following:  \n\u25cf Positive contact, abnormal respiratory signs, abnormal, \npositive Mantoux  \nNote: If the child has clinical signs suggestive of EPTB, refer to \nEPTB diagnostic table*  \nTreatment  Treat for TB as follows:  \n\u25cf All children with bacteriologically confirmed TB \n\u25cf All children with a clinical diagnosis of TB  \nNB: In children who do not have an Xpert result, or their Xpert results is negative, but \nthey have clinical signs and symptoms suggestive of TB they should be treated for TB  \nAll forms of TB (Except TB meningitis, bone and joint TB) Treat for 6 months (2 RH ZE/ \n4 RH)  \nTB meningitis, bone and joint TB: Treat for 12 months ( 2 RHZE/ 10 RH)  \n*Specimen may include: Expectorated sputum (child > 5 years), induced sputum, nasopharyngeal \naspirate and gastric aspirate. Attempt to obtain specimen in every child  \n**Do a cultu re and DST for the following children:  \n1. Rifampicin resistance detected by the Xpert test  \n2. Refugees and children in contact with anyone who has Drug Resistant TB  \n3. Those not responding to TB treatment  \n4. Those with indeterminate Xpert results  \n***This may include IGRA in facilities where it is available  \n#Use IMCI guidelines to classify severity of disease", "start_char_idx": 3, "end_char_idx": 2624, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "45cb9011-76a8-49fb-8a63-ed979fe7aa1a": {"__data__": {"id_": "45cb9011-76a8-49fb-8a63-ed979fe7aa1a", "embedding": null, "metadata": {"page_label": "179", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "720f6c4c-e2ac-4ad9-8a86-16a486232b95", "node_type": "4", "metadata": {"page_label": "179", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9e948e83c6d5e0d55e1e0584452ef6cff90bf4738291e40d9d31cc11ba9b34f4", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7cd447f1-75b0-4dcf-8efc-656d336879df", "node_type": "1", "metadata": {"page_label": "178", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0a97b67e619d75ddd6209915c80ee563e7d78d15f20ed501c268844f7357963a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "02836ec8-6b6b-4ae6-ab86-5bd87e820dba", "node_type": "1", "metadata": {}, "hash": "b9604888920abc34f93732d3252f24aa3afad87a8cc17c00f3418eef3c928bb9", "class_name": "RelatedNodeInfo"}}, "hash": "c389caade8f9a2eac40a6e26fb17d3ee089adb6856de44fe717bfa6369880495", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 7 \n Table 8.2: Drug Susceptible TB Treatment Regimen for Children, Adolescents and Adults  \nTB disease category  Recommended regimen  \nIntensive phase        Continuation phase  \nAll forms of TB except TB meningitis, bone \nand joint TB (osteoarticular TB)  2 RHZE  4 RH  \nTB meningitis   \nOsteoarticular TB  2 RHZE  10 RH  \nDrug resistant TB  Refer to a DRTB Clinical Team  \n\u25cf Follow up smears should be done for all bacteriologically confirmed pulmonary TB cases at end of \nmonth 2, 5 and 6 of TB treatment using smear microscopy  \n\u25cf Follow up of RR TB and DR TB should be done as per PMDT guidelines  \n\u25cf Patients taking isoniazid containing regimen should also be given Pyridoxine (Vitamin B6) daily for \nthe duration of treatment to reduce the risk of developing peripheral neuropathy (see Annex 10 for \npyridoxine dosing)  \nOnce TB treatment is started it should be completed; unless another definitive diagnosis (like lung \ncancer) is established and TB is ruled out.", "start_char_idx": 2, "end_char_idx": 1030, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "02836ec8-6b6b-4ae6-ab86-5bd87e820dba": {"__data__": {"id_": "02836ec8-6b6b-4ae6-ab86-5bd87e820dba", "embedding": null, "metadata": {"page_label": "180", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "40da6388-06c3-48d5-a372-d45cc5399098", "node_type": "4", "metadata": {"page_label": "180", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "15e415c67f6e56b984be44394607e0d3f076079478b5d67aeea72f694f0b26ef", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "45cb9011-76a8-49fb-8a63-ed979fe7aa1a", "node_type": "1", "metadata": {"page_label": "179", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c389caade8f9a2eac40a6e26fb17d3ee089adb6856de44fe717bfa6369880495", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6476a633-9731-4f25-9a2c-4bde8606cd6b", "node_type": "1", "metadata": {}, "hash": "6322ce883813584b88620be7860cef8185d9d29823b784709db86706e6ec3502", "class_name": "RelatedNodeInfo"}}, "hash": "b9604888920abc34f93732d3252f24aa3afad87a8cc17c00f3418eef3c928bb9", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 8  \nTB-LAM is a rapid point -of-care urine dip -stick test that can be performed at the bedside. LAM stands for \nlipoarabinomannan, which  can be detected in urine when it sheds off of the TB  cell wall . \nGeneXpert is the recommended initial diagnostic test for people with presumptive TB.\nTB-LAM SHOULD NOT be used as an alternative test to GeneXpert, but can be performed  to help diagnose TB while \nwaiting for GeneXpert test results. TB -LAM cannot detect resistance to rifampicin.\nIndications for use of TB -LAM, as an adjunct test to GeneXpert:\n\u2022 PLHIV with advanced disease (WHO stage 3 or 4 or CD4 count       cells/mm3 (or       for children     \nyears old)) with presumed TB \n\u2022 PLHIV that have any danger signs of severe illness: respiratory rate >30 breaths per minute, temperature >39\u00b0C, \nheart rate >120 beats per minute, unable to walk unaided\n\u2022 Currently admitted to hospital \nLF-LAM Negative LF-LAM Positive\nTB is not ruled out \n\u2022 Evaluate the clinical response after 3\u20135 days of \nantibiotic treatment, while awaiting GeneXpert \nresultsTB is likely\n\u2022 Initiate TB treatment\n\u2022 Conduct additional investigations for TB \nand other HIV related diseases as \nappropriate\n\u2022 Continue TB treatment even if GeneXpert \nresults come back negative\nClinical improvementClinical worsening or no \nimprovement\nTB is unlikely\n\u2022 Conduct additional investigations for TB and \nother opportunistic illnesses\n\u2022 Complete the course of parenteral antibiotics\nNote: \n\u2022 If GeneXpert results are positive for TB, \ninitiate TB treatment irrespective of TB -LAM \nresults or clinical improvement \n\u2022 If GeneXpert results are negative for TB, \nconsider TPTTB is likely\n\u2022 Start TB treatment if patient is seriously \nill or if GeneXpert results come back \npositive (irrespective of TB -LAM results)\n\u2022 Conduct additional investigations for TB \nand other HIV -related diseases\n\u2022 Complete the course of parenteral \nantibiotics\n \nFigure 8.2: Use of TB-LAM for Diagnosis of TB among PLHIV", "start_char_idx": 3, "end_char_idx": 2026, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6476a633-9731-4f25-9a2c-4bde8606cd6b": {"__data__": {"id_": "6476a633-9731-4f25-9a2c-4bde8606cd6b", "embedding": null, "metadata": {"page_label": "181", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "9de0a5df-0b9b-413a-b5af-b66c1add463e", "node_type": "4", "metadata": {"page_label": "181", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "118ff1ca4024919573fa44f99ead4223bfd85e223b62c8598bb95d96f6cfa90a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "02836ec8-6b6b-4ae6-ab86-5bd87e820dba", "node_type": "1", "metadata": {"page_label": "180", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b9604888920abc34f93732d3252f24aa3afad87a8cc17c00f3418eef3c928bb9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7a63b105-2a44-4c90-b69d-31100430f419", "node_type": "1", "metadata": {}, "hash": "0f04a241a89a2d6ef5e0ec581a2d05dfd4b0dcc20bb1ba3fcd8cb64df3d206cd", "class_name": "RelatedNodeInfo"}}, "hash": "6322ce883813584b88620be7860cef8185d9d29823b784709db86706e6ec3502", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 9 8.2. TB Preventive Therapy (TPT)  \nThis section summarizes the current national recommendations for treatment of latent TB \ninfections (LTBI) in the PLHIV population. These are in line with the updated World Health \nOrganization guidelines which include the use of shorter, safer LTBI treatment options for an \nexpanded at -risk population. For further guidance, refer to the national guidelines on LTBI \nmanagement.  \n8.2.1. Indications for TPT  \nTPT should be provided to those p atients in whom TB is excluded (using the ICF tool) and meet \nthe eligibility criteria to initiate TPT. The following client categories are eligible for TPT who \nscreen negative for active TB  \n\u25cf All PLHIV above 12 months of age (children, adolescents and adults  including pregnant \nand breastfeeding women)  \n\u25cf All household contacts of persons with bacteriologically confirmed pulmonary TB            \n\u25cf Prisoners and staff working in prison setting            \n\u25cf Health care workers and other staff in health care setting  \n\u25cf Other clinical risk groups as defined in LTBI guidelines  \n*Neonates born to mothers with TB, or exposed to close contacts with TB should be given TPT \nonce TB disease has been ruled out. BCG should be given 2 weeks after completion of TPT or anti -\nTB treatment  \nSummary of recommendations for TPT among the PLHIV  \n\u25cf PLHIV are at a much higher risk of getting TB disease compared to the general population  \n\u25cf TB preventive therapy should be given to all PLHIV above 12 months of age who do not \nhave active TB disease. This should be done irrespective of immune status, ART status, \nprevious history of TB and pregnancy status.  \n\u25cf Children aged <12 months living with HIV who are household contacts of a person with \nbacteriologically confirmed pulmonary TB, and whom act ive TB has been ruled out \nshould receive TB preventive therapy.  \n\u25cf TPT may be given immediately following successful completion of TB treatment among \nthe PLHIV.  \n\u25cf Repeat TPT is not recommended among PLHIV except if a PLHIV becomes a \nhousehold contact of a perso n with bacteriologically confirmed pulmonary TB  \n\u25cf PLHIV aged 15 years and above should be provided with 3 months of weekly Rifapentine \nand Isoniazid (3HP), while those less than 15 years are given 6 months of daily INH (6H)  \n\u25cf In PLHIV on PI/r -based ART, pregna nt women and those who do not tolerate 3HP should \nbe given six months of daily INH (6H)  \n\u25cf For eligible patients previously treated for TB, initiate TPT upon completion of their TB \ntreatment.", "start_char_idx": 3, "end_char_idx": 2579, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7a63b105-2a44-4c90-b69d-31100430f419": {"__data__": {"id_": "7a63b105-2a44-4c90-b69d-31100430f419", "embedding": null, "metadata": {"page_label": "182", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a4e648b4-78d1-4369-a12f-6a21f275a3fb", "node_type": "4", "metadata": {"page_label": "182", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9f301e4245d2dcf315c6bbbeba3392c2394d65b8bd92884e281dba978cd93953", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6476a633-9731-4f25-9a2c-4bde8606cd6b", "node_type": "1", "metadata": {"page_label": "181", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6322ce883813584b88620be7860cef8185d9d29823b784709db86706e6ec3502", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "15760338-4e33-499e-8839-21c377925ae5", "node_type": "1", "metadata": {}, "hash": "faf91a9c44507b46a08b0c10e4c108fe476b603882d3c82b4922b9a9d7580c07", "class_name": "RelatedNodeInfo"}}, "hash": "0f04a241a89a2d6ef5e0ec581a2d05dfd4b0dcc20bb1ba3fcd8cb64df3d206cd", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 10 8.2.2. Contraindications to TPT  \nPatients with the following should not receive TPT until the underlying issue(s) are \naddressed  \n\u25cf Active tuberculosis disease  \n\u25cf Active hepatitis (acute or chronic)  \n\u25cf Chronic alcohol abuse      \n\u25cf Symptoms of peripheral neuropathy  \n \n8.2.3. Dose and Duration of TPT  \nTable 8.3: Recommended TPT Regimens for PLHIV  \nTarget populations  TPT Regimen  \n\u25cf Adult PLHIV excluding patients \non PI/r -based ARV regimens  Rifapentine and Isoniazid (3HP)  \nOnce weekly for three months  \n          (12 doses)  \n\u25cf Adult PLHIV on PI/r -based ARV \nregimens  \n\u25cf All CALHIV aged below 15 years  \n\u25cf Any patient with intolerance or \ncontraindication to 3HP  \n\u25cf Pregnant women  Isoniazid (6H)  \nOnce daily for 6 months  \n\u25cf The 3RH (rifampicin and isoniazid) regimen is not recommended for PLHIV due \nto drug - drug interactions  \n\u25cf All TPT regimens should be given with Vitamin B6 (pyridoxine), if available, to \nreduce the risk of developing peripheral neuropathy  \n\u25cf Comprehensive health  education and adherence counselling should be \nconducted prior to initiation of TPT  \n\u25cf Dosing of TPT is in Annex 10  \n \n\u25cf Children should be weighed at each visit and correct weight -based dosing confirmed.  \n\u25cf Clients on 3HP should receive weekly dose of pyridoxine, Those on Rifapentine and \nIsoniazid regimen should be given pyridoxine once a week  \n\u25cf The 3RH (rifampicin and isoniazid) regimen is not recommended for PLHIV due \nto drug -drug interactions. 3RH is used in HIV negative populations", "start_char_idx": 3, "end_char_idx": 1578, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "15760338-4e33-499e-8839-21c377925ae5": {"__data__": {"id_": "15760338-4e33-499e-8839-21c377925ae5", "embedding": null, "metadata": {"page_label": "183", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "7df0b3c5-7e5e-4c52-a9ff-ac63c829cc28", "node_type": "4", "metadata": {"page_label": "183", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2623cb5144d7c507cbbb5e339b18d53484bc13ce0d5eb5684435c784c0e84056", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7a63b105-2a44-4c90-b69d-31100430f419", "node_type": "1", "metadata": {"page_label": "182", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0f04a241a89a2d6ef5e0ec581a2d05dfd4b0dcc20bb1ba3fcd8cb64df3d206cd", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2d5cbeb6-30ec-47bb-a447-9c472f0edbcd", "node_type": "1", "metadata": {}, "hash": "8567bb806e5769b525a2f937d68519a4fd3521d95e9a64471d3901466764a952", "class_name": "RelatedNodeInfo"}}, "hash": "faf91a9c44507b46a08b0c10e4c108fe476b603882d3c82b4922b9a9d7580c07", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 11 8.2.4. Follow -up of Patients on TPT  \nPatients on TPT should be followed up on a monthly basis and their return -to-clinic dates \nharmonized with any other routine schedules. During each clinic visit, conduct the following;  \n\u25cf Symptom screening for active TB disease and update status  \n\u25cf Assess and reinforce adherence to treatment  \n\u25cf If a patient screens positive for TB while on TPT, stop TPT and manage according to \nNational TB guidelines  \n\u25cf Assess for any adverse drug reactions at each visit and intervene appropriately  \n\u25cf Provide/update TPT appointment card  \n\u25cf Document and update the relevant recording and reporting tools, e.g., ICF/TPT cards, \nContact Management/TPT register  \n\u25cf Document outcome of TPT use e.g., completion in the relevant tools and/or EMR  \n*Baseline liver function tests are not mandatory for patients initiating TPT. These may, however, be \nconsidered on an individual ba sis, especially for patients taking other medications for chronic \nmedical conditions or symptomatic patients suspected to have active hepatitis  \n \n8.3. Identifying and Managing Drug Toxicities from TPT  \nThe management of drug toxicities should be based on severity, with appropriate grading of \nindividual patients. The most common adverse drug reactions associated with TPT are peripheral \nneuropathy, drug -induced liver injury (DILI), and rash.  \n8.3.1 Periphe ral Neuropathy - Suspected drug: INH        \nDiagnosis of Peripheral Neuropathy  \n\u25cf Symptoms include: burning sensation, numbness, or tingling, usually starting at the feet \non both sides  \n\u25cf May have decreased sensation on examination  \n\u25cf May develop weakness in severe cases  \n\u25cf May be potentiated by other neurotoxic drugs, alcoholism, metabolic disease (e.g., \ndiabetes), malnutrition and infections  \n\u25cf Rarely severe enough to require drug withdrawal  \nManagement of INH -induced Peripheral Neuropathy  \n\u25cf Increase the dose of pyridoxine to 100 mg per day  \n\u25cf For children give double the standard weight -based dose  \n\u25cf Assess for other causes of peripheral neuropathy (e.g., diabetes, thyroid disorder, B12 \ndeficiency, syphilis, etc.)  \n\u25cf Relief of symptoms can be achieved with analgesics, tricyclic antidepressants \n(amitriptyline, nortriptyline), anticonvulsants (carbamazepine, phenytoin)  \n\u25cf If symptoms do not improve, or there is any worsening, then discontinue TPT; symptoms \nmay persist even  after discontinuing TPT", "start_char_idx": 3, "end_char_idx": 2472, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2d5cbeb6-30ec-47bb-a447-9c472f0edbcd": {"__data__": {"id_": "2d5cbeb6-30ec-47bb-a447-9c472f0edbcd", "embedding": null, "metadata": {"page_label": "184", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "dabb301c-5697-4adf-be57-daec89d0ebdc", "node_type": "4", "metadata": {"page_label": "184", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ba8bc45af84411453ea56d8908fbd75ef365623dcd721c66e134c4106c3b1d45", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "15760338-4e33-499e-8839-21c377925ae5", "node_type": "1", "metadata": {"page_label": "183", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "faf91a9c44507b46a08b0c10e4c108fe476b603882d3c82b4922b9a9d7580c07", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2fc1c010-bd1b-496c-ae3b-2f014a07945c", "node_type": "1", "metadata": {}, "hash": "11a58595258954faeeb954cf2fecaa7f1a2f29f2014f6116b0b3ff674ad68165", "class_name": "RelatedNodeInfo"}}, "hash": "8567bb806e5769b525a2f937d68519a4fd3521d95e9a64471d3901466764a952", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 12 8.3.2 Drug -Induced Liver Injury (DILI) -Suspected drugs include Isoniazid (H), \nRifapentine (P), Rifampicin (R)  \n\u25cf Elevation of liver enzymes may occur in the first weeks of treatment  \n\u25cf In asymptomatic patients, serum liver enzyme lev els do not need to be monitored \nroutinely   \n\u25cf All clients with gastrointestinal symptoms (nausea and vomiting, liver tenderness, \nhepatomegaly or jaundice) should have their liver function assessed  \n\u25cf Patients should be screened for other causes of liver injury  (the hepatitis viruses -A, B, C)  \n\u25cf Table 8.4 shows the grading of liver injury and management of DILI  \n\u25cf Once the drugs are discontinued, no attempt should be made to reintroduce these drugs \nuntil liver functions have normalized  \n\u25cf An expert with experience in managing DILI should be involved in the further \nmanagement of such cases  \nDiagnosis of DILI  \n\u25cf Jaundice, a bdominal pain, nausea, vomiting, anorexia, etc.  \n\u25cf Abnormal liver enzymes  \n \nTable 8.4: Grading and Management of DILI  \n Grade 1: Mild  Grade 2: Moderate  Grade 3: Severe  Grade 4: Life \nthreatening  \nALT (SGPT)  1.25 \u2013 2.5 x ULN  2.6 \u2013 5.0 x ULN  5.1 \u2013 10.0 x ULN  > 10.0 x ULN  \nAST (SGOT)  1.25 \u2013 2.5 x ULN  2.6 \u2013 5.0 x ULN  5.1 \u2013 10.0 x ULN  > 10.0 x ULN  \n  \n  \n  \nACTION  Continue treatment \nregimen;  \npatients should have \nweekly followed up \nuntil resolution \n(return to baseline) \nor stabilization of \nAST/ALT elevation  Continue treatment \nregimen;  \npatients should have \nweekly followed up \nuntil resolution \n(return to baseline) \nor stabilization of \nAST/ALT elevation  Stop all drugs, \nincluding TPT \ndrugs;  \nmeasure LFTs \nweekly;  \nTPT should not  \nbe reintroduced \nafter severe DILI1 Stop all drugs, \nincluding TPT drugs;  \nmeasure LFTs weekly. \nTPT should not  be \nreintroduced after life \nthreatening DILI1 \n \n \n1. PLHIV who develop DILI during treatment of active TB disease, may have anti -TBs reintroduced \nafter toxicity is resolved in consultation with a senior clinician", "start_char_idx": 3, "end_char_idx": 2045, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2fc1c010-bd1b-496c-ae3b-2f014a07945c": {"__data__": {"id_": "2fc1c010-bd1b-496c-ae3b-2f014a07945c", "embedding": null, "metadata": {"page_label": "185", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "57cc9814-ff00-430a-8e58-56c431c483b1", "node_type": "4", "metadata": {"page_label": "185", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9e68dd2d35034d003788f69f474f0f8d698cd3312d6e6cb4844ab4fb5bd212cb", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2d5cbeb6-30ec-47bb-a447-9c472f0edbcd", "node_type": "1", "metadata": {"page_label": "184", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8567bb806e5769b525a2f937d68519a4fd3521d95e9a64471d3901466764a952", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1f5493b1-686c-4907-b63f-7c404e265fca", "node_type": "1", "metadata": {}, "hash": "14427a090f413ebb5b1804bf8988e578c2772aebb1842f6dc312dd4635c903ec", "class_name": "RelatedNodeInfo"}}, "hash": "11a58595258954faeeb954cf2fecaa7f1a2f29f2014f6116b0b3ff674ad68165", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 13 8.3.3 Management of TPT -associated Rash - Suspected Drugs include Isoniazid (H), \nRifapentin e (P), Rifampicin (R)  \n\u25cf A rash may occasionally develop, usually within a few days following initiation of TPT. It \nis often a relatively mild maculopapular rash with or without pruritus.  \n\u25cf Flu-like and other systemic hypersensitivity reactions are rare amongst children. \nHypersensitivity reactions in adults are usually mild and self -limiting  \n\u25cf Rarely, rash may develop with severe exfoliation of the skin and Stevens -Johnson \nsyndrome  \n\u25cf Rash severity should be assessed and managed appropriately as shown in table  8.5  \n \nTable 8.5: Management of TPT -Associated Skin Rash  \nSeverity  Characteristics  Action  \nMild  Dry; erythema +/ - fine \npapules; pruritus; affecting \n< 50% of body surface area  Continue TPT; close monitoring; symptomatic \ntreatment with antihistamines +/ - topical steroids \n(NOT oral steroids)  \nModerate  Dry; erythema +/ - fine \npapules; pruritus; affecting \n\u2265 50% of body surface area  Stop TPT; symptomatic treatment with \nantihistamines +/ - topical steroids (NOT oral \nsteroids); trial of desensitization after symptoms \ncompletely resolved  \nSevere  Mucosal involvement;  \nblistering; associated \nfever; any % of body \nsurface area  Stop TPT; admission to hospital for supportive \nmanagement (IV fluids, wound care, pain control, \ninfection control, monitoring for super -infection); \npatient should NEVER be re -challenged;  \ndocument and report adverse event and issue \npatient alert card  \n \n8.4. ART for TB/HIV Co -infection  \nAs with all PLHIV, those who are diagnosed with TB/HIV co -infection should be on ART and CPT \nas part of the comprehensive package of care for PLHIV.  \nTiming of ART for TB/HIV Co -infection  \n\u25cf Patients who are not yet on ART  \no Start TB treatment immediately  \no Initiate ART as soon as anti -TB medications are tolerated, preferably within 2 \nweeks  \no For TB meningitis delay ART for 4 to 8 weeks  \no Monitor closely for IRIS (Annex 16)", "start_char_idx": 3, "end_char_idx": 2074, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1f5493b1-686c-4907-b63f-7c404e265fca": {"__data__": {"id_": "1f5493b1-686c-4907-b63f-7c404e265fca", "embedding": null, "metadata": {"page_label": "186", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "bf0d9d52-f30d-4050-9a8a-56fe384f4438", "node_type": "4", "metadata": {"page_label": "186", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "25d4c0b69110a37c7b27820e17e519a6e6e6dee5f72f8f2e32b3b9ddf476aca2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2fc1c010-bd1b-496c-ae3b-2f014a07945c", "node_type": "1", "metadata": {"page_label": "185", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "11a58595258954faeeb954cf2fecaa7f1a2f29f2014f6116b0b3ff674ad68165", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "16f3c9b9-0812-413e-915f-09d981098994", "node_type": "1", "metadata": {}, "hash": "9094da1b36d49f43e3b0094c6fa60c2e3175b884359a6e3da9bdf7ef70932a35", "class_name": "RelatedNodeInfo"}}, "hash": "14427a090f413ebb5b1804bf8988e578c2772aebb1842f6dc312dd4635c903ec", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 14 \u25cf Patients who are already on ART  \no Start TB treatment immedi ately  \no Continue ART, assessing for treatment failure and making any required \nadjustments to the ART regimen based on drug -drug interactions (Table 8.7)  \no Monitor closely for IRIS (Annex 16)  \n\u25cf Patient being treated concurrently for TB and HIV require close monitoring for \ntoxicity  \n\u25cf MDR TB and HIV co -infection should be managed in settings where close toxicity \nmonitoring and follow up by experienced clinicians or multi -disciplinary team is \npossible       \nPreferred ART regimens for patients with TB/HIV co -infecti on are summarized in Tables 8.6 - 8.8. \nTable 8.6: Preferred ART Regimens for TB/HIV Co -infection for Patients Newly Initiating 1st \nLine ART 1 \nAge  Weight  1st Line ART if TB/HIV Co -infection  \nBirth to 4 \nweeks  Any  Start anti -TB treatment immediately; start ART after 4 weeks \nof age, once tolerating anti -TB drugs (follow the regimen \nrecommendations for children \u2265 4 weeks old)  \n> 4 weeks to < \n15 years  < 30 kg  \u25cf ABC + 3TC + DTG  \n\u25cf Increase DTG dosing frequency to twice daily for duration \nof rifampicin -containing TB treatment and for an additional \n2 weeks after TB treatment is completed, then revert to \nonce daily dosing  \n\u2265 30 kg  \u25cf Give TDF/3TC/DTG FDC morning + DTG 50mg evening for \nduration of rifampicin -containing TB treatment and for an \nadditional 2 weeks after TB treatment is completed, then \nrevert to TDF/3TC/DTG FDC once daily  \n\u2265 15 years  Any  \u25cf Give TDF/3TC/DTG FDC morning + DTG 50mg evening for \nduration of rifampicin -containing TB treatment and for an \nadditional 2 weeks after TB treatmen t is completed, then \nrevert to TDF/3TC/DTG FDC once daily  \n1 Refer to Annex 10 for weight -based ARV dosing", "start_char_idx": 3, "end_char_idx": 1808, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "16f3c9b9-0812-413e-915f-09d981098994": {"__data__": {"id_": "16f3c9b9-0812-413e-915f-09d981098994", "embedding": null, "metadata": {"page_label": "187", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5b082e6b-72d8-40f0-80b1-107e4447d24f", "node_type": "4", "metadata": {"page_label": "187", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5ef95dde06d9d282589f9310b463d07b1e2b99ec999ea3fecf9fd5034500ad44", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1f5493b1-686c-4907-b63f-7c404e265fca", "node_type": "1", "metadata": {"page_label": "186", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "14427a090f413ebb5b1804bf8988e578c2772aebb1842f6dc312dd4635c903ec", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7bb65ef6-1abd-4ecd-a1c7-3da80e63f78c", "node_type": "1", "metadata": {}, "hash": "0f5cee441ab7229b4f48036f8bfec910efbb211504095aab63d2bcbe474cc9a5", "class_name": "RelatedNodeInfo"}}, "hash": "9094da1b36d49f43e3b0094c6fa60c2e3175b884359a6e3da9bdf7ef70932a35", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 15 Table 8.7: Preferred ART Regimens for Patients who Develop TB while Virally Suppressed on \n1st Line ART 1,2 \nCurrent \nRegimen3  Recommended Substitution  \nPI/r -based4 All ages  \u25cf Switch from PI/r to DTG and continue this regimen even after \ncompleting TB treatment. Follow DTG dosing as below  \n\u25cf If it is not possible to switch to DTG:  \no Children < 30 kg requiring PI/r -based ART should receive \nLPV/r with additional ritonavir super -boosting for the duration \nof rifampicin -based TB therapy, reverting to standard LPV/r \ndosing 2 weeks after completing TB treatment  \no Patients \u2265 30 kg who cannot switch to DTG should be switched \nto EFV -based ART and maintained on EFV -based ART after \ncompletion of TB treatment  \nRAL -based  All ages Switch from RAL to double -dose DTG dosing during TB treatment and \nmaintain on DTG after completion of TB treatment  \nDTG -based  All ages   \nAdminister the double -dose of DTG (i.e., the standard weight -based \ndose of DTG given twice daily) while taking rifampicin containing TB \ntreatment. Two weeks after completion of TB treatment revert to the \nrecommended DTG dose once daily.  \n1 Always assess for HIV treatment failure in patients who develop TB after being on ART for \u2265 6 \nmonths. For patients failing 1st line ART refer to Table 8.8 for recommended 2nd line regimens  \n2 For patients on 2nd line ART, subsequent regimens, or nonstandard drugs who require regimen \nchange because of TB treatment, consult the Regional or National HIV Clinical TWG (Uliza Hotline \n0726  460 000; https://nhcsc.nascop.org/clinicalform ) \n3 NRTIs in the patient\u2019s current regimen do not require any adjustments with anti -TB treatment  \n4 Use \u201csuper -boosted\u201d LPV/r by adding additional ritonavir to manage the drug interaction between \nLPV/r and rifampicin (see Annex 10 for dosing recommendations)", "start_char_idx": 3, "end_char_idx": 1900, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7bb65ef6-1abd-4ecd-a1c7-3da80e63f78c": {"__data__": {"id_": "7bb65ef6-1abd-4ecd-a1c7-3da80e63f78c", "embedding": null, "metadata": {"page_label": "188", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "9f0b3379-c6e1-4717-bdd8-6baf983e5929", "node_type": "4", "metadata": {"page_label": "188", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3ba50d6e456ceff00e65c270c166423830b9876d466146f3c71d588f7fab43d2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "16f3c9b9-0812-413e-915f-09d981098994", "node_type": "1", "metadata": {"page_label": "187", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9094da1b36d49f43e3b0094c6fa60c2e3175b884359a6e3da9bdf7ef70932a35", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4c250f58-784c-4ac7-a477-92d3f2370c8b", "node_type": "1", "metadata": {}, "hash": "a3559e7832ea8999d3d89380214bf9c25e3841e9e198d4730a45777eed1bce49", "class_name": "RelatedNodeInfo"}}, "hash": "0f5cee441ab7229b4f48036f8bfec910efbb211504095aab63d2bcbe474cc9a5", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 16 Table 8.8: Recommended ART Regimens for Patients who Develop TB while Failing 1st Line \nART 1 \nAge/  \nScenario  First -line \nART  Second -line ART  \n< 30 kg \nbody \nweight  LPV/r -\nbased 1st \nline \u25cf Start anti -TB immediately.  \n\u25cf Change to DTG -based second -line immediately. Increase DTG dosing \nfrequency to twice daily for duration of rifampicin -containing TB \ntreatment and for an additional 2 weeks after TB treatment is completed, \nthen revert to once daily dosin g  \n\u25cf Immediately collect a sample for DRT2 \n\u25cf Assess for and address reasons for treatment failure.  \n\u25cf If unable to switch to DTG then use super -boosted LPV/r3 \nABC (or \nAZT) + \n3TC + \nDTG  \u25cf Start anti -TB immediately  \n\u25cf Increase DTG dosing frequency to twice daily for duration of rifampicin -\ncontaining TB treatment and for an additional 2 weeks after TB treatment \nis completed, then revert to once daily dosing.  \n\u25cf Follow the viral load monitoring algorithm (Figure 6.6), inclu ding \nassessing for and addressing reasons for treatment failure, and collecting \nDRT. Consult the Regional or National TWG to constitute a second -line \nregimen based on DRT results  \n\u2265 30 kg or \n\u2265 15 years \nold TDF (or \nABC or \nAZT) + 3TC \n+ DTG  \u25cf Start anti -TB immediately  \n\u25cf Give TDF/3TC/DTG FDC morning + DTG 50mg evening for duration of \nrifampicin -containing TB treatment and for an additional 2 weeks after \nTB treatment is completed, then revert to TDF/3TC/DTG FDC once daily  \n\u25cf Follow the viral load monitoring algorithm (Figure 6.6), including \nassessing for and addressing reasons for treatment failure, and collecting \nDRT. Consult the Regional or National TWG to constitute a second -line \nregimen based on DRT results  \nTDF (or \nABC or \nAZT) + \n3TC + EFV  \u25cf Start anti -TB immediately  \n\u25cf Continue current regimen while following the viral load monitoring \nalgorithm (Figure 6.6), including assessing for and addressing reasons for \ntreatment failure.  \n\u25cf Once treatment failure is confirmed and patient ready to switch to 2nd \nline, switch to TDF + 3TC + DTG (maintain the TDF, even if the patient was \nalready on a TDF -containing regimen), increasing the DTG dose to twice \ndaily for the duration of rifampicin -based TB therapy, switching back to \nstandard DTG dose 2 weeks after rifampin is discontinued.  \nPI/r -\nbased 1st \nline \u25cf Start anti -TB immediately  \n\u25cf Switch to TDF+3TC+DTG immediately. Give TDF/3TC/DTG FDC morning \n+ DTG 50mg evening for duration of rifampicin -containing TB treatment \nand for an additional 2 weeks after TB treatment is completed, then revert \nto TDF/3TC/DTG FDC once daily  \n\u25cf Immediately collect a sample for DRT2  \n\u25cf Assess for and address reasons for treatment failure.  \nPregnant or \nBreastfeeding  Follow the same recommendations as for \u2265 30 kg or \u2265 15 years old.   \nHIV/HBV \nCo-infection  Always maintain TDF or TAF in second -line instead of switching to a different NRTI and \ninstead of adding an additional NRTI", "start_char_idx": 3, "end_char_idx": 3004, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "4c250f58-784c-4ac7-a477-92d3f2370c8b": {"__data__": {"id_": "4c250f58-784c-4ac7-a477-92d3f2370c8b", "embedding": null, "metadata": {"page_label": "189", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "abdae3c8-476b-4c9c-b26d-c7738a91da23", "node_type": "4", "metadata": {"page_label": "189", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b5b3bd63b957bb481dcf59416e3d7d72b1634c67db1002eb9fddec0de5c41267", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7bb65ef6-1abd-4ecd-a1c7-3da80e63f78c", "node_type": "1", "metadata": {"page_label": "188", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0f5cee441ab7229b4f48036f8bfec910efbb211504095aab63d2bcbe474cc9a5", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1522ccf7-33a9-4970-b245-84446f18c691", "node_type": "1", "metadata": {}, "hash": "bb613a3f5c55ed29001152fbecb41f024f6cde2bd3839b484e1f53fe5a0b2b89", "class_name": "RelatedNodeInfo"}}, "hash": "a3559e7832ea8999d3d89380214bf9c25e3841e9e198d4730a45777eed1bce49", "text": "TB/HIV Co -infection, Prevention and Management  \n \n8 - 17 Table 8.8 Cont.  \n1. For patients on 2nd line ART, subsequent regimens, drug intolerance, or nonstandard drugs who require \nregimen change because of TB treatment, consult the Regional or National HIV Clinical TWG (Uliza Hotline \n0726 460 000; https://nhcsc.nascop.org/clinicalform ) \n2. Contact  the Regional or National HIV Clinical TWG (Uliza Hotline 0726 460 000; \nhttps://nhcsc.nascop.org/clinicalform ) for guidance on urgent collection of DRT samples  \n3. Use \u201csuper -boosted\u201d LPV/r by adding additional ritonavir to manage the drug interaction between LPV/r \nand rifampicin (see Annex 10 for dosing recommendations). Two weeks after TB treatment is completed \nthe child should go back to standard LPV/r dosing.", "start_char_idx": 3, "end_char_idx": 780, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1522ccf7-33a9-4970-b245-84446f18c691": {"__data__": {"id_": "1522ccf7-33a9-4970-b245-84446f18c691", "embedding": null, "metadata": {"page_label": "190", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "abfd4ef7-8547-4625-8225-aeb2943eac4a", "node_type": "4", "metadata": {"page_label": "190", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9a27ea4f59931772247bfd5e3b058d58959cd205e10a2309a1499da32eb50e11", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "4c250f58-784c-4ac7-a477-92d3f2370c8b", "node_type": "1", "metadata": {"page_label": "189", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a3559e7832ea8999d3d89380214bf9c25e3841e9e198d4730a45777eed1bce49", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bda113a2-975f-41a6-bfa0-61cd3ab2f8ea", "node_type": "1", "metadata": {}, "hash": "c352f24ff1f1b736ae3a8674ace874b4360eae91c4bb9d1adda66f1c55fc2787", "class_name": "RelatedNodeInfo"}}, "hash": "bb613a3f5c55ed29001152fbecb41f024f6cde2bd3839b484e1f53fe5a0b2b89", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 8 - 18", "start_char_idx": 3, "end_char_idx": 64, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bda113a2-975f-41a6-bfa0-61cd3ab2f8ea": {"__data__": {"id_": "bda113a2-975f-41a6-bfa0-61cd3ab2f8ea", "embedding": null, "metadata": {"page_label": "191", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "939a138e-59c2-4d14-a770-95efe46a538d", "node_type": "4", "metadata": {"page_label": "191", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "639d64b6d2f33a0491f97cd989c0bae13b2cc37c579cf0434ddc8cdeae378b38", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1522ccf7-33a9-4970-b245-84446f18c691", "node_type": "1", "metadata": {"page_label": "190", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "bb613a3f5c55ed29001152fbecb41f024f6cde2bd3839b484e1f53fe5a0b2b89", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7f569209-b026-4496-91bc-320e07eac6ff", "node_type": "1", "metadata": {}, "hash": "afdbfab06e44303a0073366211955afce02e14881e0213815072f9d4d5e7d4b6", "class_name": "RelatedNodeInfo"}}, "hash": "c352f24ff1f1b736ae3a8674ace874b4360eae91c4bb9d1adda66f1c55fc2787", "text": "TB/HIV Co -infection, Prevention and Management  \n \n9 - 1  \n9. HBV/HIV and HCV/HIV Co -infection \nPrevention and Management  \n9.1 Hepatitis B/HIV Co -infection  \nHIV and Hepatitis -B Virus (HBV) share infection transmission routes.  Acute HBV infection in HIV \npositive people is associated with increased risk of chronicity, reduced chances of spontaneous \nclearance, higher rates of replication and reactivation and therefore increased incidence of \nchronic liver disease, cirrhosis and hep atocellular carcinoma (HCC). Additionally, HIV/HBV co -\ninfection has been associated with rapid HIV disease progression and poorer HIV treatment \noutcomes.  Other complications of HIV/HBV co -infection include increased incidence of drug -\nrelated hepatotoxicit y, drug -drug interactions and ART -related immune reconstitution hepatitis.  \n9.1.1 Screening  \nAll adolescents and adults living with HIV (plus children who did not complete routine childhood \nimmunizations) should be screened for HBV infection, using HBsAg, as part of initial evaluation. \nTo promote population -wide prevention, hepatitis B prevention should be integrated into \nroutine HIV prevention and care programs. In this setting, other indications for HBsAg screening \ncould include  \n\u25aa Household and sexual contacts of HBsAg positive individuals  \n\u25aa Pregnant women  \n\u25aa Persons who inject drugs (PWID)  \n\u25aa Men who have sex with men  \n\u25aa Sex workers  \n\u25aa Persons with multiple sexual partners  \n\u25aa Prisoners  \n\u25aa Blood donors  \n\u25aa Unvaccinated healthcare providers  \n \nPLHIV on follow -up who presen t with signs of liver disease (jaundice, ascites, abnormal liver on \npalpation, other signs of cirrhosis) or unexplained and persistent ALT elevation should also be \nscreened for HBV as part of their work -up. \n9.1.2 Prevention  \nA. Vaccination : HBV vaccination reduces the risk of new (incident) HBV infection in PLHIV and \nalso reduces the risk of new infections becoming chronic. Therefore;  \n\u25cf HIV positive infants, children, adolescents and adults without evidence of hepatitis B \ninfection (HBsAg negative)  should be vaccinated against hepatitis B (Table 9.1)  \n\u25cf HIV exposed infants (HEI) should also receive hepatitis B vaccination as part of childhood \nimmunization (Table 4.21)  \n\u25cf As a strategy to reduce the population level burden of HBV infection, HIV prevention and \ntreatment settings should integrate HBV prevention through vaccination. Thus, HBV \nvaccination is recommended for the following groups who test HBsAg negative.", "start_char_idx": 3, "end_char_idx": 2508, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7f569209-b026-4496-91bc-320e07eac6ff": {"__data__": {"id_": "7f569209-b026-4496-91bc-320e07eac6ff", "embedding": null, "metadata": {"page_label": "192", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1f2f3e13-2350-4afc-8aed-fb37dcda7ca5", "node_type": "4", "metadata": {"page_label": "192", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "df8542bfd6031e94155f8f761d14945eb7ebf56fe338f31ed284ee2ffac301e9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bda113a2-975f-41a6-bfa0-61cd3ab2f8ea", "node_type": "1", "metadata": {"page_label": "191", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c352f24ff1f1b736ae3a8674ace874b4360eae91c4bb9d1adda66f1c55fc2787", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "de9b60d4-cf0b-46ac-b996-4b77180ea83a", "node_type": "1", "metadata": {}, "hash": "29c86c0212c0892aaf5655e1007a96ddb993979b125c591d8d31003d79c310c2", "class_name": "RelatedNodeInfo"}}, "hash": "afdbfab06e44303a0073366211955afce02e14881e0213815072f9d4d5e7d4b6", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 9 - 2 o Babies and young children (through EPI and catch -up immunization for those who \nmissed EPI vac cination)  \no Household contacts of HBsAg positive people  \no Sexual contacts of HBsAg positive people  \no People on haemodialysis  \no PWID  \no Individuals with chronic liver disease and/or hepatitis C  \no Inmates and prison personnel  \no Healthcare workers  \nTable 9.1: Hepatitis B Vaccination Schedule for HIV -positive Adolescents and Adults  \nVaccine  Dose (intramuscular)  Schedule  \nNon -adjuvanted formulation  Double the standard dose   \n0, 1, 2, and 6 months  Adjuvanted formulation  Standard dose  \n*Booster vaccination is not required for persons who have completed the full vaccination schedule  \nB. General preventive measures:  General measures for infection prevention adopted by \nPLHIV and in healthcare settings are effective in preventing HBV transmission. The se \ninclude  \n\u25cf Hand hygiene  \n\u25cf Use of personal protective equipment  \n\u25cf Medical waste management including safe disposal of used sharps  \n\u25cf Disinfection and sterilization  \n\u25cf General health advice against sharing of personal effects like towels, tooth -brushes, \nrazors, combs and other grooming equipment  \n\u25cf Harm reduction counselling and services for PWID as outlined in Chapter 12  \n\u25cf Safer sex practices  \n9.1.3 Treatment  \nA. When to start ART  \nAll HIV infected patients who are co -infected with hepatitis B should be started on ART \nirrespective of CD4 cell count, WHO clinical stage or stage of liver disease  \n \nThe general recommendations for treatment preparation, adherence counselling and support \nand monitoring of therapy for PLHIV apply. However, because HBV positive patients are at higher \nrisk of hepatotoxicity, closer monitoring of liver function (with ALT) is advised. Table 9.2 \nprovides a summary of areas of focus during initial evaluation for HIV/HBV co -infected patients \ninitiating therapy.", "start_char_idx": 3, "end_char_idx": 1964, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "de9b60d4-cf0b-46ac-b996-4b77180ea83a": {"__data__": {"id_": "de9b60d4-cf0b-46ac-b996-4b77180ea83a", "embedding": null, "metadata": {"page_label": "193", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a0187de4-0202-4697-b002-f2d785fe52cd", "node_type": "4", "metadata": {"page_label": "193", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a181799509c9ee4ec0928d37ff4a892327b6a6bf611b87cafae4f9cc82354e8d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7f569209-b026-4496-91bc-320e07eac6ff", "node_type": "1", "metadata": {"page_label": "192", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "afdbfab06e44303a0073366211955afce02e14881e0213815072f9d4d5e7d4b6", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bf202adf-2567-4e9b-a8d5-f5586b387a86", "node_type": "1", "metadata": {}, "hash": "1b46a18fedf4715c61421cf151825803fb1aaf26ecb0665590f19f9b131a6f7f", "class_name": "RelatedNodeInfo"}}, "hash": "29c86c0212c0892aaf5655e1007a96ddb993979b125c591d8d31003d79c310c2", "text": "TB/HIV Co -infection, Prevention and Management  \n \n9 - 3 B. Recommended first -line ART in HIV/HBV co -infection  \nThe recommended first -line ART in adolescents and adults with HIV/HBV co -infection \nis TDF + 3TC + DTG, including for women and adolescent girls of childbearing potential  \n \nTreatment with both TDF (or TAF) and 3TC is recommended as 3TC without TDF or TAF will \nresult in rapid emergence of resistance. In case of renal impairment (as assessed by creatinine \nclearance), the dose of TDF and 3TC should be adjusted (Table 9.3).  \nTable 9.2: Summary of Initial Clinical and Labora tory Evaluation in HIV/HBV Co -infection  \n Findings  Action  \nHistory  Alcohol use, cigarette \nsmoking, intravenous drug \nuse, risky sexual practices, \nanorexia, right upper \nquadrant pain, jaundice, early \nsatiety, haematemesis, dark \nstool, bleeding, pruritus  Assess, counsel and support to stop taking \nalcohol; counsel and support smoking \ncessation; counsel and provide or refer for \nharm reduction interventions  \ndiscuss or refer to a consultant for additional \nevaluation and management  \nPhysical \nexamination  Enlarged liver, enlarged \nspleen, ascites, scratch marks  Evidence of established chronic liver disease, \ncloser follow -up due to increased risk of \nhepatotoxicity.  \ndiscuss or refer to a consultant for additional \nevaluation and management  \nALT  If elevated, may point to \nactive liver disease. Exclude \nother causes of elevation of \nliver enzymes  Every effort should be made to assess for \nother liver function (albumin and INR), \nespecially in symptomatic patients. However, \nthis should not delay initiation of ART  \nCreatinine  Calculate creatinine clearance  In HIV/HBV co -infection, TDF is indicated \neven in patients with CrCl < 50 ml/min. In \nsuch patients, avoid FDCs. Instead administer \nthe ART as single drugs to allow for dosage \nadjustment as shown in Table 9.3  \nComorbidities  HCV antibody, random blood \nsugar, lipid profile, alcoholic \nand non -alcoholic liver \ndisease, hepatocellular \ncarcinoma (family history)  Consult/Refer the patient for additional \ninvestigations where these are suspected", "start_char_idx": 3, "end_char_idx": 2144, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bf202adf-2567-4e9b-a8d5-f5586b387a86": {"__data__": {"id_": "bf202adf-2567-4e9b-a8d5-f5586b387a86", "embedding": null, "metadata": {"page_label": "194", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "523e3d53-2362-4bf2-8925-321918c59ec0", "node_type": "4", "metadata": {"page_label": "194", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "75e43ade5fe2a3c62465783962405e041d78c3c6c7daac6bed95ba4485ad4ccf", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "de9b60d4-cf0b-46ac-b996-4b77180ea83a", "node_type": "1", "metadata": {"page_label": "193", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "29c86c0212c0892aaf5655e1007a96ddb993979b125c591d8d31003d79c310c2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bac27ca2-892e-4f52-90d5-9ccecf17601d", "node_type": "1", "metadata": {}, "hash": "3a52aa6ae4ffae4e7f1975803395e401917db63480bb1104b6909ea56b5264b5", "class_name": "RelatedNodeInfo"}}, "hash": "1b46a18fedf4715c61421cf151825803fb1aaf26ecb0665590f19f9b131a6f7f", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 9 - 4 Table 9.3: Dose Adjustment of TDF and 3TC in Patients with Impaired Renal Function 1 \nDrug  Creatinine clearance (ml/min)  Haemodialysis  \n50 - 80 30-49 10-29 \nTDF 33 mg/g \ngranules  \n(=1scoop)  245 mg (7.5 scoops of \ngranules or 245mg \nfilm -coated tablet) \nonce daily  132 mg (4 \nscoops of \ngranules) once \ndaily  65 mg (2 scoops \nof granules once \ndaily  16.5 mg (0.5 scoop) \nafter each 4 hr session \nof dialysis  \n \nTDF 300 mg  Unchanged: 300 mg \nonce daily  300 mg every  \n48 hrs  300 mg every 72 to 96 hours (twice \nweekly). For patients getting hemodialysis, \nadminister 300 mg once weekly after \ncompletion of dialysis sessions 2 \n3TC 300mg  Unchanged: 300 mg \nonce daily or 150 mg \nBD  150 mg once \ndaily  150 mg once \ndaily  50 mg first dose,  \n25 mg once daily  \n1 Patients with impaired renal function in whom the benefits of continued use of TDF outweighs the \nrisks (such as in the management of HIV/HBV co -infection) should be managed with input from a \nspecialist in internal/paediatric or renal medicine  \n2 Assuming 3 haemodialysis sessions per week, each of approximately 4 hours duration or after 12 \nhours cumulative haemodialysis  \n \nC. Follow -up/Monitoring  \nFollow -up of HIV/HBV co -infected patients should be as for all other patients on ART. However, \nconsider more frequent monitoring (using ALT) for patients with active liver disease (jaundice, \nliver cirrhosis and features of portal hypertension) at baseline.  The presence of co -infection also \nincreases the risk of drug -related hepatotoxicity from all classes of ARVs by 3 -5 times, especially \nwhen anti -TB and ART are given simultaneously. Also, hepatic flare -up (AST > 5 times normal \nvalue) can occur, often in th e initial 3 months.  \nNote:  ALT elevations 5 -10 times normal can be tolerated in the first 3 months of ART as \nlong as the patient is not severely symptomatic, remains stable without progression, and \nthere is no evidence of synthetic dysfunction (INR normal,  glucose normal, albumin \nnormal).  \nPatients with persistently elevated ALT levels during follow -up should be referred to a \nspecialist. Subsequent laboratory monitoring after baseline should be conducted every 6 \nmonths. Patients should be counselled and supp orted to abstain from consuming alcohol.  \nD. Stopping treatment, /treatment interruptions  \nTDF -containing ART should not be stopped in a patient with HIV/HBV co -infection as this may \nresult in a flare -up of the hepatitis. If the regimen must be stopped and another alternative for \nsuppressing hepatitis B cannot be found, liver enzymes should be monitored and treatment re -\ninstated as soon as possible.", "start_char_idx": 3, "end_char_idx": 2710, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bac27ca2-892e-4f52-90d5-9ccecf17601d": {"__data__": {"id_": "bac27ca2-892e-4f52-90d5-9ccecf17601d", "embedding": null, "metadata": {"page_label": "195", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1993a30f-ddc3-4661-b16c-5b89222cb0ee", "node_type": "4", "metadata": {"page_label": "195", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a0c1810c2fd378ee4e0a61c8fba81f50f0ea1d01b773e4844d4e12ed90088c56", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bf202adf-2567-4e9b-a8d5-f5586b387a86", "node_type": "1", "metadata": {"page_label": "194", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1b46a18fedf4715c61421cf151825803fb1aaf26ecb0665590f19f9b131a6f7f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "0b99a1c1-0fa0-4580-8a30-620344faea19", "node_type": "1", "metadata": {}, "hash": "52801c7af54c93fe51e790d93fb9a2f1c5048babceba59076f1d50a70b691437", "class_name": "RelatedNodeInfo"}}, "hash": "3a52aa6ae4ffae4e7f1975803395e401917db63480bb1104b6909ea56b5264b5", "text": "TB/HIV Co -infection, Prevention and Management  \n \n9 - 5 E. Second line for HIV/ HBV co -infected  \nMaintain TDF + 3TC in the ART regimen for patients switc hing from TDF -based -therapy.  So, for \nexample, if a patient with HIV/HBV co -infection fails TDF/3TC/EFV in first -line, they should \nswitch to TDF/3TC/DTG in second -line.  \nHIV/HBV co -infected patients failing second -line ART should be discussed in the MDT and  \ndiscussed with the Regional or National HIV Clinical TWG (Uliza Hotline 0726 460 000.)  \n9.2 Hepatitis C/HIV Co -infection  \nIn Kenya, the prevalence of HCV infection is high in PWID (estimated to be 12 -16%). The \nprevalence in the general population and among PLHIV is low (estimated to be < 3%), but likely \nto be higher in HIV infected PWID due to shared routes of transmission. HIV/ HCV co -infection is \nassociated with  \n\u2022 Rapid progression of liver fibrosis  \n\u2022 Higher risk of deteriorating liver disease even in the pres ence of controlled HIV disease  \n\u2022 Worsened hepatotoxicity as a result of ART and other drugs used in the treatment of \ncomorbidities  \nThus, HIV -positive persons at risk of HCV co -infection should be identified and offered HCV \ntreatment. The recent introduction of direct acting antiviral therapies (DAAs) for treatment of \nHCV has simplified the management of HIV/HCV co -infection, making it possible to manage \nuncomplicated HIV/HCV infection safely even in primary care settings.  \nHowever, treatment for H CV is a rapidly evolving field of therapeutics. Providers are encouraged \nto seek regular updates on the subject and, when in doubt, to discuss individual cases with \nexperienced providers.  \n9.2.1 Screening  \nHCV serology should be offered to individuals at ri sk of HCV infection. These include  \n\u25cf People who inject or use intranasal drugs  \n\u25cf Persons who have had tattoos, body piercing or scarification procedures from \nsettings with doubtful infection prevention precautions  \n\u25cf Children born to HCV positive mothers  \nUp to 30 % of individuals who are infected with HCV spontaneously clear the infection. To confirm \nchronic HCV infection, HCV positive individuals should be offered nucleic acid HCV RNA testing \nto establish presence of chronic HCV infection.", "start_char_idx": 3, "end_char_idx": 2243, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "0b99a1c1-0fa0-4580-8a30-620344faea19": {"__data__": {"id_": "0b99a1c1-0fa0-4580-8a30-620344faea19", "embedding": null, "metadata": {"page_label": "196", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "7a519234-d861-41ff-b91e-2deeaec75711", "node_type": "4", "metadata": {"page_label": "196", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "28101bb6551a2c1c5d6d2b59268a23f9f0416a80929fcd74e849cbe32f2c9c1c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bac27ca2-892e-4f52-90d5-9ccecf17601d", "node_type": "1", "metadata": {"page_label": "195", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3a52aa6ae4ffae4e7f1975803395e401917db63480bb1104b6909ea56b5264b5", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5dd70ac2-2309-4007-b405-89ae0737c55b", "node_type": "1", "metadata": {}, "hash": "a149862b4f4d4fb94357d60093564711ec3a835235d820e109594ff6e864b399", "class_name": "RelatedNodeInfo"}}, "hash": "52801c7af54c93fe51e790d93fb9a2f1c5048babceba59076f1d50a70b691437", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 9 - 6 9.2.2 Prevention  \nGeneral measures for prevention of blood -borne infections are effective in preventing HCV \ntransmission.  \n\u25cf Recommendations for healthcare settings  \nTraining of healthcare providers on:  \no Hand hygiene: including surgical hand preparation, hand -washing and use of gloves  \no Safe handling and disposal of sharps and waste  \no Effective disinfection and sterilization  \no Provision of safe blood and blood products  \n\u25cf Recommendations for PWID  \no Harm reduction counselling and support (Table 12.1)  \n\u25cf Recommendations for prevention of sexual transmission  \no Correct and consistent condom use  \no Access to prevention services for sex workers and other people at risk (including \nscreening and treatment of STIs, frequent testing for HIV and HCV testing)  \n \n9.2.3 Treatment of HIV/HCV Co -infection  \nTable 9.4: Summary of Initial Clinical and Laboratory Evaluation in HIV/HCV Co -infection  \n Findings  Action  \nHistory  Alcohol use, cigarette smoking, \nintravenous drug use, risky sexual \npractices, anorexia, right upper quadrant \npain, jaundice, early satiety, haematemesis, \ndark stool, bleeding, pruritus  Assess, counsel and support to stop \ntaking alcohol; counsel and support \nsmoking cessation; counsel provide \nand refer for harm reduction \ninterventions  \nPhysical \nexamination  Enlarged liver, enlarged spleen, ascites, \nscratch marks  Evidence of established chronic liver \ndisease, closer follow -up due to \nincreased risk of hepatotoxicity, \ndiscuss or refer to a consultant for \nadditional evaluation and management  \nHCV RNA PCR  For confirmation of chronic HCV  \ninfection  If available, at baseline  \nHCV genotype  May be important for selecting appropriate \nDAA regimen. (Current regimens pan -\ngenotypic, so HCV genotype testing not \nrequired)   \nALT  If elevated, may point to active liver \ndisease. Exclude other causes of elevation \nof liver enzymes  Every effort should be made to assess \nfor liver function (albumin and INR), \nespecially in symptomatic patients. \nHowever, this should not delay \ninitiation of ART  \nComorbidities  HBV, random blood su gar, lipid profile, \nalcoholic and non -alcoholic liver disease,  \nhepatocellular carcinoma (family history)  Consult/Refer the patient for \nadditional investigations where these \nare suspected", "start_char_idx": 3, "end_char_idx": 2363, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5dd70ac2-2309-4007-b405-89ae0737c55b": {"__data__": {"id_": "5dd70ac2-2309-4007-b405-89ae0737c55b", "embedding": null, "metadata": {"page_label": "197", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "adc40fc1-df33-49c3-98c4-94200835da7b", "node_type": "4", "metadata": {"page_label": "197", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e4827d5656d240b4b476f0a4d4e3f3f64f3fd7b83f8771b51ad6c884f716cb21", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "0b99a1c1-0fa0-4580-8a30-620344faea19", "node_type": "1", "metadata": {"page_label": "196", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "52801c7af54c93fe51e790d93fb9a2f1c5048babceba59076f1d50a70b691437", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3b1654b6-cf2a-4073-a655-ba86d12fc66a", "node_type": "1", "metadata": {}, "hash": "94e3c2c0d5b3ae4aa86c4e42137dddc65bb447db5ac04f6f1b8e79b200976ba5", "class_name": "RelatedNodeInfo"}}, "hash": "a149862b4f4d4fb94357d60093564711ec3a835235d820e109594ff6e864b399", "text": "TB/HIV Co -infection, Prevention and Management  \n \n9 - 7 Table 9.5: Recommended DAA for the Treatment of HCV among PLHIV  \nGenotype  DAA Regimen*  Duration of treatment  \n1 and 4  Sofosbuvir + Ledipasvir (Harvoni)  12 weeks  \nAll Sofosbuvir + Velpatasvir (Epclusa)  12 weeks  \n* DAA regimen availability continues to evolve; this table just shows the most readily available regimens at \ntime of publication. Always start DAA HCV therapy, and review most recent drug -drug interactions with \nARVs.", "start_char_idx": 3, "end_char_idx": 500, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3b1654b6-cf2a-4073-a655-ba86d12fc66a": {"__data__": {"id_": "3b1654b6-cf2a-4073-a655-ba86d12fc66a", "embedding": null, "metadata": {"page_label": "198", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1df544c6-6b31-4a48-9d37-74a5886fd48b", "node_type": "4", "metadata": {"page_label": "198", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "573ad60a2059fe68550bfba60031cde33063e1092adce05f0b7f364a27ef23e0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5dd70ac2-2309-4007-b405-89ae0737c55b", "node_type": "1", "metadata": {"page_label": "197", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a149862b4f4d4fb94357d60093564711ec3a835235d820e109594ff6e864b399", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2fb8de61-1704-49bf-92d7-1b65b7f99abe", "node_type": "1", "metadata": {}, "hash": "04c94a5c2b6ae8fdfe51eaf1c6377379e7d1a71d417fa19c96e3e14f97dfeb65", "class_name": "RelatedNodeInfo"}}, "hash": "94e3c2c0d5b3ae4aa86c4e42137dddc65bb447db5ac04f6f1b8e79b200976ba5", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 9 - 8", "start_char_idx": 3, "end_char_idx": 63, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2fb8de61-1704-49bf-92d7-1b65b7f99abe": {"__data__": {"id_": "2fb8de61-1704-49bf-92d7-1b65b7f99abe", "embedding": null, "metadata": {"page_label": "199", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6007186e-a737-4048-a953-b3eb1c6cadd9", "node_type": "4", "metadata": {"page_label": "199", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "803c1bd1c32abd2a7e39eb8b1499153a013424d4989de5f4d2e3191be5c17d37", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3b1654b6-cf2a-4073-a655-ba86d12fc66a", "node_type": "1", "metadata": {"page_label": "198", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "94e3c2c0d5b3ae4aa86c4e42137dddc65bb447db5ac04f6f1b8e79b200976ba5", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d4e879d4-3d45-4b40-9ec0-45c6e933f633", "node_type": "1", "metadata": {}, "hash": "4bea6bb6d9abcc781e0a003f294916abe5cf221f013768576d61432958600687", "class_name": "RelatedNodeInfo"}}, "hash": "04c94a5c2b6ae8fdfe51eaf1c6377379e7d1a71d417fa19c96e3e14f97dfeb65", "text": "ARVs for Post -exposure Prophylaxis  \n10 - 1  \n10. ARVs for Post -exposure Prophylaxis  \n \n \nAn ARV regimen, with preferably three -drugs, should be offered as post exposure prophylaxis as \nsoon as possible (preferably within 72 hours) after an exposure.  \n  \n10.1 What is PEP?  \nPost -exposure prophylaxis (PEP) is short -term use of antiretroviral treatment to reduce the \nlikelihood of HIV infection after potential exposure.  \nPeople can be accidentally exposed to HIV through healthcare work or due to exposures outside \nhealthcare setting, for example, through unprotected sex or sexual assault among adults and \nchildren. Healthcare workers are at increased risk of exposure to HIV through contact with \ncontaminated blood and other body fluids  containing HIV through needle stick injuries and \ninjuries by other sharp objects or through non -intact skin and mucous membranes.  \n10.2 Recommended ARVs for PEP  \nThree -drug regimens are preferred for PEP. However, if the person is unable to tolerate the thi rd \ndrug, (usually the PI/r), two drugs  can be used.  \nTable 10.1: Recommended ARVs for PEP  \nAge  Weight  Preferred  Alternate  \n \n \n<15 years  < 30kg  ABC + 3TC + DTG  \u25cf AZT + 3TC + DTG  \n\u25cf AZT+3TC and LPV/r may be used \nas the third drug  \n\u2265 30 kg  TDF + 3TC /FTC + DTG  \u25cf TDF+3TC/FTC and ATV/r may be \nused as alternative third drug  \n\u2265 15 years  Any weight  TDF + 3TC/FTC + DTG  \u25cf TDF+3TC/FTC and ATV/r may be \nused as alternative third drug  \n.", "start_char_idx": 3, "end_char_idx": 1470, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d4e879d4-3d45-4b40-9ec0-45c6e933f633": {"__data__": {"id_": "d4e879d4-3d45-4b40-9ec0-45c6e933f633", "embedding": null, "metadata": {"page_label": "200", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b814096b-e1dd-4052-8c5d-309ca5f9333c", "node_type": "4", "metadata": {"page_label": "200", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e677251eefcf375a076ffe9ebd8bf1d7d3c384c3e7edb7356743b684887b3699", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2fb8de61-1704-49bf-92d7-1b65b7f99abe", "node_type": "1", "metadata": {"page_label": "199", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "04c94a5c2b6ae8fdfe51eaf1c6377379e7d1a71d417fa19c96e3e14f97dfeb65", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "94d827a1-9bd0-43af-a7a9-019d419dfa8d", "node_type": "1", "metadata": {}, "hash": "e5e61e2af360adc6e0a6d3a6c457095f5bcc7d0a61a24bad99359ade031db0aa", "class_name": "RelatedNodeInfo"}}, "hash": "4bea6bb6d9abcc781e0a003f294916abe5cf221f013768576d61432958600687", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 10 - 2 10.3 Eligibility For PEP  \nPEP should always be offered as soon as possible, preferably within 72 hours, after an exposure.  \nPersons who present after 72 hours should be provided with other appropriate services including \ncounselling and support.  \nEligibilit y assessment for PEP is based on the type of exposure, HIV status of source where \npossible and timing of seeking care.  \nThe following include the eligibility criteria for PEP.  \n\u25cf Exposed individual is HIV negative at baseline.  \n\u25cf Exposure must have occurred within the past 72 hours.  \n\u25cf Exposure to bodily fluids pose a significant risk (exposure and/or material):  \n\u25aa Type of exposure:  mucous membrane (i.e.  sexual exposure; splashes to eye, nose, or \noral cavity), non -intact skin, percutaneous injury or paren teral exposures  \n\u25aa Material : blood, blood -stained body fluids, breast milk; semen; vaginal secretions; \nsynovial, pleural, pericardial, amniotic fluids; CSF, and HIV cultures in laboratories  \nExposures that do not require HIV PEP include:  \n\u25cf When the exposed individual is already HIV positive.  \n\u25cf Exposures to bodily fluids that do not pose a significant risk, i.e., tears, non -blood -stained \nsaliva, urine, and sweat.  \n10.4 Management and Follow Up  \nPatients should be counselled and encouraged to complete the full course of PEP once a decision \nhas been made to initiate PEP.  \nFor occupational exposure, immediate care of the exposure site includes washing the site with \nsoap and water and allow the wound  to bleed freely for several minutes  \nNOTE: Do not do anything that will increase tissue damage such as squeezing, scrubbing, or \ncutting the site further .", "start_char_idx": 3, "end_char_idx": 1726, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "94d827a1-9bd0-43af-a7a9-019d419dfa8d": {"__data__": {"id_": "94d827a1-9bd0-43af-a7a9-019d419dfa8d", "embedding": null, "metadata": {"page_label": "201", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "afbfe9b3-0e43-4237-8bbc-948332b07b6e", "node_type": "4", "metadata": {"page_label": "201", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4ce9dc054ad64a6b80524004736c0b0e80fe0e3f3753ce2ac85ebbd64d3f2aee", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d4e879d4-3d45-4b40-9ec0-45c6e933f633", "node_type": "1", "metadata": {"page_label": "200", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4bea6bb6d9abcc781e0a003f294916abe5cf221f013768576d61432958600687", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "c0c7282f-cf58-44c7-a137-9b5f65c44a18", "node_type": "1", "metadata": {}, "hash": "c24b96e03b8e3627edaa1d8a0b205f30101ac5cde9276b4bc521664ff7ea6dd9", "class_name": "RelatedNodeInfo"}}, "hash": "e5e61e2af360adc6e0a6d3a6c457095f5bcc7d0a61a24bad99359ade031db0aa", "text": "ARVs for Post -exposure Prophylaxis  \n10 - 3 Table 10.2: Recommendations for PEP Management and Follow -up \nConsiderations  Recommendation  \nManagement at initial \ncontact  \u25cf Counsel on risks and benefits of PEP and obtain verbal consent for HIV \ntesting.  \n\u25cf Voluntary testing for both exposed and source individuals  \n\u25cf Offer PEP as soon as high -risk exposure is established and the exposed \nindividual tests HIV-negative at baseline (if HIV testing not feasible, \noffer 1 -2 days of PEP to cover until HIV test performed)  \n\u25cf Provide first aid in case of broken skin or other type of wound  \nTime of initiation  As soon as possible after exposure, but no later than after 72 hours  \nDuration of PEP  28 days (dispense all 28 days of treatment at the first visit if tested HIV negative)  \nDose of PEP  Same as indicated for treatment; use weight -based dosing for children  \nLaboratory \ninvestigation at \nbaseline  \u25cf Conduct creatine testing (if TDF -containing regimen) and Hb (if AZT -\ncontaining regimen), however PEP should be offered even when lab tests \nare not available. Do not delay administration of PEP while waiting for lab \nresults.  \n\u25cf HBsAg testing is recommended. Do not del ay administration of PEP while \nwaiting for lab results. If negative provide HBV vaccination  \n\u25cf Pregnancy testing for women of childbearing potential in case of sexual \nassault.  \nFollow -up \u25cf Follow up client at 7 days, 14 days, 28 days, and 12 weeks after starting \nPEP  \n\u25cf Assess for and manage side effects due to PEP  \n\u25cf Follow -up HIV testing should be done at the completion of PEP and if \nnegative, test again at 12 weeks  \n\u25cf Link to HIV treatment if positive  \nCounselling  Counselling at baseline should include:  \n\u25cf Adherence counselling  \n\u25cf Information on side effects  \n\u25cf Risk reduction counselling  \n\u25cf Trauma and mental health counselling  \n\u25cf Specific support for sexual assault  \nOther services for \nsexual assault  \u25cf STI prophylactic treatment to all (treat for vaginal/urethral discharge \nsyndrome following the national STI algorithms)  \n\u25cf Emergency contraception for non -pregnant women  \n\u25cf Tetanus toxoid for any physical injury of skin or mucous membranes  \n\u25cf Documentation of clinic evidence of assault and collection of foren sic \nevidence  \nRefer to post -rape care guidelines for additional details", "start_char_idx": 3, "end_char_idx": 2321, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "c0c7282f-cf58-44c7-a137-9b5f65c44a18": {"__data__": {"id_": "c0c7282f-cf58-44c7-a137-9b5f65c44a18", "embedding": null, "metadata": {"page_label": "202", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "1a46c8f3-980d-42fc-acc5-62ae7833ec08", "node_type": "4", "metadata": {"page_label": "202", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f1eb70c5d614329a1ca4bba17aeacac423b2f275d2df16dd78d3daca810daea8", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "94d827a1-9bd0-43af-a7a9-019d419dfa8d", "node_type": "1", "metadata": {"page_label": "201", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e5e61e2af360adc6e0a6d3a6c457095f5bcc7d0a61a24bad99359ade031db0aa", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "10d5f02c-7898-48b3-bfa0-e7cda4d0a398", "node_type": "1", "metadata": {}, "hash": "98a6299dfea53bf0a633f5a90b7a8cd598e63ab066ff7451bfaad4fa5d1fa521", "class_name": "RelatedNodeInfo"}}, "hash": "c24b96e03b8e3627edaa1d8a0b205f30101ac5cde9276b4bc521664ff7ea6dd9", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 10 - 4 10.5 Risk reduction counselling  \nTo reduce the risk of further HIV transmission, it is necessary to prevent transmission to sexual \npartners and the children of breastfeeding mothers. R isk reduction counselling should form part \nof each consultation with the individual. Measures to reduce transmission to another person may \ninclude:  \n\u25cf The use of condoms and safe injecting practices to prevent secondary transmission  \n\u25cf Avoiding blood donation until confirmed HIV negative at 12 weeks post exposure  \nTable 10.3 Considerations for special circumstances  \nCircumstance   Recommendation  \nBreastfeeding women  \u2022 Breastfeeding is not a contraindication for PEP  \n\u2022 The risks and benefits of continuing breastfeeding while HIV \ntransmission risk is unknown and should be discussed with the \nmother  \nChildren  \u2022 HIV testing approaches for children should be in line with national \nguidelines and age appropriate  \n\u2022 Informed consent from the caregiver is needed  \nAdolescents  \u2022 Requiring parental consent for adolescents can be a barrier to HIV \ntesting, particularly in cases of sexual assault  \n\u2022 HIV testing should be performed in accordance with national \nguidelines and consenting requirements  \n \n10.6 Preventing HIV exposure  \nTo avoid or minimize the risk of exposure to HIV the following infection prevention control (IPC) \nmeasures are recommended:  \n\u2022 Precautions should be taken when handling contaminated body fluids including the use \nof appropriate barriers such as gloves, gowns, and goggles.  \n\u2022 Care with sharps including minimizing blind surgical procedures and proper handling \nand disposal o f sharps.  \n\u2022 Safe disposal of contaminated waste  \n\u2022 Safe handling of soiled linen.  \n\u2022 Adequate disinfection procedures  \n\u2022 Universal Hepatitis B vaccination of non -immune at -risk groups including HCWs, police, \nprison staff and rescue workers.  \nIn cases that do not requi re PEP, the exposed person should be counselled about limiting future \nexposure risk.", "start_char_idx": 3, "end_char_idx": 2045, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "10d5f02c-7898-48b3-bfa0-e7cda4d0a398": {"__data__": {"id_": "10d5f02c-7898-48b3-bfa0-e7cda4d0a398", "embedding": null, "metadata": {"page_label": "203", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0f636011-15c2-4a67-a075-df338cdf36e7", "node_type": "4", "metadata": {"page_label": "203", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e8d956f9f0aba08101b81f673fa8365b1f5630deaba3e320ab93fde418b5bfca", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "c0c7282f-cf58-44c7-a137-9b5f65c44a18", "node_type": "1", "metadata": {"page_label": "202", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c24b96e03b8e3627edaa1d8a0b205f30101ac5cde9276b4bc521664ff7ea6dd9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bd0dbe52-31a4-447b-9335-f86fcf75fc0b", "node_type": "1", "metadata": {}, "hash": "9f07ca2d5014755d879f87af57b1c0947465dd2398e948ab2550760236e41ef9", "class_name": "RelatedNodeInfo"}}, "hash": "98a6299dfea53bf0a633f5a90b7a8cd598e63ab066ff7451bfaad4fa5d1fa521", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 1  \n11. Pre-Exposure Prophylaxis (PrEP)  \n \nPre-exposure prophylaxis (PrEP) is the use of antiretroviral medication to prevent the acquisition \nof HIV infection by an uninfected person at ongoing risk of acquiring HIV infection.  \nPrEP is recommended for use as follows:  \n\u2022 Daily Oral PrEP for all indivi duals, irrespective of gender or sexual orientation who are at risk \nof HIV infection.  \n\u2022 Event -Driven (ED) PrEP is currently recommended for all people born male who are not \ntaking exogenous estradiol -based gender affirming hormones  \n11.1 Indications for PrEP and Criteria for Eligibility   \n11.1.1 Indications for PrEP  \nPrEP is indicated for;  \n\u25cf HIV uninfected persons at ongoing risk of HIV acquisition  \n\u25cf Some risk situations that place one at ongoing risk include individuals or sexual partner/s \nwho is/are:  \no HIV positive and: not on ART, or on ART < 6 months, on ART with viral non -suppression, \nor on ART with suspected poor adherence  \no In sero -discordant relat ionships trying to conceive  \no Of unknown HIV status and at high -risk of HIV infection  \no Engaging in transactional sex or sex work  \no With history of recent or current sexually transmitted infections  \no With recurrent use of Post -Exposure Prophylaxis  \no With a history of sex whilst under the influence of alcohol or recreational drugs  \no Inconsistent or no condom use or unable to negotiate condom use during intercourse \nwith persons of unknown HIV status  \no Using injection drugs where needles and/or syringes are  shared  \n11.1.2 HIV Risk Assessment  \nClients accessing health services should be screened for HIV risk and additionally provided with \ninformation on HIV prevention options available including the availability of PrEP. This is in \naddition to the use of HIV testing services (HTS), as clients ar e assessed for HIV risk before testing.  \nThe risk assessment questions are enquiry of behavioural practices that may expose an individual \nto HIV (Table 11.2).  \n A simple Risk Assessment Tool (RAST) is provided to guide the provider in generating a \nconversat ion about HIV risk. Screening for HIV risk should be integrated within other service \ndelivery points. HIV negative individuals who answer \u201cyes\u201d to any of the screening questions \nshould be engaged in a discussion about the risks and benefits of PrEP. The cl ient then is evaluated \nfor eligibility to receive PrEP.", "start_char_idx": 3, "end_char_idx": 2435, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bd0dbe52-31a4-447b-9335-f86fcf75fc0b": {"__data__": {"id_": "bd0dbe52-31a4-447b-9335-f86fcf75fc0b", "embedding": null, "metadata": {"page_label": "204", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "eb9256a1-ee5c-483c-bb1d-3cb1d75888c8", "node_type": "4", "metadata": {"page_label": "204", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8d69324ec85aa0efe96c47807df3b35dcae22fe52cd16caf7ba1617b1810bc6b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "10d5f02c-7898-48b3-bfa0-e7cda4d0a398", "node_type": "1", "metadata": {"page_label": "203", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "98a6299dfea53bf0a633f5a90b7a8cd598e63ab066ff7451bfaad4fa5d1fa521", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d95c4cb2-2fd8-4736-a7e9-7957af25bfd8", "node_type": "1", "metadata": {}, "hash": "79aeb27b7f9ad530d8908233206be93fccf3b509280a655cc4b449db74e42d28", "class_name": "RelatedNodeInfo"}}, "hash": "9f07ca2d5014755d879f87af57b1c0947465dd2398e948ab2550760236e41ef9", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 2 Table 11:1 HIV Screening questions  \nScreening question refer to the past 6 months & include;  \n\u2022 \u201cHave you had sex with more than one person?\u201d  \n\u2022 \u201cHave you had sex without a condom?\u201d  \n\u2022 \u201cHave you had sex with a nyone whose HIV status you do not know?\u201d  \n\u2022 \u201cAre any of your partners at risk of HIV?\u201d  \n\u2022 \u201cHave you had sex with a person who has HIV?\u201d  \n\u2022 \u201cHave you received a new diagnosis of a sexually transmitted infection?\u201d  \n\u2022 \u201cDo you desire pregnancy?\u201d  \n\u2022 \u201cHave you used or wanted t o use PEP or PrEP for sexual exposure to HIV?\u201d  \n\u2022 \u201cHave you injected drugs that were not prescribed by healthcare provider? If yes, did \nyou use syringes, needles or other drug preparation equipment that had already been \nused by another person?\u201d  \n\u2022 \u201cHave you rece ived money, housing, food or gifts in exchange for sex?\u201d  \n\u2022 \u201cHave you been forced to have sex against your will?\u201d  \n\u2022 \u201cHave you been physically assaulted, including assault by a sexual partner?\u201d  \n11.1.3 Criteria for PrEP Eligibility  \nTo be eligible for PrEP, individuals identified to be at risk of HIV infection from Risk Assessment \nmust meet ALL the following criteria prior to initiating PrEP.  \n\u25cf Confirmed HIV negative status through rapid antibody testing following the HTS algorithm.  \n\u25cf Determine if the client is w illing to take PrEP as prescribed. (This is done by adherence \neducation and counselling on the PrEP regimen to be given, and assessing the client\u2019s \nreadiness to follow the regimen.)  \n\u25cf Does not have a current or recent (within the past one month) illness consistent with acute \nHIV infection (fever, sore throat, muscle or joint pains, swollen glands, diarrhoea or headache) \nin combination with a preceding high -risk exposure for HIV.  \n\u25cf No contraindication to use of any of the ARVs recommended for PrEP e. g., TDF +/ - FTC (or \n3TC) for those who choose oral PrEP.  \n\u25cf Renal or liver disease  \no Clients with renal and liver disease should receive further clinical and laboratory tests, \nto determine the renal/liver function and extent of disease.  \nOther important factors  for screening  \n1. Gender based violence (GBV) screening:  All clients accessing PrEP must be screened for \ngender -based violence, especially intimate partner violence (IPV), and appropriate \nintervention offered or client linked to appropriate.  \n2. Mental Status Assessment:  Psychological issues that may influence adherence should be \nassessed and addressed. It is important to carry out basic mental health evaluation and \noffer appropriate referral as necessary.", "start_char_idx": 3, "end_char_idx": 2604, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d95c4cb2-2fd8-4736-a7e9-7957af25bfd8": {"__data__": {"id_": "d95c4cb2-2fd8-4736-a7e9-7957af25bfd8", "embedding": null, "metadata": {"page_label": "205", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5993544a-a0be-493d-a62e-eb7838a0de84", "node_type": "4", "metadata": {"page_label": "205", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e62efba9d7a282b769a2aee1c3698f16f7b71fcbc8fb9a33ad9c0bab300b9c2a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bd0dbe52-31a4-447b-9335-f86fcf75fc0b", "node_type": "1", "metadata": {"page_label": "204", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9f07ca2d5014755d879f87af57b1c0947465dd2398e948ab2550760236e41ef9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ff65c22e-3b95-4576-90c7-04e8365adf10", "node_type": "1", "metadata": {}, "hash": "ff6a83be7d4b4062d3b4becf15b73c51dd5cf8cbf78128d2a7faf0e682138ee7", "class_name": "RelatedNodeInfo"}}, "hash": "79aeb27b7f9ad530d8908233206be93fccf3b509280a655cc4b449db74e42d28", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 3 HIV self -test (HIVST) should not be used as a de finitive HIV test for PrEP initiation and \nfollow up monitoring.  \n11.2 Package of PrEP Service  \nPrEP should be offered as part of the comprehensive prevention package which includes \nbehavioural, bio medical and structural components. Integration of PrEP serv ices is \nrecommended within different service delivery points, including in the community, ANC and FP \nclinics.  \n \n Client  seeking  any service  from the facility /Communit y\n(See section  on PrEP Integration)\n \n \n \n \nSCREEN  for ongoing  risk for HIV \nTEST for HIV  \n  \nHIV Positive \u2013 link/refer\nAdditional Screening:\nGBV/HIV\n \n \n \n \n \n \n \n \n \n1 \n \nFigure 11.1 : Package of Service for PrEP", "start_char_idx": 3, "end_char_idx": 749, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ff65c22e-3b95-4576-90c7-04e8365adf10": {"__data__": {"id_": "ff65c22e-3b95-4576-90c7-04e8365adf10", "embedding": null, "metadata": {"page_label": "206", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "fe5c902c-98cb-43d8-afaa-62b808d7cef7", "node_type": "4", "metadata": {"page_label": "206", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9f219c48fb36975647454d53190a5ca26b01cf9b175003e1cc6f3e590cebbd4b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d95c4cb2-2fd8-4736-a7e9-7957af25bfd8", "node_type": "1", "metadata": {"page_label": "205", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "79aeb27b7f9ad530d8908233206be93fccf3b509280a655cc4b449db74e42d28", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "570820ee-b862-4d9c-8ee8-d898bf5305aa", "node_type": "1", "metadata": {}, "hash": "78d3a2c59119109a6904dffca76e31a572cd7e2fedf8fee0190a2350a54c4654", "class_name": "RelatedNodeInfo"}}, "hash": "ff6a83be7d4b4062d3b4becf15b73c51dd5cf8cbf78128d2a7faf0e682138ee7", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 4 11.2.1 Pre -Initiation Checklist  \nThis checklist is intended to help the service provider ensure all necessary screening and \nassessments are done prior to PrEP initiation  \nTable 11.2: Pre -Initiation Assessment Checklist  \nITEM  Y/N  \nScreening and Support for GBV   \nHIV Testing   \nCheck symptoms of acute viral infection in last 6 weeks   \nBehavior risk assessment   \nSubstance use and mental health screening   \nPartner information   \nPre-initiation education and understanding of PrEP   \nClient readiness and willingness to adhere to prescribed PrEP and follow -up schedule   \nSTI screening and treatment   \nFor women  \n\u2714 Pregnancy test, pregnancy intention and / or breastfeeding  \n\u2714 Screen for contraception use using appropriate contraceptive screening tool   \n\u2714 Highlight the need for condom use   \nDiscussed plans for continually accessing PrEP   \nAdditional laboratory tests (Availability of these test should not delay initiation of PrEP)  \n\u2714 Serum creatinine and creatinine clearance  \n\u2714 HBsAg  \n\u2714 HCV serology  \nNB:  absence of these tests should not hinder initiation   \nMedication history and potential drug interactions", "start_char_idx": 3, "end_char_idx": 1203, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "570820ee-b862-4d9c-8ee8-d898bf5305aa": {"__data__": {"id_": "570820ee-b862-4d9c-8ee8-d898bf5305aa", "embedding": null, "metadata": {"page_label": "207", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "205abfb9-a43b-4ca5-8455-de86de189391", "node_type": "4", "metadata": {"page_label": "207", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cec65d43e51bf2d0b23ef34bbfbca539cd5453153434b864d16ced63f8fc0e02", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ff65c22e-3b95-4576-90c7-04e8365adf10", "node_type": "1", "metadata": {"page_label": "206", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ff6a83be7d4b4062d3b4becf15b73c51dd5cf8cbf78128d2a7faf0e682138ee7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2aafc067-039e-448e-b422-c233a32c5f9b", "node_type": "1", "metadata": {}, "hash": "4760f548242c8c2efd858b5d5913cb60faa5c8dc375bdcd36d7a2dc04952097c", "class_name": "RelatedNodeInfo"}}, "hash": "78d3a2c59119109a6904dffca76e31a572cd7e2fedf8fee0190a2350a54c4654", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 5 11.2.2 Pre -initiation client education  \nThe following components should be discussed prior to PrEP initiation:  \nTable 11.3: Client Education Checklist  \nTopic  Check  \n\u2714 Explain how PrEP works as part of combination HIV prevention  \u2714  \n\u2714 Explain the need for baseline and follow -up tests including regular HIV testing  \u2714  \n\u2714 Explain PrEP use: include the following: (refer to the different types of PrEP \navailable for details)  \no The medications used (show the client the pills or other PrEP options  \no How the medications are used (frequency of dosing for the various options)  \no Number of doses required to achieve efficacy (7 doses for daily oral PrEP, \nloading dose for event driven oral PrEP)  \no What to do when doses are missed (continue for daily doses)  \no Discontinuation of PrEP, how and when it can be discontinued.  \no Side effects and what to do in case these are experienced (including when to \nconsult the clinician)   \u2714  \n\u2714 Discuss what to do in case client experiences symptoms of seroconversion (acute \nHIV infect ion)   \n\u2714 Discuss the Limitations of PrEP  \no PrEP reduces but does not eliminate the risk of acquiring HIV.  \no PrEP does not prevent pregnancies and STIs.   \u2714  \n\u2714 Risk reduction counselling and support education  \no Managing mental health needs  \no Couple counselling  \no Access to, and consistent use of condoms and lubricants  \no Access to and need for frequent HIV testing.  \no Early access to ART  \no VMMC  \no STI screening and treatment  \no Harm reduction for PWID  \u2714  \n \n11.3 Recommended ARVs for PrEP  \nThe preferred ARV regimen is Tenofovir 300mg/ Emtricitabine 200mg (TDF/FTC) given as one \nfixed dose combination (FDC) tablet orally daily.", "start_char_idx": 3, "end_char_idx": 1736, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2aafc067-039e-448e-b422-c233a32c5f9b": {"__data__": {"id_": "2aafc067-039e-448e-b422-c233a32c5f9b", "embedding": null, "metadata": {"page_label": "208", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "80a40f42-4a11-4db5-802e-bdca0ff65c32", "node_type": "4", "metadata": {"page_label": "208", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "55ef2a282d7fdce8eec73a7af395c9d5174fa698fbf030c91e0c4a739adf14a7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "570820ee-b862-4d9c-8ee8-d898bf5305aa", "node_type": "1", "metadata": {"page_label": "207", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "78d3a2c59119109a6904dffca76e31a572cd7e2fedf8fee0190a2350a54c4654", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e925ec78-e5f7-43dc-97ff-d9410d66d151", "node_type": "1", "metadata": {}, "hash": "272d4ee4ab32ccd3027d40b22775c81597c662b1caea121e77b008fa7cd6ceed", "class_name": "RelatedNodeInfo"}}, "hash": "4760f548242c8c2efd858b5d5913cb60faa5c8dc375bdcd36d7a2dc04952097c", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 6 Table 11.4: Antiretrovirals for Use in PrEP  \nPrEP Dosing \nStrategies  Preferred  Alternative  \nDaily Oral PrEP  TDF/FTC (300 mg/200 mg) as FDC \nonce daily  TDF/3TC (300 mg/300 mg) as FDC once \ndaily  \nEvent Driven Oral \nPrEP    TDF/FTC (300 mg/200 mg) as FDC \n\u2013 two pills taken between 2 and 24 \nhours in advance of anticipated sex; \nthen, a third pill 24 hours after the \nfirst two pills and a fourth pill 48 \nhours after the first two pills; 2 -1-1 TDF/3TC (300 mg/300 mg) as FDC \u2013 \ntwo pills taken between 2 and 24 hours \nin advance of anticipated sex; then, a \nthird pill 24 hours after the first two \npills and a fourth pill 48 hours after the \nfirst two pills ; 2-1-1 \n*Recommended Long -acting Products: These products are at different stages of approval and availability \nin Kenya. The Ministry of Health will issue specific implementation guidelines when they become \navailable.  \n*Long Acting \nCabotegravir \nInjection  Initiation injections: 600 mg \nIntramuscular (IM) x 2 doses given \n1 month apart (the second \ninitiation injection can be given up \nto 7 days before or after the date \nscheduled to receive injection)  \nTHEN  \nContinuation injections: 600 mg  IM \nevery 2months   \n*Dapivirine \nvaginal ring  Dapivirine vaginal ring, 25mg, \ninserted vaginally every 28 days.   \nThe drugs can be taken with or without food, and can be stored at room temperature.  \nPrescription intervals for daily oral PrEP  \nThe first prescription should be for 30 days to allow for the first follow -up visit during which a \nrepeat HIV test should be conducted, and adherence, tolerability and adverse effects assessed.   \nDuring the one -month visit, if no major concerns are noted, PrEP should be prescribed for 2 \nmonths and thereafter 3 -monthly. Clients with sub -optimal adherence and or other major \nconcerns should be given monthly follow up visit.  \nRemind individuals using daily oral PrEP that it takes 7 doses (equivalent to 7 days) o f \ncontinuous PrEP use to achieve adequate levels of the ARVs in tissues for it to be \neffective. During these days, safer sex practices should be encouraged (including \nabstinence and condom use). This only applies for individuals born female. Those born \nmal e can have protective levels as soon as 2 hours before sex but ideally 24 hours. This \nis true even for people intending to take daily oral PrEP for ongoing exposure.", "start_char_idx": 3, "end_char_idx": 2435, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e925ec78-e5f7-43dc-97ff-d9410d66d151": {"__data__": {"id_": "e925ec78-e5f7-43dc-97ff-d9410d66d151", "embedding": null, "metadata": {"page_label": "209", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8524aeab-adb4-4295-bde8-6affdf63f683", "node_type": "4", "metadata": {"page_label": "209", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3f431795757b9d2a2fb478372444bcc837c9dd11edd00ee1dd7139d9a94a83eb", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2aafc067-039e-448e-b422-c233a32c5f9b", "node_type": "1", "metadata": {"page_label": "208", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4760f548242c8c2efd858b5d5913cb60faa5c8dc375bdcd36d7a2dc04952097c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a36db603-dda9-4e84-ae78-394a31293e76", "node_type": "1", "metadata": {}, "hash": "abc7210e5ec4dc5f03c99b861cf785d3edc4a85e68d9192893a8522b1cc3eff7", "class_name": "RelatedNodeInfo"}}, "hash": "272d4ee4ab32ccd3027d40b22775c81597c662b1caea121e77b008fa7cd6ceed", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 7 11.3.1 Schema for follow up for daily oral PrEP  \nInitial Visit/First Contact\nPerform a risk assessment to determine if PrEP is indicated:\n\u2022 Discuss effective PrEP use and Clarify misinformation\n\u2022 Perform Initial clinical and laboratory assessment:\no Baseline HIV test and rule out symptoms of Acute \nHIV infection.\no Screen for STIs and risk of renal disease/Hepatitis \nB/C infectionIf HIV Negative and meets eligibility for PrEP\n\u2022 Offer adherence counselling and support. \n\u2022 Prescribe 30 -day supply of PrEP (TDF 300 mg/FTC \n200 mg OD) \n\u2022 Discuss combination prevention and risk reduction.\n\u2022 Offer other HIV prevention services e.g., condoms as \nappropriate.\n30 Day review\n\u2022 Assess for adherence and offer adherence counselling and support.\n\u2022 Ask about any side effects. Find out how the client is coping with the side effects if any. Reassure if minor.\n\u2022 Assess for STIs, risk of acute HIV infection, and perform pregnancy test in women. \n\u2022 Assess for risk of kidney disease, if available, obtain serum creatinine and calculate creatinine clearance \n\u2022 Discuss risk reduction and provide condoms.\n\u2022 Perform a repeat HIV test. (Discontinue PrEP for those who test positive and link to care for ART initiation) \nGive a 60-day PrEP prescription for drug refill of PrEP. Schedule the 3 -month return visit.\n3 monthly reviews \n\u2022 Assess for adherence and offer adherence counselling and support. \n\u2022 Ask about any side effects\n\u2022 Assess for STIs, (and pregnancy in women) and acute HIV infection. \n\u2022 Perform HIV test every 3 months (HIV self -test may be used followed by a \nconfirmatory test in health facilities for those testing positive) \n\u2022 Discuss risk reduction and provide condoms.\nDo serum creatinine and calculate creatinine clearance within 3 months after initiation \nand thereafter annually as recommended.\n \nFigure 11.2: Schema for Follow -up for Daily Oral PrEP  \n \n11.3.2 EVENT DRIVEN PrEP (ON DEMAND PrEP or 2+1+1 PrEP)  \nWhat is event driven?  \nAn \u201cEvent\u201d refers to a sexual act. Event driven PrEP is where oral PrEP is to be used when an  \nisolated sexual act is anticipated.   \nEvent -Driven PrEP is recommended for all people assigned male at birth not taking exogenous \nestradiol -based gender affirming hormones", "start_char_idx": 3, "end_char_idx": 2270, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a36db603-dda9-4e84-ae78-394a31293e76": {"__data__": {"id_": "a36db603-dda9-4e84-ae78-394a31293e76", "embedding": null, "metadata": {"page_label": "210", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "be101974-04b4-4608-9e09-ba1417f521ca", "node_type": "4", "metadata": {"page_label": "210", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2f80b33a649cb18d9cf92b1f8a402467b2e2ddf7d7616320ec9531cb721e5f6f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e925ec78-e5f7-43dc-97ff-d9410d66d151", "node_type": "1", "metadata": {"page_label": "209", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "272d4ee4ab32ccd3027d40b22775c81597c662b1caea121e77b008fa7cd6ceed", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "515de72b-00ba-4a3d-8ba4-a62ddd32c77c", "node_type": "1", "metadata": {}, "hash": "bb7509b34a76ebf604d26d1bb630b053909ca25b485e6cc5dc29c65b3f5eaab6", "class_name": "RelatedNodeInfo"}}, "hash": "abc7210e5ec4dc5f03c99b861cf785d3edc4a85e68d9192893a8522b1cc3eff7", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 8 \n \nFigure 11.3 Schema for Event -Driven PrEP  \nWhen is ED -PrEP considered most appropriate?  \nEvent driven PrEP is most appropriate for men who:  \n\u2022 Have infrequent sex (for example, sex less than 2 times per week on average).  \n\u2022 Can plan for sex at least 2 hours in advance or who can delay sex for at least 2 hours.  \n\u2022 Would find ED -PrEP more convenient  \nClients on Event driven PrEP require follow up. Figure 11.4  shows the schema for follow up of \nevent driven PrEP.  \nAssess HIV risk and determine eligibility for oral PrEP\nOffer PrEP and discuss dosing options.\nDaily dosing if risk is more frequent \nthan 2 times per week and sex cannot \nbe predicted or delayed by 2 hours.Men who have sex with men on PrEP \ncan switch from daily dosing to ED -\nPrEP (and vice -versa)Event -driven dosing if sex can be \npredicted (particularly for infrequent \nsex)\nFollow -up visit (1 month after initiation and/or every 3 months) \n\u2713 Provide HIV testing and screen for STIs\n\u2713 Offer counselling by discussing adherence dosing strategy during use, and if PrEP user \ntransitions from one dosing strategy to another. \n\u2713 Assess if HIV risk is likely to persist in the next few weeks and months. \n\u2713 May require more active support in continuing PrEP, whichever dosing strategy is chosen.\n \nFigure 11.4 Schema for Initiation and Follow -up for Event -driven PrEP", "start_char_idx": 3, "end_char_idx": 1416, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "515de72b-00ba-4a3d-8ba4-a62ddd32c77c": {"__data__": {"id_": "515de72b-00ba-4a3d-8ba4-a62ddd32c77c", "embedding": null, "metadata": {"page_label": "211", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "56a8af8b-1319-4020-8bf8-f0c7198384ce", "node_type": "4", "metadata": {"page_label": "211", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3a5d5624ebf4645a8ad2e0cffcc2319b118d0ade248dcdd71b7a7b5900353520", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a36db603-dda9-4e84-ae78-394a31293e76", "node_type": "1", "metadata": {"page_label": "210", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "abc7210e5ec4dc5f03c99b861cf785d3edc4a85e68d9192893a8522b1cc3eff7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d4e4b0fe-bc6e-42c9-b535-64661080299a", "node_type": "1", "metadata": {}, "hash": "828d829d9f338e8516d1e6b81f1d700cc5ed417cedb7db3bef50d60b1d0d2091", "class_name": "RelatedNodeInfo"}}, "hash": "bb7509b34a76ebf604d26d1bb630b053909ca25b485e6cc5dc29c65b3f5eaab6", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 9 Changing between ED PrEP and daily oral PrEP  \nMen can be offered the two dosing options: daily oral PrEP or Event driven PrEP.  \n\u2022 Daily dosing is appropriate for those whose occurrence of sex cannot be predicted and for \nthose whose potential exposures to HIV  are more frequent than 2 times per week, such \nthat ED -PrEP would be taken so frequently that it would effectively resemble daily PrEP.  \n\u2022 If sex continues beyond one day, a user of ED -PrEP can stay protected by taking another \npill each day as long as sex co ntinues and stopping 2 days after the last sex act.  \n\u2022 On the other hand, if an individual starts daily oral PrEP, but then sex becomes infrequent \nand predictable, ED -PrEP can be used instead.  \n \n11.4 Managing Clinical and Laboratory Results on Initial and Fol low -up \nAssessment  \nTable 11.5 Initial & follow up laboratory test  \nLaboratory Test  Guidelines for clients initiating \nPrEP  Guidelines for clients on \nfollow up  \nHIV Rapid Test  Before initiating PrEP as per the National \nHTS algorithm  At Month 1, Month 3, thereafter \nevery 3months  \nCreatinine Test  Test within 1 -3 months of PrEP Initiation  If client >50years \u2013 Screen every \n6-12months  \nClients of any age with renal \ncomorbidity: recommended before  \ninitiating PrEP  Screen every 6 -12months  \nHepatitis B Surface \nAntigen (HBsAg)  Test once within 3 months of initiating PrEP. If negative, offer/refer for \nimmunization   \nHepatitis C Virus \nSerology  Test once within 3months of PrEP \ninitiation  Every 12 months for persons at \nhigh risk of Hepatitis C infection", "start_char_idx": 3, "end_char_idx": 1616, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d4e4b0fe-bc6e-42c9-b535-64661080299a": {"__data__": {"id_": "d4e4b0fe-bc6e-42c9-b535-64661080299a", "embedding": null, "metadata": {"page_label": "212", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "cdfcb08f-966a-485c-abd9-1ee81af917bd", "node_type": "4", "metadata": {"page_label": "212", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2630c278336f57f37bf67df21810ddcecc130f8e969926a65aa9c8deab7b9291", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "515de72b-00ba-4a3d-8ba4-a62ddd32c77c", "node_type": "1", "metadata": {"page_label": "211", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "bb7509b34a76ebf604d26d1bb630b053909ca25b485e6cc5dc29c65b3f5eaab6", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "35002ccc-e783-4caf-bc42-52659ff972d4", "node_type": "1", "metadata": {}, "hash": "289fe86347d541b5e588331d8cdb6943cbafdae104c344c0fd615c6d9b734a44", "class_name": "RelatedNodeInfo"}}, "hash": "828d829d9f338e8516d1e6b81f1d700cc5ed417cedb7db3bef50d60b1d0d2091", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 10 Table 11.6: Managing Clinical and Laboratory Results on Initial and Follow -up Assessment  \nScreening  Action  \nHIV -positive at \ninitial evaluation  Do not start PrEP, counsel and link to care and treatment  \nHIV -positive after \ninitiation of PrEP  Discontinue PrEP, counsel and link to care and treatment. Take DBS or plasma \nsample for drug resistance testing.  \n \nPositive STI Screen  Thorough genitourinary and anorectal examination, urine dipstick for urethritis, \nserological testing for syphilis, full STI evaluation if resources available (refer to \nSTI algorithm). Refer to guidelines on syndromic management of STIs.  \nHBsAg -negative  Offer HBV vaccination  \n \nHBsAg -positive  This is not a contraindication to oral PrEP.  However, will require monitoring of \nliver function and referral for management of liver disease.  \nNB: TDF -based daily or event -driven oral PrEP can be safely offered to \npersons with HBV infection.  \nHepatitis C - \nNegative  Continue PrEP and follow Hepatitis C testing algorithm.  \nHepatitis C - \nPositive  Continue PrEP, refer for Hepatitis C confirmatory testing and management with \ndirectly acting antivirals (DAAs).  \nFlu-like illness after \ninitiating PrEP  Continue PrEP, test for HIV at first contact and after 28 days, and if negative,  \ncontinue with usual follow -up \n \n \n \n \n \n \n \nSide effects of PrEP  GIT - nausea, vomiting, weight loss: these are often mild, self -limiting and occur \nduring the first 1 -2 months. Provide supportive counselling, offer symptomatic \ntreatment e.g., anti -emetics like metoclopramide 10 mg 8 hourly for 3 to 5 days.  \nRenal \u2013 individuals may experience transient increase in creatinine, and rarely \nproteinuria and Fanconi\u2019s syndrome (presenting as polyuria, bone pain and \nweakness). Measure creatinine (and ca lculate estimated creatinine clearance) at \ninitiation of PrEP and annually thereafter (or whenever indicated (symptom \ndirected)).  \nIf creatinine clearance (eGFR) < 50 ml/min do not start PrEP, recheck after 2 \nweeks. Refer for evaluation of underlying renal  disease.  \nIf the renal function returns to normal, reassess for PrEP and initiate/ continue \nPrEP.  \nPrEP should not be prescribed for individuals using nephrotoxic drugs like \nacyclovir, aminoglycosides, retinoids etc. instead, offer alternative HIV \nprevent ion services.  \n \nPregnancy or \nBreastfeeding  \n Pregnancy and breastfeeding are not contraindications to provision of PrEP.  \nPregnant or breastfeeding women whose sexual partners are HIV positive or are \nat high risk of HIV infection may benefit from PrEP as part of combination \nprevention of HIV infection.  \nPrEP is also indicated for HIV -negative women in sero -different partnersh ips \nwho wish to conceive. PrEP in these situations can be prescribed during the pre -\nconception period and throughout pregnancy to reduce risk of sexual HIV \ninfection.", "start_char_idx": 3, "end_char_idx": 2949, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "35002ccc-e783-4caf-bc42-52659ff972d4": {"__data__": {"id_": "35002ccc-e783-4caf-bc42-52659ff972d4", "embedding": null, "metadata": {"page_label": "213", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "cb194b1e-4795-47c3-b413-33a2a4c9c11f", "node_type": "4", "metadata": {"page_label": "213", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3a4b3ff9e1896201c2de52c2a96aed95be23de9a073ab4cc079f9d264d147e8d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d4e4b0fe-bc6e-42c9-b535-64661080299a", "node_type": "1", "metadata": {"page_label": "212", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "828d829d9f338e8516d1e6b81f1d700cc5ed417cedb7db3bef50d60b1d0d2091", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4774847b-92c7-4d0e-b458-56288fac22c9", "node_type": "1", "metadata": {}, "hash": "7c7659ace90c085a9ea7e8da00558c71b2df930bfd88ff469a9b8e956bfd241a", "class_name": "RelatedNodeInfo"}}, "hash": "289fe86347d541b5e588331d8cdb6943cbafdae104c344c0fd615c6d9b734a44", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 11 Table 11.7: Summary of PrEP Initial and Follow -up Assessment  \nVisit  Action  \nFirst (Screening Visit) \nClinician Visit  \u2022 HIV testing and counselling.  \n\u2022 Evaluate for eligibility, willingness and readiness to take PrEP.  \n\u2022 Educate about the risks, benefits, and limitations of different PrEP \noptions  \n\u2022 Educate client about recognizing symptoms of Acute  HIV Infection (AHI) \nand what to do if such symptoms occur (i.e., urgently return for HIV \ntesting)  \n\u2022 Conduct behavior risk assessment  \n\u2022 STI screening and treatment  \n\u2022 Pregnancy, contraceptive use and counselling (for women); if pregnancy \nsuspected, obtain a preg nancy test. However, pregnancy is not a \ncontraindication to PrEP.  \n\u2022 Adherence counselling  \n\u2022 Discuss combination prevention.  \n\u2022 Laboratory test; serum creatinine test and calculate Creatinine Clearance \n(CrCl), HBsAg, pregnancy test, Hepatitis C (baseline investigations should \nnot delay initiation of PrEP)  \nIf no contraindication to TDF and the client is eligible and ready, \nprescribe TDF/FTC one tablet once daily for 30 days (alternative \nTDF/3TC one tablet once daily for 30 days, or TDF 300 mg once daily for \n30 days); agree on a follow -up date before the prescription is finished  \nVisit 2 (Month 1) \nCounsellor/Clinician \nVisit  \u2022 Counsellor/ Clinician visit  \n\u2022 Assess for side effects and adverse effects  \n\u2022 Safety monitoring clinical assessment/ Review lab results  \n\u2022 Conduct a HIV test as per the national algorithm  \n\u2022 Behavioral risk assessment .  \n\u2022 Review for PrEP continuation or discontinuation  \n\u2022 Adherence and risk reduction counselling  \n\u2022 Give a prescription for PrEP for 2 months.  \n\u2022 Offer HBV vaccination if available and HBsAg negative (follow HBV \nvaccination schedule complete series  \nFollow up visits - \nMonths 3, 6,  , 12, 15.\u2026.  \nClinician/Counsellor -\nled visits  \u2022 HIV testing and counselling  \n\u2022 HIV risk assessment   \n\u2022 Review for PrEP continuation or discontinuation  \n\u2022 Assess for side effects and adverse effects  \n\u2022 Safety monitoring clinical assessment/ Review lab results  \n\u2022 Adherence and risk reduction counselling  \n\u2022 Give a prescription for PrEP for 3 months  \n\u2022 Refill PrEP prescription  \n\u2022 Serum creatinine and creatinine clearance", "start_char_idx": 3, "end_char_idx": 2268, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "4774847b-92c7-4d0e-b458-56288fac22c9": {"__data__": {"id_": "4774847b-92c7-4d0e-b458-56288fac22c9", "embedding": null, "metadata": {"page_label": "214", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "39033f7a-2f3e-4cc5-aca7-54af1cf68ad3", "node_type": "4", "metadata": {"page_label": "214", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8019bc0aa395d3646add9d124beccaaa8a9104d80119f3182a977c7d3e3f89d6", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "35002ccc-e783-4caf-bc42-52659ff972d4", "node_type": "1", "metadata": {"page_label": "213", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "289fe86347d541b5e588331d8cdb6943cbafdae104c344c0fd615c6d9b734a44", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "477d38f4-fd80-4c5f-88b1-b180cb90c0dd", "node_type": "1", "metadata": {}, "hash": "292137f032ce910fbf7a861df6b3a6c07c1a74bbbb7f0da3fffb70b4ac3d32b0", "class_name": "RelatedNodeInfo"}}, "hash": "7c7659ace90c085a9ea7e8da00558c71b2df930bfd88ff469a9b8e956bfd241a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 12 Table 11.7 Cont: Summary of PrEP Initial and Follow -up Assessment  \nDuring every visit  \n\u2022 Assess adherence  \n\u2022 Reassess risk of HIV infection and offer risk reduction counselling  \n\u2022 HIV testing should be repeated at month 1 and thereafter, every 3 months (this applies for both \ndaily and Event driven PrEP)  \n\u2022 Assess for adverse effects   \n11.5 Contra -indications to Oral PrEP (daily or ED PrEP)  \n\u2022 HIV infection or suspected acute HIV infection (i.e., flu -like symptoms in the last 4 weeks in \ncombination with a preceding h igh-risk exposure for HIV)  \n\u2022 Adolescents < 35 kg or age < 15 years  \n\u2022 Impaired renal function (estimated creatinine clearance of <50 ml/min)  \n\u2022 Unable or unwilling to adhere to prescribed PrEP or follow -up schedule.  \n11.6 Criteria for Discontinuing Oral PrEP  \nPrEP should be discontinued if ANY of the following criteria are met.  \n\u25cf Positive HIV test during follow up.  \n\u25cf Change in risk status (no ongoing risk)  \n\u25cf Renal dysfunction with creatinine clearance below 50 ml/min  \n\u25cf Client request to stop.  \n\u25cf Sustained non -adherence.  \nDiscontinuing daily oral PrEP:   Users discontinuing PrEP due to no ongoing risk or requesting \nto stop should continue PrEP for at least 7 days after the last potential exposure to HIV. Reasons \nfor discontinuation should be documented in the client\u2019s record.  \nDiscontinuing event \u2013driven PrEP:  Event -driven PrEP can be stopped after two daily doses \nfollowing the last sexual exposure.  \n11.7 Restarting PrEP  \nAny client restarting PrEP regardless of the preferred method should be assessed for HIV status \nand a rapid HI V test conducted:  \n\u25cf Daily Oral PrEP : Clients who stop PrEP for more than 7 days and wishes to restart should \nbe assessed for resumption of PrEP similar to the assessment done for an initial (first) visit. \nImportantly, conduct a HIV test before re -starting PrEP. If a high -risk exposure occurre d in \nthe previous 7 days (i.e., acute HIV infection is suspected), defer PrEP and obtain repeat HIV \ntest after 4 weeks; if negative, PrEP can be prescribed if the other criteria are fulfilled. The \nuse of condoms should be recommended during the waiting per iod.  \n\u25cf Event driven Oral PrEP :  Clients who have stopped PrEP for more than a week and who are \nrestarting ED -PrEP should commence with a double dose (two pills) of PrEP as new \ninitiators. Risk assessment should be conducted. If a high -risk exposure occurred  in the \nprevious 7 days (i.e., acute HIV infection is suspected), defer PrEP and obtain repeat HIV \ntest after 4 weeks; if negative, PrEP can be prescribed if the other criteria are fulfilled. The \nuse of condoms should be recommended during the waiting peri od.", "start_char_idx": 3, "end_char_idx": 2762, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "477d38f4-fd80-4c5f-88b1-b180cb90c0dd": {"__data__": {"id_": "477d38f4-fd80-4c5f-88b1-b180cb90c0dd", "embedding": null, "metadata": {"page_label": "215", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "30f8fb0e-d2d2-40b7-b658-54374931a67d", "node_type": "4", "metadata": {"page_label": "215", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f52d79111767e61a039d130127d5d934b2c579d04df758952ea948479d1ca6e2", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "4774847b-92c7-4d0e-b458-56288fac22c9", "node_type": "1", "metadata": {"page_label": "214", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7c7659ace90c085a9ea7e8da00558c71b2df930bfd88ff469a9b8e956bfd241a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ecf3d20b-89ee-48aa-8924-ac7491fef59a", "node_type": "1", "metadata": {}, "hash": "19e4b73c61214b89e4ccb4ff11de21ab3bf983dd28f36e636b2a94d42b55dbda", "class_name": "RelatedNodeInfo"}}, "hash": "292137f032ce910fbf7a861df6b3a6c07c1a74bbbb7f0da3fffb70b4ac3d32b0", "text": "Pre-Exposure Prophylaxis (PrEP)  \n11 - 13 11.8 Improving adherence to PrEP  \nApproaches to improve adherence include:  \n\u25cf Encourage ring users to keep ring in place continuously through the 28 -day period from \ninitial insertion  \n\u25cf Disclosure of PrEP use to a partner or trusted person  \n\u25cf Use of reminder de vices like a cell phone alarm.  \n\u25cf SMS reminders where available and feasible  \n\u25cf Exploring and mitigation of other barriers to adherence  \n\u25cf Peer support  \n11.9 Monitoring Sero -conversion among PrEP users  \nPrEP substantially reduce the risk of HIV acquisition.  The effi cacy of PrEP is correlated with \nadherence.  Sero -conversion during use of PrEP should be monitored critically as it is increasing \nthe risk of developing drug resistance if clients continue the use of PrEP while HIV infected.  \nFactors that lead to HIV seroco nversion among PrEP sero -converters include:  \n\u25cf Inconsistency in use of PrEP (non -adherence).  \n\u25cf Social -behavioral factors e.g., poverty, HIV stigma and relationship status that may affect \nthe ability to use PrEP as prescribed.  \n\u25cf Possible infections with drug res istant strains  \n \nWhat should be done upon identification of a PrEP sero -converter?  \nHIV testing among PrEP should be conducted consistently as per the algorithm. Identification of \nnew HIV positive diagnosis among PrEP users should be followed with:  \n\u25cf Immediate discontinuation of PrEP  \n\u25cf Counselling of client on positive results  \n\u25cf Linkage to care and ART (immediate ART initiation).  \n\u25cf Assessment of barriers to adherence that may affect use of ART.  \n\u25cf Document sero -conversion in client file, PrEP registers, and monthly reporting as \nrequired.", "start_char_idx": 3, "end_char_idx": 1680, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ecf3d20b-89ee-48aa-8924-ac7491fef59a": {"__data__": {"id_": "ecf3d20b-89ee-48aa-8924-ac7491fef59a", "embedding": null, "metadata": {"page_label": "216", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ca18c545-3154-4e61-b437-84a004268571", "node_type": "4", "metadata": {"page_label": "216", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b94c1a28cd418be6c5734fc26edbea907e9ef5dd0996a80fdd1b55abcd7a277d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "477d38f4-fd80-4c5f-88b1-b180cb90c0dd", "node_type": "1", "metadata": {"page_label": "215", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "292137f032ce910fbf7a861df6b3a6c07c1a74bbbb7f0da3fffb70b4ac3d32b0", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3c93c946-73a4-4f1b-b3ce-43705ba23a7a", "node_type": "1", "metadata": {}, "hash": "c6994cbfdb36d36fba22e5cf27583af49b689a0ae31ca52a6825a1e91ebc9b6d", "class_name": "RelatedNodeInfo"}}, "hash": "19e4b73c61214b89e4ccb4ff11de21ab3bf983dd28f36e636b2a94d42b55dbda", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 11 - 14", "start_char_idx": 3, "end_char_idx": 65, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3c93c946-73a4-4f1b-b3ce-43705ba23a7a": {"__data__": {"id_": "3c93c946-73a4-4f1b-b3ce-43705ba23a7a", "embedding": null, "metadata": {"page_label": "217", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b2e571cb-d920-4fb7-b890-ad21eecf8318", "node_type": "4", "metadata": {"page_label": "217", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "971007a4f68c7a8730484ec3648ade1c3b46c8308f12dccbd4453c5af5cd753d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ecf3d20b-89ee-48aa-8924-ac7491fef59a", "node_type": "1", "metadata": {"page_label": "216", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "19e4b73c61214b89e4ccb4ff11de21ab3bf983dd28f36e636b2a94d42b55dbda", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3af03eff-0a54-4d4a-b58a-04fad83ef9af", "node_type": "1", "metadata": {}, "hash": "d414526f8b763f8cf7aaaff5ec8264c2898cd34d07e445c400ce0252ebeefc85", "class_name": "RelatedNodeInfo"}}, "hash": "c6994cbfdb36d36fba22e5cf27583af49b689a0ae31ca52a6825a1e91ebc9b6d", "text": "People Who Inject Drugs (PWID) and HIV  \n12 - 1  \n12. People Who Inject Drugs (PWID) and HIV  \n \n12.1 Introduction  \nThe use of ART for HIV treatment in key populations should follow the same general principles \nand recommendations as for all adults. Individuals within key populations groups may experience \ndiscrimination and marginali zation that can impede their access to health care, including \ntreatment for HIV, and frequently present late for treatment. It is important to ensure that people \nfrom key populations have equitable access to HIV treatment and care.  Programs should ensure \nthat missed opportunities are minimized and every single encounter with key populations is \noptimally used. ART service delivery includes decentralization of HIV care and treatment and \nintegration of ART services into other clinical services such as Medical ly Assisted Therapy and \ndrop -in centers where appropriate capacity exists.  \nPeople who inject drugs (PWID) are at increased risk of HIV infection. In Kenya, the HIV \nprevalence among PWID is up to 4 times that of the general population. PWID also suffer a hi gher \nburden of viral hepatitis (HBV and HCV), TB and sexually transmitted infections irrespective of \ntheir HIV status. Despite this, PWID have limited access to HIV treatment and prevention services.  \nEvery effort should be made to implement evidence -inform ed interventions in the comprehensive \npackage of measures targeting PWID, either in combination or (depending on site capacity) singly, \nwith linkage to comprehensive care (Table 12.1).  \nPackage of care for PWID  \nPWID have complex needs related to drug dependency, psychosocial and medical \ncomplications of injection and other substance use. When they require ART, anti -TB, or any \nother therapy, they are at increased risk of adverse drug reactions, drug -drug interactions and \nnon-adherence.  These patients a re best comprehensively managed by providers who have \nreceived specific training in the management of injection drug users. Once identified, PWID \nshould be counselled and linked to programs with the capacity to offer comprehensive care for \nsuch patients.", "start_char_idx": 3, "end_char_idx": 2158, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3af03eff-0a54-4d4a-b58a-04fad83ef9af": {"__data__": {"id_": "3af03eff-0a54-4d4a-b58a-04fad83ef9af", "embedding": null, "metadata": {"page_label": "218", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "64cf5732-e412-4f4c-9e52-fbf4389d8b87", "node_type": "4", "metadata": {"page_label": "218", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "071186f82f81fe916d13b03244a6e544e0aec49f9dfd591f751b4bc045e5da8c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3c93c946-73a4-4f1b-b3ce-43705ba23a7a", "node_type": "1", "metadata": {"page_label": "217", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c6994cbfdb36d36fba22e5cf27583af49b689a0ae31ca52a6825a1e91ebc9b6d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "92c2df4f-c512-4a1a-877d-2192e5d1727f", "node_type": "1", "metadata": {}, "hash": "3a058073bf727e651313353163c4bd46943ac36ea1f580efb1c45e52d5a3f418", "class_name": "RelatedNodeInfo"}}, "hash": "d414526f8b763f8cf7aaaff5ec8264c2898cd34d07e445c400ce0252ebeefc85", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 12 - 2 Table 12.1: Comprehensive Package of Harm Reduction for PWID  \nIntervention  Comment/Recommendations  \nHIV testing services  PWID are at high risk of HIV infection, are likely to be diagnosed late and \ntherefore have poorer treatment outcomes following ART i nitiation.  \n\u25cf PWID should be offered HIV testing and counselling and be linked to \ncomprehensive HIV treatment and prevention services including \nharm reduction counselling and support.  \n\u25cf Retest for HIV every 3 months if there is ongoing risk.  \n\u25cf HIV self -testing should be integrated into drop -in centers (DICEs) \nthrough both assisted and non -assisted approaches after initial \ntesting by a provider.  \n\u25cf HTS should also be offered to sexual partners  of PWID.   \n \nTargeted information, \neducation, and \ncommunication for PWID \nand their sexual partners  PWID and sexual partners should be provided with information and \ncounselling on risks related to drug use and risky sexual behavior. PWID \nshould be informed of where and what harm -reduction services are \navailable, and linked to appropriate services.  \nPeer -based networks are effective in improving access and retention to \nharm reduction care  \n \n \nCondom provision  The correct and consistent use of condoms with condom -compatible \nlubricants is recommended for all PWID to prevent unintended pregnancy \nand sexual transmission of HIV and other STIs.  \n \n \nPrevention and treatment of \nsexually transmitted \ninfections  PWID may be at higher risk of STIs due to sex work or other risky sex \npractices.  \nSTIs, especially genital ulcer diseases increase the risk of HIV infection and \ntransmission and are often a sign of unsafe sexual behavior or risk of HIV \ntransmission.  \nScreening, dia gnosis, treatment, and prevention of STIs should be offered \nroutinely as part of comprehensive HIV prevention and care for PWID.  \n \n \nPrevention, diagnosis, and \ntreatment of TB  Independent of HIV infection, PWID have an increased risk of TB. HIV \ninfection f urther increases this risk.  \n\u25cf All PWID should be screened regularly for active TB using the \nsymptom -based screening algorithm at each contact with healthcare \nworkers.  \n\u25cf Once active TB is ruled out, TPT should be provided to PWID living \nwith HIV as per National guidelines for TPT.  \n\u25cf PWID w ith active TB should receive standard TB treatment as per the \nNational guidelines and be supported to complete treatment.  \n\u25cf Anticipate and manage complications due to viral hepatitis or renal \nimpairment.", "start_char_idx": 3, "end_char_idx": 2558, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "92c2df4f-c512-4a1a-877d-2192e5d1727f": {"__data__": {"id_": "92c2df4f-c512-4a1a-877d-2192e5d1727f", "embedding": null, "metadata": {"page_label": "219", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f3be78c9-d72c-436f-bccd-0b3607412724", "node_type": "4", "metadata": {"page_label": "219", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ba9410dcf598a41c4de50ab6cca7f7a8f6685535d57b2ddd02d3cc73d0566eab", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3af03eff-0a54-4d4a-b58a-04fad83ef9af", "node_type": "1", "metadata": {"page_label": "218", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d414526f8b763f8cf7aaaff5ec8264c2898cd34d07e445c400ce0252ebeefc85", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "49a875d8-b7f5-4c73-a49f-7b8b1d8f755b", "node_type": "1", "metadata": {}, "hash": "c3c4205c631e9f96888fa6285caf633607667870d89794db3f3c52d0ccf4c40a", "class_name": "RelatedNodeInfo"}}, "hash": "3a058073bf727e651313353163c4bd46943ac36ea1f580efb1c45e52d5a3f418", "text": "People Who Inject Drugs (PWID) and HIV  \n12 - 3 Table 12.1 Cont.  \nPrevention, vaccination, \ndiagnosis, and treatment for \nviral hepatitis  Hepatitis B and C disproportionately affect PWID due to overlapping risk \nfactors of sexual transmission and sharing needles, syringes, and other \ndrug use items.  \nHarm reduction and behavioral interv entions are also effective in \nreducing risk of infection/transmission of HBV and HCV.  \n\u25cf Peer interventions should be offered to people who inject drugs to \nreduce the incidence of viral hepatitis  \n\u25cf PWID should be screened for HBV (by HBsAg) and HCV (by HCV \nsero logy) at first contact  \n\u25cf Hepatitis B  \no Hepatitis B vaccination is recommended for those who are \nHBsAg negative. A higher -dose HBV vaccine should be used \nwith the rapid regimen (day 0, 7, 21, and a booster at 12 \nmonths). If the rapid regimen is not available, the standard \nregimen should be offered. For PWID who are HIV positive, they \nshould follow the dosing schedule in Table. 9.1  \no HBV/HIV co -infected PWID should be started on TDF - or TAF - \ncontaining ART (the current recommended first line is \nTDF/3TC/ DTG) in addition to harm -reduction interventions to \noptimize adherence and treatment outcomes.  \n\u25cf Hepatitis C  \no HCV/HIV co -infected PWID should be initiated on ART.  \no Specific HCV antiviral therapy should be provided in \nconsultation with expertise in the management of HCV infection \n(refer to national guidelines on management of viral hepatitis)  \n  \nNeedle and syringe \nprogrammes (NSPs)  NSPs help decrease drug -related risk behaviors, reduce quantity of \ncontaminated needles in circulation, reduce risk of new HIV infections and \nimprove referrals and linkage to HTS and HIV treatment and prevention \nservices.  \nNSPs are effective means for intr oducing combination prevention to PWID \nincluding HTS, STI screening and treatment, condoms provision, OST, and \nHIV treatment and prevention.  \nAll PWID should be linked to NSPs to access sterile injecting \nequipment  \n \nOpioid substitution therapy \n(OST)  OST usi ng methadone or another suitable alternative is effective in the \ntreatment of opioid dependency, reducing risk behaviors related to drug \nuse and therefore reducing HIV transmission and improving PWIDs\u2019 \nadherence to ART  \nIdentify and link all PWID who have o pioid dependence for opioid \nsubstitution therapy", "start_char_idx": 3, "end_char_idx": 2377, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "49a875d8-b7f5-4c73-a49f-7b8b1d8f755b": {"__data__": {"id_": "49a875d8-b7f5-4c73-a49f-7b8b1d8f755b", "embedding": null, "metadata": {"page_label": "220", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0e6b315d-c0ad-4e40-9ed7-f205c66b74b0", "node_type": "4", "metadata": {"page_label": "220", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b94ad5d6c27475e760b584dfc0377630f3a74c307b69c9fe23ef7a10e98cfb50", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "92c2df4f-c512-4a1a-877d-2192e5d1727f", "node_type": "1", "metadata": {"page_label": "219", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3a058073bf727e651313353163c4bd46943ac36ea1f580efb1c45e52d5a3f418", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e61f7390-1cd3-4d13-8577-f6052955a85a", "node_type": "1", "metadata": {}, "hash": "8ff08f686d0678f1f5c8f94cdbdb297ceedfdd9cfe788fbde9ee663f914586d5", "class_name": "RelatedNodeInfo"}}, "hash": "c3c4205c631e9f96888fa6285caf633607667870d89794db3f3c52d0ccf4c40a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 12 - 4 Table 12.1 Cont.  \nAntiretroviral therapy \n(refer to Table 12.2 for \ndetails)  \u2022 ART is effective in managing HIV infection in PWID. However, poor \nadherence may interfere with ART success. Intensive support is \nrequired including OST, enhanced counselling techniques and daily \nwitnessed ingestion (DWI) when available.  \n\u2022 Close monitoring of ART is necessary because of risk of drug -drug \ninteractions, renal and liver toxicity.  \n\u2022 HIV-positive PWID should be off ered comprehensive HIV treatment \nand prevention services including ART. When ART is provided with \nadditional targeted support, PWID can achieve and maintain viral \nsuppression.  \n\u2022 Oral PrEP is recommended as an additional prevention choice for \nPWID at substant ial risk of HIV infection as part of combination \nprevention and harm reduction approaches.  \nCommunity outreach  PWID face barriers to accessing formal facility -based health services due \nto stigma, discrimination, and fear of victimization among other factors.  \nOutreach either directly from the facility or through collaborations with \ncommunity -based groups is an effe ctive means of delivering harm -\nreduction interventions in addition to HIV treatment and prevention \nservices.  \nPeer -led, community -based approaches are particularly useful in \nimproving adherence and retention.  \n \n12.3 ART in HIV positive PWID  \nAntiretroviral  therapy is part of the comprehensive care package for PWID living with HIV. ART \nservice provision should follow the same general principles and recommendations as for all \nadults.", "start_char_idx": 3, "end_char_idx": 1623, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e61f7390-1cd3-4d13-8577-f6052955a85a": {"__data__": {"id_": "e61f7390-1cd3-4d13-8577-f6052955a85a", "embedding": null, "metadata": {"page_label": "221", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "89de34e7-33d7-4d77-a73f-6ce8ae321f72", "node_type": "4", "metadata": {"page_label": "221", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c74d4f0a4a2d15706f068a9421dd556a0582a31de03d9cbaa0ebec85eb426d37", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "49a875d8-b7f5-4c73-a49f-7b8b1d8f755b", "node_type": "1", "metadata": {"page_label": "220", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c3c4205c631e9f96888fa6285caf633607667870d89794db3f3c52d0ccf4c40a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e078e230-3fe6-4098-ba46-954b53cb669a", "node_type": "1", "metadata": {}, "hash": "389a0d972368b2a1ee822eb8bc8a9a5cea4d495d5dfadbd5b1cfde9c583ecc93", "class_name": "RelatedNodeInfo"}}, "hash": "8ff08f686d0678f1f5c8f94cdbdb297ceedfdd9cfe788fbde9ee663f914586d5", "text": "People Who Inject Drugs (PWID) and HIV  \n12 - 5 Table 12.2: Summary of ART Recommendations for PWID  \nCare and Support  Recom mendation/Additional Information  \nWhen to start ART in \nHIV positive PWID  ART should be initiated in all individuals with HIV regardless of WHO clinical \nstage or CD4 cell count  \nWhat to start (first -line \nART)  Irrespective of OST, PWID with HIV infection should be initiated on a first -line \nregimen of TDF + 3TC + DTG  including women of childbearing potential.  \nTDF + 3TC + ATV/r may be offered as an alternative where DTG cannot be used. \n(Table 6.3)  \nTB Co -infecti on  ART should be started as soon as possible within two weeks of initiating TB \ntreatment, regardless of CD4 cell count.  \nFor PWID with TB/HIV co -infection on DTG, give TDF/3TC/DTG FDC given in \nthe am + DTG 50mg given in the pm for duration of rifampicin -containing TB \ntreatment and for an additional 2 weeks after TB treatment is completed, then \nrevert to TDF/3TC/DTG FDC once daily.  \nSecond -line \nART  Patients failing DTG -based first line ART (including PWID) should be managed \nas per the viral load  monitoring algorithm (Figure 6.6), including performing a \nDRT for selection of a second -line regimen (Table 6.10)  \nTreatment preparation \nand adherence \ncounselling and \nsupport  Injection drug use is not a contra -indication to ART initiation. OST, though \nimp ortant in contributing to the success of ART in PWID, should not be a pre -\nrequisite to initiation of ART. However, these patients benefit from additional \npreparation and support to increase their chances of successful treatment \nincluding:  \n\u25cf Harm reduction in terventions  \n\u25cf Thorough baseline assessment for important comorbid conditions like \nAdvanced HIV Disease (AHD) including TB, hepatitis, renal impairment \nand depression or other psychiatric disorders  \n\u25cf Negotiation for, and access to daily witnessed ingestion (DWI ). \n\u25cf Community outreach and support", "start_char_idx": 3, "end_char_idx": 1956, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e078e230-3fe6-4098-ba46-954b53cb669a": {"__data__": {"id_": "e078e230-3fe6-4098-ba46-954b53cb669a", "embedding": null, "metadata": {"page_label": "222", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e24a2af2-39de-482f-adea-c60cebf6aa5f", "node_type": "4", "metadata": {"page_label": "222", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c14d2d4daf9ebe4d5d59f9c087ef3588718dbfc7d58aba70e1e039193390b2b0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e61f7390-1cd3-4d13-8577-f6052955a85a", "node_type": "1", "metadata": {"page_label": "221", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8ff08f686d0678f1f5c8f94cdbdb297ceedfdd9cfe788fbde9ee663f914586d5", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "014a1501-674f-4f40-8242-2bf83e2bcd70", "node_type": "1", "metadata": {}, "hash": "21fb20bd2bb4ffc70c39bc3c21474c8256b787bc8e19c982e21f8d3a487943d2", "class_name": "RelatedNodeInfo"}}, "hash": "389a0d972368b2a1ee822eb8bc8a9a5cea4d495d5dfadbd5b1cfde9c583ecc93", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n 12 - 6 Table 12.1 Cont.  \nPreventing and \nmanaging drug -drug \ninteractions  Selection of drugs should take into consideration possible drug to drug \ninteractions and their effects on opioids, OST and ART. Any interaction that \nreduces the levels of methadone may induce withdrawal symptoms and \nrequire an increased dose of methadone.  \n\u25cf ARV interactions with methadone and opioids  \no NRTIs  \n\u25aa TDF, TAF, 3TC, FTC: no significant interactions  \n\u25aa AZT levels are increased, with higher risk of AZT toxicity.  \n\u25aa ABC levels are decreased, and methadone levels are \ndecreased.  \no NNRTIs  \n\u25aa EFV: methadone levels are decreased and may induce \nwithdrawal symptoms.  \no PI/r: all boosted PIs decrease methadone levels.  \n\u25aa LPV/r and methadone increase risk for prolonged QT \nsyndrome and sudden cardiac death.  \no INSTIs: no significant interactions  \n\u25cf ARV interactions with buprenorphine  \no ATV/r and DRV/r increase concentrations of buprenorphine or \nits active metabolites and may increase risk of toxicity.  \no EFV decreases buprenorphine levels substantially.  \no No known significant interactions with other ARVs  \n\u25cf Rifampicin and Rifapentine decrease levels of methadone and \nbuprenorphine and may induce withdrawal symptoms.  \n\u25cf INH can be used safely with methadone or bupr enorphine  \n\u25cf Management of Drug -Drug Interactions (Annex 13)  \n \nMonitoring ART  \u25cf PWID on ART require more frequent monitoring and support to ensure \nadherence to treatment and harm reduction interventions, assessment for \nand management of adverse drug reactions or drug -drug interactions  \n\u25cf Ongoing monitoring should also include screening for other illicit \nsubstance/drug use.", "start_char_idx": 3, "end_char_idx": 1728, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "014a1501-674f-4f40-8242-2bf83e2bcd70": {"__data__": {"id_": "014a1501-674f-4f40-8242-2bf83e2bcd70", "embedding": null, "metadata": {"page_label": "223", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ccd580d4-7380-4beb-a0a3-99054279fdcf", "node_type": "4", "metadata": {"page_label": "223", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "79533b222f68a55e04b1f5f6963318ae07ce47f28a984b3947da98f47fe401a7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e078e230-3fe6-4098-ba46-954b53cb669a", "node_type": "1", "metadata": {"page_label": "222", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "389a0d972368b2a1ee822eb8bc8a9a5cea4d495d5dfadbd5b1cfde9c583ecc93", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "19ce77c0-fe12-411c-a434-4c06e803d0b5", "node_type": "1", "metadata": {}, "hash": "5706f134d25ad182d0bb59f22f6af17d20f6aa3ee504316400f7c6dc63d1e69e", "class_name": "RelatedNodeInfo"}}, "hash": "21fb20bd2bb4ffc70c39bc3c21474c8256b787bc8e19c982e21f8d3a487943d2", "text": "Annexes  \n \n13 - 1  \n13. Annexes  \n \nAnnex 1: WHO Clinical Staging of HIV Infection in Infants and Children  \nStage I  \n\u2022 Asymptomatic  \n\u2022 Persistent generalized lymphadenopathy  \n\u2022 (PGL)  \n\u2022 Unexplained, asymptomatic \nhepatosplenomegaly  Stage II  \n\u2022 Papular pruritic eruptions (PPE)  \n\u2022 Seborrheic dermatitis  \n\u2022 Fungal nail infections  \n\u2022 Angular cheilitis  \n\u2022 Linear gingival erythema  \n\u2022 Extensive HPV or molluscum infection (>5% of \nbody area/face)  \n\u2022 Recurrent oral ulcerations (>2 episodes/ in 6 \nmonths)  \n\u2022 Parotid enlargement  \n\u2022 Herpes zoster (>1 episode/12 months)  \n\u2022 Recurrent or chronic upper respiratory infection \n(URI): otitis media, otorrhea, sinusitis (>2 \nepisodes/6 months)  \nStage III  \n\u2022 Unexplained moderate malnutrition ( -\n2SD or Z score) not responding to \nstandard therapy  \n\u2022 Unexplained persistent diarrhoea (>14 \ndays)  \n\u2022 Unexplained persistent fever  \n\u2022 (Intermittent or constant, > 1 mo.)  \n\u2022 Oral candidiasis (outside neonatal \nperiod)  \n\u2022 Oral hairy Leucoplakia  \n\u2022 Pulmonary tuberculosis  \n\u2022 Severe recurrent presumed bacterial \npneumonia (>2 episodes/12 months)  \n\u2022 Acute necrotizing ulcerative gingivitis/  \n\u2022 periodontitis  \n\u2022 Lymphoid interstitial pneumonitis (LIP)  \n\u2022 Unexplained anaemia (<8g/dL), \nneutropenia (<1,000/mm3), or \nthrombocytopenia (<30,000/mm3) for \n>1 mo.  \n\u2022 HIV-related cardiomyopathy  \n\u2022 HIV-related nephropathy  Stage IV  \n\u2022 Unexplained severe wasting or severe malnutrition \n(-3 \nSD or Z score) not responding to standard \ntherapy  \n\u2022 Pneumocystis pneumonia  \n\u2022 Recurrent severe bacterial infections (>2 \nepisodes/12 months, excluding pneumonia)  \n\u2022 Chronic orolabial or cutaneous HSV (lasting > 1 \nmo.)  \n\u2022 Extra -pulmonary tuberculosis  \n\u2022 Kaposi\u2019s sarcoma  \n\u2022 Oesophageal candidiasis  \n\u2022 CNS toxoplasmosis  \n\u2022 Cryptococcal meningitis  \n\u2022 Any disseminated endemic mycosis  \n\u2022 Cryptosporidiosis or Isosporiasis (with \ndiarrhoea > 1 month)  \n\u2022 CMV infection of organ other than liver, spleen, \nlymph nodes (and onset age >1 month)  \n\u2022 Disseminated mycobacterial disease other \nthan tuberculosis  \n\u2022 Candida of trachea, bronchi or lungs  \n\u2022 Acquired recto -vesicular fistula  \n\u2022 Cerebral or B -cell non -Hodgkin\u2019s lymphoma  \n\u2022 Progressive multifocal leukoencephalopathy PML)  \n\u2022 HIV encephalopathy  \nNOTE: WHO Clinical Staging should be carried out only on children confirmed (by serology or DNA PCR) \nto be HIV infected", "start_char_idx": 3, "end_char_idx": 2389, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "19ce77c0-fe12-411c-a434-4c06e803d0b5": {"__data__": {"id_": "19ce77c0-fe12-411c-a434-4c06e803d0b5", "embedding": null, "metadata": {"page_label": "224", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6a57e285-19b1-414b-8357-e14ed5c050ee", "node_type": "4", "metadata": {"page_label": "224", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e18d6e387fbfdfd1af321ff944b40d469bb7b1124181cfd1f1bde37d0a08d730", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "014a1501-674f-4f40-8242-2bf83e2bcd70", "node_type": "1", "metadata": {"page_label": "223", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "21fb20bd2bb4ffc70c39bc3c21474c8256b787bc8e19c982e21f8d3a487943d2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ab31fc2a-bd94-43c8-86ac-f5bdcb5b4dbd", "node_type": "1", "metadata": {}, "hash": "a8ad966f60eaf6448ad4624c6a4ebf06b40769a892403d7099cadaff9fcd2b1a", "class_name": "RelatedNodeInfo"}}, "hash": "5706f134d25ad182d0bb59f22f6af17d20f6aa3ee504316400f7c6dc63d1e69e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 2 Annex 2: WHO Clinical Staging of HIV Infection in Adolescents and Adults  \nStage 1  \n\u2022 Asymptomatic  \n\u2022 Persistent Generalized  \nLymphadenopathy (PGL)  Stage 2  \n\u2022 Moderate unexplained weight loss (< 10% of presumed \nor measured body weight)  \n\u2022 Minor mucocutaneous manifestations (seborrheic \ndermatitis, papular pruritic eruptions, fungal nail \ninfections, recurrent oral ulcerations, angular cheilitis)  \n\u2022 Herpes zoster  \n\u2022 Recurrent upper respiratory tract infections (sinusitis, \ntonsillitis, bronchitis, otitis m edia, pharyngitis)  \nStage 3  \n\u2022 Unexplained severe weight loss \n(over  \n\u2022 10% of presumed or measured \nbody weight)  \n\u2022 Unexplained chronic diarrhoea for \nlonger than one month  \n\u2022 Unexplained persistent fever \n(intermittent or constant for longer \nthan one month)  \n\u2022 Persistent oral candidiasis  \n\u2022 Oral hairy leukoplakia  \n\u2022 Pulmonary tuberculosis  \n\u2022 Severe bacterial infections (e.g., \npneumonia, empyema, \npyomyositis, bone or joint \ninfection, meningitis, bacteraemia)  \n\u2022 Acute necrotizing ulcerative \nstomatitis, gingivitis or \nperiodontitis  \n\u2022 Unexplained anaemia (below 8 \ng/dl), neutropenia (below 0.5 x \n109/l) and/or chronic \nthrombocytopenia (below 50 x 109 \n/l) Stage 4  \nConditions where a presumptive diagnosis can be made \nusing clinical signs or simple investigations:  \n\u2022   HIV wastin g syndrome  \n\u2022   Pneumocystis jirovecipneumonia (PCP)  \n\u2022   Recurrent severe bacterial pneumonia (\u2265 2 episodes \nwithin 1 year)  \n\u2022   Cryptococcal meningitis  \n\u2022   Toxoplasmosis of the brain  \n\u2022   Chronic orolabial, genital or ano -rectal herpes simplex \ninfection for > 1 month  \n\u2022   Kaposi\u2019s sarcoma (KS)  \n\u2022   HIV encephalopathy  \n\u2022   Extra pulmonary tuberculosis (EPTB) Conditions \nwhere confirmatory diagnostic testing is  \nnecessary:  \n\u2022   Cryptosporidiosis, with diarrhoea > 1 month  \n\u2022   Isosporiasis  \n\u2022   Cryptococco sis (extra pulmonary)  \n\u2022   Disseminated non -tuberculous mycobacterial infection  \n\u2022   Cytomegalovirus (CMV) retinitis or infection of the \norgans (other than liver, spleen, or lymph nodes)  \n\u2022   Progressive multifocal leukoencephalopathy (PML)  \n\u2022   Any disseminated mycosis (e.g., histoplasmosis, \ncoccidiomycosis)  \n\u2022   Candidiasis of the esophagus or airways  \n\u2022   Non -typhoid salmonella (NTS) septicaemia  \n\u2022   Lymphoma cerebral or B cell Non -Hodgkin\u2019s Lymphoma  \n\u2022   Invasive cervical cancer  \n\u2022   Visceral leishmaniasis  \n\u2022   Symptomatic HIV -associated nephropathy or HIV  \nassociated cardiomyopathy", "start_char_idx": 3, "end_char_idx": 2531, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ab31fc2a-bd94-43c8-86ac-f5bdcb5b4dbd": {"__data__": {"id_": "ab31fc2a-bd94-43c8-86ac-f5bdcb5b4dbd", "embedding": null, "metadata": {"page_label": "225", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3c1dad65-e501-475c-96c7-30e5b6775c61", "node_type": "4", "metadata": {"page_label": "225", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "14dd24b6629a5a1b7fd885e03be9326797a7ec72ff1cfb4578aaea8f8e92c45e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "19ce77c0-fe12-411c-a434-4c06e803d0b5", "node_type": "1", "metadata": {"page_label": "224", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5706f134d25ad182d0bb59f22f6af17d20f6aa3ee504316400f7c6dc63d1e69e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1d4b6a2f-bd08-4f39-aa61-c3bb74e796cd", "node_type": "1", "metadata": {}, "hash": "098685bee6d0bc5c35d5a573357a5734d27a9b8790e3a5d98d0db035c7fd29dc", "class_name": "RelatedNodeInfo"}}, "hash": "a8ad966f60eaf6448ad4624c6a4ebf06b40769a892403d7099cadaff9fcd2b1a", "text": "Annexes  \n \n13 - 3 Annex 3: Normal Developmental Milestones in Children  \nAGE  GROSS MOTOR  FINE MOTOR  WARNING SIGNS  \n3 Months  Supine:  \n\u25cf Pull to sit:  \n\u25cf 45 o head lag still present  \nSitting: Propped up  \n\u25cf Flexed/C -Position  \n\u25cf Hold head steady  \nProne:  \n\u25cf Bears weight on flexed arms  \n\u25cf Lifts head 45 o turn head to side  Eyes:  \n\u25cf Follow through 90 o in lying  \nHands:  \n\u25cf Open for longer  \n\u25cf Shake a rattle when it is placed \nin the hand (not intentional)  \n\u25cf Mouthing begins  \u25cf No visual fixation or following \nasymmetry of tone or movement.", "start_char_idx": 3, "end_char_idx": 558, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1d4b6a2f-bd08-4f39-aa61-c3bb74e796cd": {"__data__": {"id_": "1d4b6a2f-bd08-4f39-aa61-c3bb74e796cd", "embedding": null, "metadata": {"page_label": "225", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3c1dad65-e501-475c-96c7-30e5b6775c61", "node_type": "4", "metadata": {"page_label": "225", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "14dd24b6629a5a1b7fd885e03be9326797a7ec72ff1cfb4578aaea8f8e92c45e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ab31fc2a-bd94-43c8-86ac-f5bdcb5b4dbd", "node_type": "1", "metadata": {"page_label": "225", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a8ad966f60eaf6448ad4624c6a4ebf06b40769a892403d7099cadaff9fcd2b1a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "af763257-5fec-4014-8c9b-a80892175e40", "node_type": "1", "metadata": {}, "hash": "e943ed1c292952af0884213d5b982c691ae71064c1252159e8ec4376761fa9f8", "class_name": "RelatedNodeInfo"}}, "hash": "098685bee6d0bc5c35d5a573357a5734d27a9b8790e3a5d98d0db035c7fd29dc", "text": "Annexes  \n \n13 - 3 Annex 3: Normal Developmental Milestones in Children  \nAGE  GROSS MOTOR  FINE MOTOR  WARNING SIGNS  \n3 Months  Supine:  \n\u25cf Pull to sit:  \n\u25cf 45 o head lag still present  \nSitting: Propped up  \n\u25cf Flexed/C -Position  \n\u25cf Hold head steady  \nProne:  \n\u25cf Bears weight on flexed arms  \n\u25cf Lifts head 45 o turn head to side  Eyes:  \n\u25cf Follow through 90 o in lying  \nHands:  \n\u25cf Open for longer  \n\u25cf Shake a rattle when it is placed \nin the hand (not intentional)  \n\u25cf Mouthing begins  \u25cf No visual fixation or following \nasymmetry of tone or movement.  \n\u25cf Floppy/stiff  \n\u25cf Consistent fisting  \n\u25cf Unstable to turn or lift head  \n\u25cf Failure to smile  \n\u25cf Poor sucking & swallowing  \n6 Months  \n Supine:  \n\u25cf Pull to sit, no more head lag  \n\u25cf Plays with feet  \n\u25cf Rolls from back to tummy  \nSitting:  \n\u25cf Unaided supported by arms  \nStanding:  \n\u25cf Bears weight on legs, equal both sides  \nProne:  \n\u25cf Props self on straight arms, legs \nextended, toes turned outwards  Eyes:  \n\u25cf Follow through 180 o in lying  \n\u25cf Focus on small objects  \nHands:  \n\u25cf Hands on midline  \n\u25cf Banging blocks against the table \nreaches and attains objects at \nwill Holds and actively plays \nwith rattle  \u25cf Floppiness  \n\u25cf No head control  \n\u25cf Failure to use both hands  \n\u25cf  Asymmetrical movement squint  \n\u25cf Failure to turn to sound  \n\u25cf Poor response to people  \n9 Months  Sitting:  \n\u25cf Sits without support lean forward  \n\u25cf And sit up again without losing balance  \nStanding:  \n\u25cf Remain standing for a few seconds by \nholding onto an object, falls down again  \nProne:  \n\u25cf Baby starts to crawl  Eyes:  \n\u25cf Extremely accurate vision  \nHands:  \n\u25cf Can pick up and button  \n\u25cf Holds a block in each hand  \n\u25cf Points  \u25cf Unable to sit  \n\u25cf Failure to use both hands  \n\u25cf Fisting  \n\u25cf Squint  \n\u25cf Persistence of primitive reflexes  \n12 Months  \n Sitting:  \n\u25cf Turns around to reach nearby toys  \n\u25cf Sits down unaided from standing  \nStanding: (Walking)  \n\u25cf Walks forward if held by one hand  \n\u25cf Walks around furniture sideways -cruising  \nProne: (crawling)  \n\u25cf Crawls  \n\u25cf Pulls up to standing by holding onto object  Eyes:  \n\u25cf Looks for toys when out of sight  \nHands:  \n\u25cf Able to pick up a button with thumb and \nindex finger (pincer grasp)  \n\u25cf Release on request  \n\u25cf Hold with 1 hand and play with the other  \n\u25cf Throws things into a container and take \nit out again  \u25cf Unable to bear \nweight on legs  \n\u25cf Not yet crawling and \npulling to stand  \n\u25cf Abnormal grasp  \n\u25cf Failure to  respond to \nsound  \n\u25cf Unable to start with \nsolids independently  \n15 Months  \n Sitting:  \n\u25cf Stand up from sitting  \n\u25cf Will climb on a chair and sit down  \nStanding: (Walking)  \n\u25cf Bend over to pick up an object  \n\u25cf Squat and stand up again  \n\u25cf Walks alone, broad base with arms in the airs  \nProne: (crawling)  \n\u25cf Able to crawl fast and manage obstacles e.g., stairs  Eyes:  \n\u25cf Hold crayon in a fist when \nscribbling  \n\u25cf Turn pages of a book roughly  \n\u25cf Hold 2 small toys in 1 hand  \n\u25cf Put lid back on container  \u25cf Unable to bear \nweight on legs  \n\u25cf Not yet wal king  \n\u25cf Abnormal grasp  \n\u25cf Abnormal posture: \nfloppy/spastic  \n\u25cf Failure to respond to \nsound  \n\u25cf Not yet talking  \n18 Months  \u25cf Walking with more confidence  \n\u25cf Walk, squat and pick up something, \nstand up and walk again  \n\u25cf Starts running, often falls  \n\u25cf Take few steps backwards  \n\u25cf Runs and change direction easily  \n\u25cf Jump off step with 2 feet together  \n\u25cf Stand and kick a ball  \n\u25cf Able to throw a ball  \u25cf Build a 3 -cube tower  \n\u25cf Scribbles  \n\u25cf Holds the crayon in a fist  \n\u25cf Turn pages of a book  \n\u25cf Page through a book page by page  \n\u25cf Obvious hand preference  \n\u25cf Uses lines: I, _,0  \n\u25cf Completes 3 -piece puzzle  \n\u25cf Remove a sweet wrapper with little help  \u25cf Failure to walk  \n\u25cf Unable to pick up small \nobjects e.g., buttons  \n\u25cf Abnormal posture  \n\u25cf Not yet talking  \n\u25cf Unable to understand \nsimple commands  \n\u25cf Poor co -ordination  \n36 Months  \u25cf Walk forward and backward  \n\u25cf Walks on tip toes  \n\u25cf Walks on straight line  \n\u25cf Jump 2 feet together  \n\u25cf Able to climb on chair  \n\u25cf Catch a big ball (hugging against chest)  \n\u25cf Holds ball above head and throws  \n\u25cf Runs and kicks ball  \u25cf Copies the following shapes: _, I, O, T \n\u25cf Start coloring in, go over the lines  \n\u25cf Pencil grip:  \n\u25cf Holding crayon to draw (still developing)  \n\u25cf Builds a 9 -block tower  \n\u25cf Thread big beads on a shoelace  \n\u25cf Draw a man: at least 4 parts  \u25cf Using only single \nwords  \n\u25cf Ataxia", "start_char_idx": 3, "end_char_idx": 4367, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "af763257-5fec-4014-8c9b-a80892175e40": {"__data__": {"id_": "af763257-5fec-4014-8c9b-a80892175e40", "embedding": null, "metadata": {"page_label": "226", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "0ec61cb8-61c7-4189-8c7b-be6e17704bc4", "node_type": "4", "metadata": {"page_label": "226", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": 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"e943ed1c292952af0884213d5b982c691ae71064c1252159e8ec4376761fa9f8", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 4 Annex 4: Tanner Staging of Sexual Maturity in Adolescents  Annex 4 A: Tanner Staging of Sexual Maturity in Girls  \nAge Range  \n(Year)  \n0-15 \n8-15 \n10-15 \n10-17 \n12-18 Tanner Staging in  \n Annex 4 B: Tanner Staging of Sexual Maturity in Boys  \nAge Range  \n(Year)  \n0-15 \n \n10-15 \n \n10-16 \n \nVariable  \n(12-17) \n13-18 Tanner Staging in", "start_char_idx": 3, "end_char_idx": 401, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "29367970-b337-4a17-8c7e-c05e15d8e658": {"__data__": {"id_": "29367970-b337-4a17-8c7e-c05e15d8e658", "embedding": null, "metadata": {"page_label": "227", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c6951f8c-ae64-4c15-8857-8999e810ff02", "node_type": "4", "metadata": {"page_label": "227", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "54f2c4e32eaad296c40d2ef3fa247a6d9bd11848fd28375e0262fa1146884970", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "af763257-5fec-4014-8c9b-a80892175e40", "node_type": "1", "metadata": {"page_label": "226", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "e943ed1c292952af0884213d5b982c691ae71064c1252159e8ec4376761fa9f8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3a3e49ed-3095-4efd-bcdb-faeb0a49fe30", "node_type": "1", "metadata": {}, "hash": "d653935d49f9fe1dec8e708f623e6176c440871f3ba96b06fe8ba26300ed3151", "class_name": "RelatedNodeInfo"}}, "hash": "62cde1b7c7937f5fe00af3b611bdd90d3c752dbaf9ea4b3c30ccf241acc52ed7", "text": "Annexes  \n \n13 - 5 Annex 5: Age -Appropriate Disclosure for Children and Adolescents  \nAge \nCharacteristics  Stage of \nDisclosure  Provider Actions  \n0 - 4 years  No disclosure  At this stage no disclosure is done since the child is too young \nto understand about HIV  \n5 - 8 years  Partial disclosure  At this age the child can understand a lot. Define the virus as a \ngerm and the CD4 as the soldier in the body that keeps fighting \nand one has to take the drugs to strengthen the soldiers in the \nbody  \n9 to 12 years  Full disclosure  Full disclosure is important since most children at this stage \nare able to understand more about HIV and would have heard \nabout HIV as part of formal education at school  \nFollow the following stages in the disclosure process  \nStage 1  \nAssessing the child\u2019s social support system to ensure \navailability of sufficient support once disclosure is completed  \nStage 2  \nAssess the child\u2019s prior knowledge about HIV including \ninformation given at school, any myths and misconceptions. \nOffer or reinforce accurate information  \nStage 3  \nUse an imaginary exercise or story to assess child\u2019s reaction to \ndisclosure of HIV status  \nStage 4  \nTell the child about their HIV status. Support parents to \ndisclose to the child and clarify the mode of infect ion. Address \nimmediate reactions and concerns a child might have  \nPost -disclosure  \n(1-2 weeks after \nfull disclosure)  Find out from the parent/guardian if they have observed \nanything after disclosure, e.g., change in behavior  \n\u2022 Introduce the child to tell their story and emerge as a hero \n(a comic book may be a useful aid)  \n\u2022 Link the child to a support group or with an older child \nwho has been disclosed to  \nNB: Find out how the child is doing at every visit after full \ndisclosure", "start_char_idx": 3, "end_char_idx": 1792, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3a3e49ed-3095-4efd-bcdb-faeb0a49fe30": {"__data__": {"id_": "3a3e49ed-3095-4efd-bcdb-faeb0a49fe30", "embedding": null, "metadata": {"page_label": "228", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "fae8e66a-fae0-4139-a4cd-15c6c545f882", "node_type": "4", "metadata": {"page_label": "228", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "75df07324fc0e4924cc83aa08f0ebd2729a40114a3b9c37544eb39b57b0e6896", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "29367970-b337-4a17-8c7e-c05e15d8e658", "node_type": "1", "metadata": {"page_label": "227", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "62cde1b7c7937f5fe00af3b611bdd90d3c752dbaf9ea4b3c30ccf241acc52ed7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9586ea7f-be37-41fa-9207-e7dbfab52e77", "node_type": "1", "metadata": {}, "hash": "7feec4f352552e58e5a3111425e046d16fa41bb984de024815064058dcb19071", "class_name": "RelatedNodeInfo"}}, "hash": "d653935d49f9fe1dec8e708f623e6176c440871f3ba96b06fe8ba26300ed3151", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 6 Annex 6: Transitioning from Adolescent to Adult HIV Services  \nInitiate transition process for all children in \npaediatric clinic who have attained 10 years of ageGoal 1 : for age 10 -12 years (early -adolescence)\n\u2022  Full disclosure\n\u2022  Understanding of the HIV\n\u2022  Understanding of HIV prevention measures\n\u2022  Link to an adolescent support group Has adolescent attained 13years and achieved Goal 1 \nabove?\nYes: Client is 13years and has achieved \ngoals at early adolescence continue to \ngoal 2No: Client is 13years and has \nnot achieved goals 1 at early \nadolescence\nGoal 2 : for age 13 -16 years (mid -adolescence)\n\u2022  Understanding of the medication and adherence\n\u2022  Encourage appointment keeping\n\u2022  Should be a member of a support group\nHas adolescent attained 17years and achieved Goal 2 above?No: Client is 17 years and has not \nachieved goals at mid adolescence\nYes: Client is 17 years and has achieved goals at mid adolescence\nGoal 3 : for age 17 -19 years (late -adolescence)\n\u2022 Demonstrated understanding importance of medication adherence in last 2 -3 visits\n\u2022 Prompt appointment keeping for 6months\nHas adolescent attained 19years and achieved Goal 3 above?\n Client chooses to transition\n Transfer medical records\n Orient adolescent in adult clinic\n Follow up of transitioned adolescentsClient declines to transition\n Continue psychosocial support to client as you prepare for transition to \nadult clinic", "start_char_idx": 3, "end_char_idx": 1478, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9586ea7f-be37-41fa-9207-e7dbfab52e77": {"__data__": {"id_": "9586ea7f-be37-41fa-9207-e7dbfab52e77", "embedding": null, "metadata": {"page_label": "229", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f2e9f73b-1c42-44ea-bdd1-41262b6ba5ab", "node_type": "4", "metadata": {"page_label": "229", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "06d63cf5224282a9312e5038202e9c9c8002b4268fdbba0b3bf138bad5b54c8d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3a3e49ed-3095-4efd-bcdb-faeb0a49fe30", "node_type": "1", "metadata": {"page_label": "228", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d653935d49f9fe1dec8e708f623e6176c440871f3ba96b06fe8ba26300ed3151", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "0ad1ef1f-9db9-487b-82cd-b103d64b7914", "node_type": "1", "metadata": {}, "hash": "92ee4ed0f95962270b865d909ab90a141655741e6b14a112050ff3c08ef4be39", "class_name": "RelatedNodeInfo"}}, "hash": "7feec4f352552e58e5a3111425e046d16fa41bb984de024815064058dcb19071", "text": "Annexes  \n \n13 - 7 Annex 7: 2018 HIV Testing Services Algorithm  \nSCREENING\nNON REACTIVE REACTIVE\nREPORT NEGATIVE CONFIRMATORY TEST\nNON REACTIVE REACTIVE\nINCONCLUSIVE REPORT POSITIVE\nREFER TO THE COMPREHENSIVE CARE CLINIC\nSCREENING TEST SCREENING TEST\nNON REACTIVE REACTIVE NON REACTIVE\nCONFIRMATORY TEST\nNON REACTIVE REACTIVE\nREPORT INCONCLUSIVE REPORT POSITIVECollect DBS and \nsend to laboratory \nfor DNA PCRINCONCLUSIVE\nRequest for retest \nafter 2 weeks at \nCCC\nIf the result is still \ninconclusive, \ncollect DBS and \nsend to the \nlaboratory for DNA \nPCREnroll to care and \ntreatment \nNB:  The use of TIE BREAKER is no longer recommendedRetesting in MCH, wards or \nsettings without CCCs: To be \ndone by a different service \nprovider on a second \nspecimen\nREPORT NEGATIVE", "start_char_idx": 3, "end_char_idx": 776, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "0ad1ef1f-9db9-487b-82cd-b103d64b7914": {"__data__": {"id_": "0ad1ef1f-9db9-487b-82cd-b103d64b7914", "embedding": null, "metadata": {"page_label": "230", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "bfa5f3f2-c32f-42a6-bbd3-2a881c64fb05", "node_type": "4", "metadata": {"page_label": "230", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c5d7aa24ecd61fd341dc91d5c1aeb98180b186572769300e97d45f2439c521e7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9586ea7f-be37-41fa-9207-e7dbfab52e77", "node_type": "1", "metadata": {"page_label": "229", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7feec4f352552e58e5a3111425e046d16fa41bb984de024815064058dcb19071", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "77a99d11-95e6-435b-8a4b-589b328cf838", "node_type": "1", "metadata": {}, "hash": "37e12f7acf592266d3d8619e346179fe9663a1d0de407c7310ee0b4f23018191", "class_name": "RelatedNodeInfo"}}, "hash": "92ee4ed0f95962270b865d909ab90a141655741e6b14a112050ff3c08ef4be39", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 8 Annex 8: HIV Education and Adherence Counselling Content Guide  \nHIV Education and Adherence Counselling  \nNote: for children/adolescents, the script below should be modified towards the caregiver  \nSection 1: Introductions, climate setting, and review of objectives for the session  \n\u2022 Ensure privacy and confidentiality  \n\u2022 Introductions of all pa rticipants  \n\u2022 Present the key message for each section using simple terms that the patient will understand, \nusing analogies as appropriate  \n\u2022 Use IEC material when available  \n\u2022 Ask the patient if they have any questions at the end of each section, and then ask them to explain the \nmain points back to you to confirm understanding  \n\u2022 If this is a follow -up session, review what they remember from previous sessions and adapt the \nsession  to address their needs  \nSection 2: HIV  \n\u2022 What is HIV  \n\u2212 HIV stands for \u201cHuman Immunodeficiency Virus\u201d  \n\u2212 HIV is a virus that attacks the body\u2019s immune system.  The immune system protects the \nbody from infections  \n\u2022 How is HIV transmitted  \n\u2212 Sexual contact  \n\u2212 Needles  \n\u2212 Exchange of blood and bodily fluids  \n\u2212 Mother -to-child transmission  \n\u2022 Why should family members be tested for HIV  \n\u2212 Sexual partners are at risk for already having HIV  \n\u2212 All children born to HIV positive mothers are at risk for already having HIV  \n\u2212 Encouraging partners/children to test for HIV now is the best way to identify HIV early, so \nthey can also get into treatment  \n\u2212 Starting treatment early will help them live long and productive lives  \n\u2212 Whether they test positive or negative, they can be an impor tant source of support for your \nown treatment", "start_char_idx": 3, "end_char_idx": 1712, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "77a99d11-95e6-435b-8a4b-589b328cf838": {"__data__": {"id_": "77a99d11-95e6-435b-8a4b-589b328cf838", "embedding": null, "metadata": {"page_label": "231", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "808c4d22-eb60-41ec-9f7a-af3db02937d1", "node_type": "4", "metadata": {"page_label": "231", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f7059d649717732b53ba6895e393d286cbd49aba9173aeb8aa33af2cc807544b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "0ad1ef1f-9db9-487b-82cd-b103d64b7914", "node_type": "1", "metadata": {"page_label": "230", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "92ee4ed0f95962270b865d909ab90a141655741e6b14a112050ff3c08ef4be39", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "764a4ae8-552f-4363-a1da-cbf79be6724b", "node_type": "1", "metadata": {}, "hash": "a38425b3d142efa5d2258219785cd051d2044037709f2dc35d0daf0b7e50d146", "class_name": "RelatedNodeInfo"}}, "hash": "37e12f7acf592266d3d8619e346179fe9663a1d0de407c7310ee0b4f23018191", "text": "Annexes  \n \n13 - 9 Annex 8: Cont.  \nSection 3: Viral load  \n\u2022 What is viral load  \n- Viral load is the amount of HIV in your body  \n- When your viral load is high it means you have a lot of HIV in your body; this causes damage to \nyour body  \n- Viral load is measured by a blood test  \n \n\u2022 How often is viral load measured  \n- Viral load is measured after being on treatment for 3 months  \n- After 3 months of treatment, we expect the amount of virus in your body to be undetectable; if \nyour VL is detectable then we have to discuss the reasons  \n- Having an \u201cundetectable\u201d VL means the test cannot measure the virus in your blood because \nyour ART is working, but it does not mean you are no longer infected with HIV  \n- Repeat viral load tests are done dependin g on how you are doing; if you are doing well on \ntreatment then the viral load is measured again every 6 months (for children/adolescents and \npregnant/breastfeeding) or annually  \n- For HEI with positive PCR, we also measure viral load at the start of treatmen t \n \n\u2022 What do viral load measurements mean  \n- After being on treatment for 3 or more months, your viral load should be undetectable  \n- If your viral load is undetectable, it means your treatment is working well and you should \ncontinue taking it the same; the virus is not damaging your body any more  \n- If your viral load is detectable, it means your treatment is not working properly, usually because \nyou have been missing some of your pills; the virus is damaging your body and you and the clinic \nteam will need to work together to figure out how to fix the problem  \nSection 4: CD4 cells  \n\u2022 What are CD4 cells  \n- CD4 cells are the immune cells that protect the body from infections  \n- CD4 cells are measured through a blood test, called CD4 count. For adults a normal CD4 count is \nabove 500  \n \n\u2022 How are CD4 cells affected by HIV  \n- HIV attacks and destroys CD4 cells  \n- After years of constant attack from HIV, the CD4 count falls  \n \n\u2022 What happens when CD4 cells decrease  \n- When the CD4 count falls too low (usually below 200), diseases called \u201copportunistic infections\u201d \nare able to infect the body because the body cannot defend itself  \n- Common opportunistic infections include: tuberculosis, pneumonia, skin problems, white spots \nin the mouth, and chronic diarrhoea  \n \n\u2022 How often is CD4 count measured  \n- CD4 count is measured for all patients at the beginning of treatment, to see if you are likely to get \nany opportunistic infections  \n- Once you start treatment for HIV, we do not need to check CD4 count frequently, but we will use \nthe VL tes t to monitor your response to anti -retroviral treatment", "start_char_idx": 3, "end_char_idx": 2667, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "764a4ae8-552f-4363-a1da-cbf79be6724b": {"__data__": {"id_": "764a4ae8-552f-4363-a1da-cbf79be6724b", "embedding": null, "metadata": {"page_label": "232", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "be93cbec-107c-4d8c-aff0-91336282f9ab", "node_type": "4", "metadata": {"page_label": "232", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fcd0a2944df836e2e1ba7940e0fbb712687044723946356a976825cd94507fea", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "77a99d11-95e6-435b-8a4b-589b328cf838", "node_type": "1", "metadata": {"page_label": "231", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "37e12f7acf592266d3d8619e346179fe9663a1d0de407c7310ee0b4f23018191", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f6122c52-3f01-4d61-9eef-816dd7522f43", "node_type": "1", "metadata": {}, "hash": "28a14f6e847a13f0295eef02ba40b964f7c86120f93ee0f42e5b97e71be4c349", "class_name": "RelatedNodeInfo"}}, "hash": "a38425b3d142efa5d2258219785cd051d2044037709f2dc35d0daf0b7e50d146", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 10 Annex 8: Cont.  \nSection 5: Antiretroviral therapy (ART)  \n\u2022 What is ART:  \n- ART is a combination of 3 or more different medicines  \n- ART fights HIV, lowering the amount of virus in the body allowing the body to protect \nitself against opportunistic infections  \n- When the virus level is low then the CD4 count can increase  \n- Increased CD4 count means the body is able to protect itself against opportunistic infections  \n \n\u2022 What are the benefits of ART:  \n- After a few weeks of taking ART, you will begin to regain appetite and weight (if it has been \naffected)  \n- Many people report an increase in their energy levels and general sense of well being  \n- People can often return to work or school or care for their families  \n- With ART,  people with HIV can live a long and healthy life if they take it properly  \n \n\u2022 When is ART started:  \n- Everybody with HIV should start ART  \n- Even if your CD4 count is high, the virus is doing damage inside of you and needs to be \ncontrolled  \n- ART should be started as soon as you are ready, preferably within 2 weeks  \n- The longer you wait to start ART, the more time the virus can damage your body, increasing \nyour chances of getting sick or even dying  \n- Sometimes ART is started a few weeks later if you have certain infections, or if you do not \nthink you are ready to take them properly  \n \n\u2022 Does ART cure HIV:  \n- ART does not cure HIV  \n- ART lowers the amount of virus in your body so your body can protect itself from infections  \n- It does not remove the virus completely  \n \n\u2022 Can you still give HIV to others while taking ART:  \n- Transmission of HIV is very unlikely once your viral load is undetectable  \n- You should practice safer sex to reduce the risk for other infections as well, including \ndisclosure of HIV status to sexual partners and consistent and correct condom use  \n \n\u2022 How long is ART taken for:  \n- ART is a life -long treatment  \n- Once you start ART, you need to take it every day for the rest of your life (either once a day, \nor twice a day, depending on which drugs you are on)  \n- You must take the ART as prescribed and never miss a dose otherwise the treatment might \nfail and the drugs stop working against the virus", "start_char_idx": 3, "end_char_idx": 2282, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f6122c52-3f01-4d61-9eef-816dd7522f43": {"__data__": {"id_": "f6122c52-3f01-4d61-9eef-816dd7522f43", "embedding": null, "metadata": {"page_label": "233", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ab6d50a1-718b-4228-b83c-0f3ab9537d0f", "node_type": "4", "metadata": {"page_label": "233", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2526d7daa2aa227acedac2b3bc1c17c5d90cd26a6a223e9dccc26a13b3301031", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "764a4ae8-552f-4363-a1da-cbf79be6724b", "node_type": "1", "metadata": {"page_label": "232", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a38425b3d142efa5d2258219785cd051d2044037709f2dc35d0daf0b7e50d146", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "0b19dd1c-6836-42c1-9f84-437eee006960", "node_type": "1", "metadata": {}, "hash": "5a4ab1ad3c7c8aa999cb9cea09b34aa3e2624bc0ce15a145c4b182c538517bfe", "class_name": "RelatedNodeInfo"}}, "hash": "28a14f6e847a13f0295eef02ba40b964f7c86120f93ee0f42e5b97e71be4c349", "text": "Annexes  \n \n13 - 11 Annex 8: Cont.  \nSection 6: Treatment failure  \n\u2022 What happens if you stop taking ART:  \n- When you stop taking ART the virus begins to increase in your body very quickly  \n- The virus goes back to the same high level it was at before you started ART  \n\u2022 What happens if you do not take ART regularly:  \n- The virus begins to increase to high levels again  \n\u2022 What happens if t he viral load increases:  \n- When the virus is allowed to increase again, it will also affect your immunity and reduce your CD4 count \nputting you at risk of opportunistic infections  \n- When the virus is allowed to increase again, it can change and get stronger, a nd becomes resistance to \nthe ART  \n- When the virus becomes resistant, the ART does not work against the virus anymore  \n- The risk of resistance increases by not taking the ART correctly and by starting and stopping the \nmedications several times  \n- When resistance o ccurs, this is called treatment failure  \n\u2022 What happens in treatment failure:  \n- The ART no longer works because the virus has become resistant to it  \n- If treatment fails, it is necessary to use stronger, more expensive ART, but it still may not work as well  \n- With the stronger ART you may need to take more pills every day, and you may have more side effects  \n- If you become resistant to the new ART as well, then there may not be any drugs that can work for you, \nand the virus will increase quickly and your CD4 coun t will go way down  \n- It is essential that you take your ART every day as prescribed so that you do not develop treatment \nfailure, and can live a long and healthy life  \nSection 7: ART side effects  \n\u2022 What are the side -effects of ART:  \n- Sometimes people can get side effects from taking ART  \n- Side effects vary from person to person  \n- Some people have none while other experience mild effects which are unpleasant but often manageable  \n- Most side effects occur within the first few weeks of starting ART and then improve aft er a few weeks or \nmonths  \n- Some common side effects include:  \n\u25cf Headache  \n\u25cf Loss of appetite  \n\u25cf Skin rash  \n\u25cf Fatigue  \n\u25cf Nausea, vomiting, diarrhoea  \n\u25cf Muscle pains  \n\u2022 What do you do if you notice any side effects:  \n- If you develop any side effects, you should continue taking your ART as prescribed, without missing any \ndoses, until you discuss with the clinician  \n- If the side effects are mild then you can continue taking your ART without missing any doses, and then \ndiscuss the side effects with the clinician at your next appointment  \n- If the side effects are bothering you too much then return to the clinic immediately, even if you do not \nhave a scheduled appointment, to discuss what to do next; you can also call the clinic if you are not able \nto make it yourself immediately  \n- Severe side effects include rash all over your body, or rash in your mouth or eyes, constant vomiting, \ninability to eat or retain food, or anything else that makes you think you should stop the ART. If this \noccurs then contact the clinic immediately  \n- The cl inician will help you manage the side effects, and occasionally the ART may need to be changed", "start_char_idx": 3, "end_char_idx": 3169, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "0b19dd1c-6836-42c1-9f84-437eee006960": {"__data__": {"id_": "0b19dd1c-6836-42c1-9f84-437eee006960", "embedding": null, "metadata": {"page_label": "234", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ac8539c0-8beb-470a-93de-20ca9f881bb1", "node_type": "4", "metadata": {"page_label": "234", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c66a37bf0df95acc5a72f4987c057ef4f66a98952d912554b254d70fbce50c49", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f6122c52-3f01-4d61-9eef-816dd7522f43", "node_type": "1", "metadata": {"page_label": "233", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "28a14f6e847a13f0295eef02ba40b964f7c86120f93ee0f42e5b97e71be4c349", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "18e8ad3c-6d14-44e2-b4e7-fd77694b991c", "node_type": "1", "metadata": {}, "hash": "1a87df9f82cc7423aa1cc7d005d8b4348c6b7575189c6e685e60522e055b7994", "class_name": "RelatedNodeInfo"}}, "hash": "5a4ab1ad3c7c8aa999cb9cea09b34aa3e2624bc0ce15a145c4b182c538517bfe", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 12 Annex 8: Cont.  \nSection 8: Adherence  \n\u2022 What is adherence  \n- Following a care plan as agreed with the healthcare team  \n- Attending clinic appointments as scheduled  \n- Picking up medicines and taking them as prescribed  \n- Getting lab tests according to the recommended schedule  \n- Following nutritional recommendations  \n\u2022 How should ART be taken  \n- You must take the correct dosage. If you take less than the dose prescribed the treatment will \nnot be effective and will result in resistance and treatment failure. Never share your ART with \nsomeone else  \n- For children, the dosage keeps changing as they grow and gain weight  \n- You must take ART the correct time of day:  \n\u2022 If your ART is supposed to be taken once per day, then pick a time when it will usually be \nconvenient for you to remember, e.g., with breakfast every day.  \n\u2022 If your ART is supposed to be taken twice per day, then you should set a convenient time to \ntake your dr ugs approximately 12 hours apart (e.g., 8.00 am and 8.00 pm every day). It \ndoes not have to be exactly 12 hours apart if your schedule does not allow; the most \nimportant thing is to take them twice per day every day (e.g., you can take it at 6.00 am and \n8.00 pm every day)  \n- If you miss a dose of ART then take your dose as soon as you remember, as long as it is not \nwithin a couple of hours of your next dose, and then return to your regular schedule. Do not \ntake a double -dose of ART to make up for a missed dose  \n- You must take ART according to dietary restrictions. Some ART should be taken with food, for \nsome it does not matter, and a few require that you have an empty stomach. These dietary \nrestrictions will be explained to you once your ART regimen is  selected  \n- It is essential to take ART as prescribed and not miss any doses  \n- Some medications (prescription, non -prescription, and herbal) interact with ART and make \nthem ineffective. Be sure to tell your clinician and pharmacist the names of all the medicat ions \n(including traditional/herbal) that you are taking, and any time you are given new medications. \nAvoid use of alcohol  \n\u2022 What usually interferes with good adherence (can apply to the patient or to the caregiver)  \n- Stigma: it is hard to take ART correctly if you need to hide it because you are worried about \npeople finding out you have HIV  \n- Disclosure: it is hard to take ART correctly if the people closest to you, particularly family \nmembers and close friends, do not know you have HIV  \n- Change in rout ine: if your daily routine suddenly changes it may be difficult to remember to \ntake your ART at the usual time  \n- Travel: frequent travel, or unexpected travel (such as for a funeral) may interfere with taking \nART, particularly if you do not have enough drugs  with you for the entire trip  \n- Alcohol and drug use: it is hard to remember to take ART when under the influence of alcohol \nor other drugs  \n- Caregiver changes: every time a child has a new caregiver, that person needs to learn about \nhow and why ART is taken  \n- Side effects: when people get side effects from ART they sometimes stop or reduce the amount \nof ART they are taking, hoping it will reduce the side effects  \n- Pill burden/palatability: sometime the number of pills (or taste of syrups for children) makes it \ndifficult to take ART correctly", "start_char_idx": 3, "end_char_idx": 3406, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "18e8ad3c-6d14-44e2-b4e7-fd77694b991c": {"__data__": {"id_": "18e8ad3c-6d14-44e2-b4e7-fd77694b991c", "embedding": null, "metadata": {"page_label": "235", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e18ee2b2-2807-464f-8bdc-ac3fe7d173ce", "node_type": "4", "metadata": {"page_label": "235", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "334b8588a64e3b47d6ff210eb1228d1d11f5c12345df0aac8c63a0c1790aa26e", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "0b19dd1c-6836-42c1-9f84-437eee006960", "node_type": "1", "metadata": {"page_label": "234", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5a4ab1ad3c7c8aa999cb9cea09b34aa3e2624bc0ce15a145c4b182c538517bfe", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "faa8c925-1e7d-42c4-8f4c-0b0f964f1a2c", "node_type": "1", "metadata": {}, "hash": "dbcbcaff47054c04dca63410f9dceed8cc9a4c45a6ee850505af1efafe6ab9df", "class_name": "RelatedNodeInfo"}}, "hash": "1a87df9f82cc7423aa1cc7d005d8b4348c6b7575189c6e685e60522e055b7994", "text": "Annexes  \n \n13 - 13 Annex 8: Cont.  \n- Distance: choosing an HIV clinic that is far away from your home can make it difficult to come to \nappointments and pick drugs regularly  \n- HIV knowledge: when people do not understand what HIV is, and why ART is important, they \nmay not take their drugs properly. This also applies to children and adolescents, if they have \nnot been told they have HIV and taught what it means  \n- Mental health disorders: depression and other mental illnesses can make it difficult to t ake ART \ncorrectly  \n- Religious beliefs: some people stop taking ART after faith -healing, although there has never \nbeen a case of someone being cured of HIV this way  \n\u2022 What might make it difficult for you individually to take your ART as prescribed  \n- Ask the patie nt: \u201cBased on what you have learned so far, what challenges do you think you will \nhave taken  ART correctly, every day, for the rest of your life?\u201d  \n- Discuss strategies to manage any expected barriers to adherence  \n\u2022 What can help you take ART as prescribed  \n- Disclosure: It is easier to take your ART properly when the people close to you know your HIV \nstatus, so you do not have to try and hide your ART or miss doses to avoid being seen. Family \nand friends can also provide additional support once they  are aware you have HIV and \nunderstand more about it. We can help you disclose your HIV status to important family \nmembers or friends when you are ready  \n- Treatment supporter: Having a \u201ctreatment buddy\u201d can help you take your ART correctly; ask a \nfriend, par tner, or family member to remind you to take your ART. If possible, invite that \nperson with you to some of your clinic appointments and counselling sessions so they can learn \nabout ART, the importance of good adherence, side effects, etc.  \n- SMS reminder syst em (if SMS reminder system in place at the facility): Receiving a regular SMS, \ne.g., every week, can help you take your ART correctly. We enroll all our patients into this \nservice for SMS reminders at our clinic, unless you do not want to receive them. The  messages \nsimply ask how you are doing, and do not mention HIV, ART, the clinic, or anything else that \nmay reveal your HIV status to others  \n- Support group: Joining a support group will help you learn from other people how they \novercome challenges in living with HIV and taking ART correctly. Some support groups also \nhave economic activities to help increase your income. We have support groups based at the \nhealth facility, and there are also support groups in the community  \n- Other reminders:  \n- Set a specific time of day to take your ART  \n- Associate your ART with a specific event/s in your daily schedule (e.g., when you eat \nbreakfast and dinner)  \n- Set an alarm on your phone or watch  \n\u2022 What happens if you miss an appointment?  \n\u2022 The healthcare team will be concerned about you, and will try to contact you by phone  \n- Confirm patient phone number and consent to call if misses an appointment or any urgent \nlab results  \n\u2022 If we cannot contact you by phone, we will try to call your treatment buddy  \n- Confirm treatment buddy name and phone number, and consent to call if needed  \n\u2022 If we cannot reach you or your treatment buddy, we may try and visit you at home, if we have \nyour permission  \n- Confirm locator information and consent to perform home visits if needed  \n\u2022 Once you are back in care, we will work with you to figure out what caused you to miss an \nappointment and how it can be prevented in the future  \n\u2022 You will not be punished for missing an appointment", "start_char_idx": 3, "end_char_idx": 3590, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "faa8c925-1e7d-42c4-8f4c-0b0f964f1a2c": {"__data__": {"id_": "faa8c925-1e7d-42c4-8f4c-0b0f964f1a2c", "embedding": null, "metadata": {"page_label": "236", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "3d78c3d0-e312-4991-b558-706c4eb4fafd", "node_type": "4", "metadata": {"page_label": "236", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d2de4be937b1d519f86a8d889e5496ffea3d287f09546028031a297ebae96207", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "18e8ad3c-6d14-44e2-b4e7-fd77694b991c", "node_type": "1", "metadata": {"page_label": "235", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1a87df9f82cc7423aa1cc7d005d8b4348c6b7575189c6e685e60522e055b7994", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f7a4ff0c-fd7b-4c3d-b051-e9582889d5aa", "node_type": "1", "metadata": {}, "hash": "11f86e59a067dd150bd190e27e07eb1d16e51fa42e79a140e7eb342c32293135", "class_name": "RelatedNodeInfo"}}, "hash": "dbcbcaff47054c04dca63410f9dceed8cc9a4c45a6ee850505af1efafe6ab9df", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 14 Annex 8: Cont.  \nSection 9: Other medications  \n\u2022 What other medications will you take, in addition to ART:  \n- CPT: all PLHIV should take cotrimoxazole preventive therapy once per day, in order to reduce \nthe chance of getting other infections such as pneumonia, malaria, and diarrhoea  \n- TPT: all PLHIV should receive 6 months of isoniazid preventive therapy (or another \napproved TPT regimen), unless they have active TB disease, in order to prevent \ndevelopment of TB  \n\u2022 Other medications may be recommended for specific conditions  \nSection 10: Nutrition  \n\u2022 Why is nutrition important:  \n- When the viral load is high, your body uses a lot of energy trying to fight the virus  \n- If your nutrition is poor, you have more chance of getting other infections as well  \n- You need to eat well so your body has everything it needs to fight HIV, and look healthy  \n\u2022 What can you do to improve your nutrition?  \n- Eat a balanced diet from a variety of foods.  \n- Try not to eat a lot of sugar, red meat, or fatty/fried foods  \n- Try to eat plenty of whole grains, vegetables, fruit, beans, and fish  \n- Drink plenty of clean safe water  \n- Physical activity and exercise is encouraged.  \nSection 11: Follow -up \n\u2022 How often will you need to come to the clinic  \n- Before starting ART: you should come to the clinic at least every week in order to get you prepared \nfor ART so you can start as soon as possible  \n- Soon after starting ART: after you start ART you should come to the clinic in 2 weeks in order to \nsee if you have had any trouble taking your pills or have developed any side effects; then you can \nbe seen after another two weeks for the same; then every month until your first viral load test  \n- Once you have been on ART for a while: if your first viral load (after 3 months) is undetectable \nthen you can be seen every 1 -6 months depending on other factors  that will be discussed with the \nclinician  \n- Unscheduled visits: if you ever have any concerns, feel unwell, or need to speak with any of the \nclinic team then you can call or come to the clinic, even if you do not have an appointment \nscheduled for that day  \n\u2022 What will we be checking for during your clinic visits  \n- At each visit you will be asked if you have had any illnesses since the last visit, if you have had any \ntrouble taking your ART, and if you are experiencing any side effects. You may need a physic al \nexam or blood tests at some visits  \nSection 12: ART readiness assessment  \n\u2022 Are you ready to start ART today?  \n- Complete the ART Readiness Assessment (Table 5.4) for each patient to see if they should \nstart ART today, and if not, to identify what issues need to be addressed before starting \nART", "start_char_idx": 3, "end_char_idx": 2774, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f7a4ff0c-fd7b-4c3d-b051-e9582889d5aa": {"__data__": {"id_": "f7a4ff0c-fd7b-4c3d-b051-e9582889d5aa", "embedding": null, "metadata": {"page_label": "237", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b18394df-509f-4e2b-a5b6-616eb0b425dc", "node_type": "4", "metadata": {"page_label": "237", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c2f97df792d08592fed4d39d788395c63d3870b0d8f7d542a70520aff8c7d86b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "faa8c925-1e7d-42c4-8f4c-0b0f964f1a2c", "node_type": "1", "metadata": {"page_label": "236", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "dbcbcaff47054c04dca63410f9dceed8cc9a4c45a6ee850505af1efafe6ab9df", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "bca2244a-ca40-4880-b7a7-41d35d3747ce", "node_type": "1", "metadata": {}, "hash": "3a78263c27d4469484aa0fdc514a897b8166278ee0e857226699eaa30f06313e", "class_name": "RelatedNodeInfo"}}, "hash": "11f86e59a067dd150bd190e27e07eb1d16e51fa42e79a140e7eb342c32293135", "text": "Annexes  \n \n13 - 15 Annex 8: Cont.  \nSection 13: Management plan  \n\u2022 Which investigations will you have today  \n- See Table 3.2 and Table 3.5 for recommended baseline and follow -up investigations \nrespectively  \n\u2022 Which medications will you start today  \n- May include: ART; CPT; TPT; other  \n\u2022 What else is required as you start or as you prepare to start ART  \n- May include: assisted disclosure; support group referral; engagement of a treatment \nbuddy; drug and alcohol counselling; depression management; referrals; other  \n- For patients not starting ART today, management plan should include specific \nstrategies to address any issues preventing/delaying ART initiation  \n\u2022 When should you return to the clinic  \n- Book appointment date  for next visit, preferably with the same healthcare worker", "start_char_idx": 3, "end_char_idx": 807, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "bca2244a-ca40-4880-b7a7-41d35d3747ce": {"__data__": {"id_": "bca2244a-ca40-4880-b7a7-41d35d3747ce", "embedding": null, "metadata": {"page_label": "238", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "48856489-862f-4d98-a8ae-0d89050debdc", "node_type": "4", "metadata": {"page_label": "238", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "96cc7cb581c597c38617875b5ef988a28fc7ec1452e6d9630eff1f8dd0075960", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f7a4ff0c-fd7b-4c3d-b051-e9582889d5aa", "node_type": "1", "metadata": {"page_label": "237", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "11f86e59a067dd150bd190e27e07eb1d16e51fa42e79a140e7eb342c32293135", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "35744d54-94ae-419b-9c7d-67351592e60a", "node_type": "1", "metadata": {}, "hash": "b104251903e3889633d63f37e677243f69f58e86ad0a65221972739bbc85bfd3", "class_name": "RelatedNodeInfo"}}, "hash": "3a78263c27d4469484aa0fdc514a897b8166278ee0e857226699eaa30f06313e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 16 Annex 9 A: Enhanced Adherence Counselling Content Guide  \nEnhanced Adherence Counselling for Patients with Suspected or Confirmed Treatment Failure  \nNote: for children/adolescents, the script below should be modified towards the caregiver  \nSession 1  \n\u2022 Assess patient\u2019s understanding of \u2018viral load\u2019, \u2018high viral load\u2019 and \u2018suppressed viral load\u2019. Ask \nthe patient to explain what each of these terms mean. Provide education if patient requires \nmore explanation  \n\u2022 Provide VL result and explanation of result:  \n\u201cYou have a detectable viral load. There are several possible reasons for this such as problems with \nadherence, dosing of your medications, interactions wit h other drugs or foods, or possible drug \nresistance. It is very important for us to work with you determine which may apply to you.\u201d  \n\u2022 How does the patient feel concerning the result?  \n\u2022 Explain the process of enhanced adherence:  \n\u201cPatients with a high viral load come for at least 3 adherence counselling sessions to discuss what \nmight cause a high viral and to look for solutions on how adherence can be improved. Another \nviral load test will be done after 3 months of good adherence to see if the ART can b e continued or \nif we need to change treatment.\u201d  \n\u2022 Check whether the patient had previous problems with adherence and/or missed \nappointments  \n\u2022 Ask:  \n\u201cWhy do you think your viral load is high?\u201d  \n\u2022 Sometimes the patient already knows why his/her VL is detectable. Sta rt by giving them a \nchance to provide their own explanation. Often, they will admit that they are struggling with \ntheir adherence  \n\u2022 If they really don\u2019t know why their VL is high you can say:  \n\u201cWe notice that when people sometimes forget to take their ART everyday it gives the virus a chance \nto multiply. Do you think that you sometimes forget your pills?\u201d  \nAssess for Possible Barriers to Adherence  \nCognitive Barriers (HIV and ART knowledge)  \n\u2022 Assess patient\u2019s knowledge about HIV and ART; correct any misconceptions  \n\u201cWhat is HIV?\u201d  \n\u201cWhat is the immune system and CD4 cells?\u201d  \n\u201cWhat is ART and how does it work?\u201d  \n\u201cWhy is it important to be adherent? And how?\u201d  \n\u201cWhy do you have to come for follow -up appointments? What should you bring?\u201d", "start_char_idx": 3, "end_char_idx": 2291, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "35744d54-94ae-419b-9c7d-67351592e60a": {"__data__": {"id_": "35744d54-94ae-419b-9c7d-67351592e60a", "embedding": null, "metadata": {"page_label": "239", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e0449bd9-30cf-4079-ab35-a12a0f698b74", "node_type": "4", "metadata": {"page_label": "239", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d16b7123d77b8854d5488dcc54d7ef1a4e405d739e52344454389677e80b55b8", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "bca2244a-ca40-4880-b7a7-41d35d3747ce", "node_type": "1", "metadata": {"page_label": "238", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3a78263c27d4469484aa0fdc514a897b8166278ee0e857226699eaa30f06313e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "dca5d3e4-174a-4b13-93e1-5b2fb3959fbf", "node_type": "1", "metadata": {}, "hash": "700cab2d1323e7699ab35cf035e2fab042d290f5f7c135550426e6fb8ba654eb", "class_name": "RelatedNodeInfo"}}, "hash": "b104251903e3889633d63f37e677243f69f58e86ad0a65221972739bbc85bfd3", "text": "Annexes  \n \n13 - 17 Annex 9A: Cont.  \nBehavioural Barriers  \n\u2022 Review how the patient takes drugs  \n\u201cPlease explain how you take your drugs, and at what time?\u201d  \n\u201cHow does treatment fit in your daily routines?\u201d  \n\u2022 Establish with the patient whether the time they are meant to take their medication is \nappropriate or whether the time is a problem. For example, if the patient has chosen 9 pm, \nbut is already asleep in bed by 9 pm, then that is not a good dosing time. If the time is a \nproblem, then determine a new, more appropriate time with the patient based on their \nschedule  \n\u2022 Remind the patient/caregiver that a missed dose should be taken as soon as he/she \nremembers (up to a couple of hours before the next scheduled dose). The next dose should \nbe taken at the usual time  \n\u201cWhat reminder tools do you use? (e.g., mobile phone alarm)\u201d \u201cWhat do you do in case of visits, and \ntravel?\u201d  \n\u2022 Travelling is always a risk for poor adherence or default from treatment. Encourage the patient \nto plan, to make sure they have enough medication on hand  before and to remember to pack \nit \n\u2022 Make sure that all relevant information is on the patient\u2019s appointment card and explain that \nif they are ever away from home and they are about to run out of medication that they must go \nto the closest ART clinic and sho w their appointment card  \n\u201cWhat do you do in case of side effects?\u201d  \n\u2022 Ask the patient if s/he has any side effects from the ARVs, and if they sometimes find it \ndifficult to take ARVs  \n\u2022 Due to the side effects, ask how s/he manages side effects and if it influences the way s/he \ntakes the drugs.  \n\u201cWhat are the most difficult situations for you to take drugs?\u201d  \n\u2022 Check for alcohol or drug use. Ask the patient in a casual way (not in an accusing way) if they \nsometimes use substances; emphasize treatment planning in case they do  \n\u2022 \u201cTaking alcohol or drugs sometimes makes it difficult for us to remember to take treatment. If \npossible, it is best to limit your use, but if you are planning to take any alcohol or drugs, it is \nimportant to plan ahead so that you don\u2019t for get to take your treatment\u201d  \n\u201cIf you feel your alcohol or drug use is affecting your adherence, are you ready to be referred to some \nprofessionals that may help you work on that problem?\u201d", "start_char_idx": 3, "end_char_idx": 2300, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "dca5d3e4-174a-4b13-93e1-5b2fb3959fbf": {"__data__": {"id_": "dca5d3e4-174a-4b13-93e1-5b2fb3959fbf", "embedding": null, "metadata": {"page_label": "240", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "317e5edd-3c29-48a3-ae7b-340862d7d3cd", "node_type": "4", "metadata": {"page_label": "240", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5d571a69f951abcbf442db38af677fb7bc4f3f1879906f9368b134c30886bd43", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "35744d54-94ae-419b-9c7d-67351592e60a", "node_type": "1", "metadata": {"page_label": "239", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b104251903e3889633d63f37e677243f69f58e86ad0a65221972739bbc85bfd3", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d96ff792-2b16-4efd-a783-022aca318e05", "node_type": "1", "metadata": {}, "hash": "602ef13d77ff12cb64f497e5b426bfbeff9b4944b06187737957b70b15ba2c9e", "class_name": "RelatedNodeInfo"}}, "hash": "700cab2d1323e7699ab35cf035e2fab042d290f5f7c135550426e6fb8ba654eb", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 18 Annex 9A: Cont.  \n\u25cf Emotional Barriers  \n\u2022 Review the patient\u2019s motivation:  \n\u201cHow do you feel about taking drugs every day?\u201d \n\u201cWhat are your ambitions in life?\u201d  \n\u2022 You can use motivation cards for this: Ask the patient to think of his or her own personal \ngoals/dreams for the future. What are the 3 most important things they  still want to achieve? \nHave them write them in their own words on a notecard. Encourage the patient to read the \nnotecard every day, preferably right before they take their medication  \n\u2022 Mental health screening:  \n- Depression is an important reason of non -adherence.  All patients with suspected or \nconfirmed treatment failure should be screened for depression using the PHQ -9 tool \n(Table 4.14)  \n- The patient may be in any of the five stages of grief (because of their HIV diagnosis or for \nother reasons): deni al and isolation; anger; bargaining; depression, or; acceptance. This \nneeds to be assessed and addressed  \nSocio -economical Barriers  \n\u2022 Review the patient\u2019s disclosure of their HIV status  \n\u201cDo you have any people in your life who you can talk to about your HIV status and ART?\u201d  \n\u2022 Discuss how the patient can enlist the support of their family, friends, and/or co -workers in \nreminding them to take their medication if they have not already done so  \n\u2022 Support from a treatment buddy: if the patient came with treatment buddy, assess their input \ntowards adherence. If patient did not come with treatment buddy, explain the role of a treatment \nbuddy and encourage the patient to come with a person they trust next visit  \n\u2022 Support in family/community/support group: expl ore support systems, in addition to the \ntreatment buddy, that the patient is currently using and options that the patient can start using. \nDiscuss the advantages of joining a support group and any reasons the patient is hesitant to join  \n\u2022 Profession, income generating resources: review the patient\u2019s and family\u2019s sources of income \nand how well they cover their needs  \n\u2022 Specific barriers to come to health centre on regular basis: ask the patient if they have any \nchallenges getting to the clinic on regular basis. Help the patient develop strategies to overcome \nthose challenges  \n\u2022 Stigma and discrimination  \n\u201cAre you ever worried about people finding out your HIV status \naccidentally?\u201d \u201cDo you feel like people treat you differently when they know \nyour HIV status?\u201d  \n\u2022 Discuss if stigma is making it difficult for them to take their medications on time, or for them \nto attend clinic appointments  \n\u2022 Religious beliefs: find out if the patient has tried faith healing, or if they have ever stopped taking \ntheir medicine because of their religious beliefs", "start_char_idx": 3, "end_char_idx": 2769, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d96ff792-2b16-4efd-a783-022aca318e05": {"__data__": {"id_": "d96ff792-2b16-4efd-a783-022aca318e05", "embedding": null, "metadata": {"page_label": "241", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "dc19bd4d-f22b-44ac-8ced-2bc30ca12b99", "node_type": "4", "metadata": {"page_label": "241", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "88cfd058d57e4a7de337005c1c35a701a96d2b21786a42320072ffce99e6ae7b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "dca5d3e4-174a-4b13-93e1-5b2fb3959fbf", "node_type": "1", "metadata": {"page_label": "240", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "700cab2d1323e7699ab35cf035e2fab042d290f5f7c135550426e6fb8ba654eb", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "27a2e45b-d307-4de0-9998-33f03fc7a408", "node_type": "1", "metadata": {}, "hash": "0bb1f0ec1d5efe84c58053a2e9afd88c676436d0f04c8b58cfb4e7b51f297d5a", "class_name": "RelatedNodeInfo"}}, "hash": "602ef13d77ff12cb64f497e5b426bfbeff9b4944b06187737957b70b15ba2c9e", "text": "Annexes  \n \n13 - 19 Annex 9A: Cont.  \nReferrals and Networking  \n\u2022 Review the patient\u2019s file to determine if they have been referred to other services. This includes \nreferrals to social services, support groups, psychology services, nutrition services, medical \nclinics, substance abuse groups, etc.  \n\u2022 Ask the patient if they attended the appointments, check in on their experience with the \nreferral services and re -organize referrals as necessary  \n\u2022 Determine if the patient could benefit from a home visit  \nDevelop Adherence Plan  \n\u2022 Go through each of the adherence challenges identified during the session and assist the \npatient to develop a plan that addresses each of the issues. It is important to let the patient \ncome up with the solutions so that they can own them  \n\u2022 Some examples of addressing adherence challenges:  \n- Behavioural barriers: using a reminder tool; using a pill box; redefining the medication \nschedule to fit with the patient\u2019s daily schedule; keeping an emergency dose of drugs when \naway from home  \n- Refer to clinician in case of side effects  \n- Socio -economical barriers: move on to disclosure process; identify a treatment buddy; join a \nsupport group; refer to CBO/NGO to learn about income generating activities  \n- Emotional barriers: emotional support or refer to clinician for mental health management  \nAgree on a follow -up date for the next session  \n \nSession 2 (usually 2 weeks after Session 1, preferably with the same provider)  \nReview Adherence Plan  \n\u2022 Ask the patient if he/she thinks adherence has improved since the last visit. Enquire in a \nfriendly way if any doses have been missed  \n\u2022 Review the patient\u2019s barriers to adherence documented during the first session and if \nstrategies identified have been taken up. If  not, discuss why  \nIdentify Any New Issues  \n\u2022 Discuss specific reasons why the patient may have missed their pills or a clinic \nappointment since the last counselling session, and determine if it is a new issue that \nwasn\u2019t addressed during the first session  \n\u2022 Discuss if other issues have come up because of implementing the adherence plan (e.g., \nperhaps the disclosure process had unintended results)  \nReferrals and Networking  \n\u2022 Follow -up on any referrals made during the previous session  \n\u2022 Determine if the patient could benefit from a home visit  \nDevelop Adherence Plan  \n\u2022 Go through each of the adherence challenges identified during the session and assist the patient \nto modify their original adherence plan to address each of the issues. It is important to let the \npatient come up with the solutions so that they own them  \n\u2022 Give another short motivational speech on how you believe in the patient! You know they can \ndo this! Together you will make sure that they suppress their viral load!!  \n\u2022 Agree on a follow -up date fo r the next session", "start_char_idx": 3, "end_char_idx": 2856, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "27a2e45b-d307-4de0-9998-33f03fc7a408": {"__data__": {"id_": "27a2e45b-d307-4de0-9998-33f03fc7a408", "embedding": null, "metadata": {"page_label": "242", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "208778b1-1a75-4b3e-b240-d4f2ad10ddca", "node_type": "4", "metadata": {"page_label": "242", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1beec0a6f6242c2176e6bd60f6e3df43198321f45395e7138d2df78b942dd515", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d96ff792-2b16-4efd-a783-022aca318e05", "node_type": "1", "metadata": {"page_label": "241", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "602ef13d77ff12cb64f497e5b426bfbeff9b4944b06187737957b70b15ba2c9e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7185b3d8-d70f-4980-9603-8571e026505b", "node_type": "1", "metadata": {}, "hash": "ba73abf398f0f09acff6f87d889eaf0a676d52f61b57354cda2c3d36fd50502c", "class_name": "RelatedNodeInfo"}}, "hash": "0bb1f0ec1d5efe84c58053a2e9afd88c676436d0f04c8b58cfb4e7b51f297d5a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 20 Annex 9A: Cont.  \nSession 3 (usually 2 weeks after Session 2, preferably with the same provider)  \nReview Adherence Plan  \n\u2022 Ask the patient if he/she thinks adherence has improved since the last visit. Enquire in a \nfriendly way if any doses have been missed  \n\u2022 Review the patient\u2019s barriers to adherence documented during the first session and if \nstrategies identified have been taken up. If not, discuss why  \n \nIdentify Any New Issues  \n\u2022 Discuss specific reasons why the patient may have missed their pills or a clinic appointment \nsince the last counselling session, and determine if it is a new issue that wasn\u2019t addressed \nduring the first session  \n\u2022 Discuss if other issues have come up because of implementing the adherence plan (e.g., perhaps \nthe disclosure process had unintended results)  \n \nReferrals and Networking  \n\u2022 Follow -up on any referrals made during the previous session  \n\u2022 Determine if the patient could benefit from a home visit  \n \nDevelop Adherence Plan  \n\u2022 Go through each of the adherence challenges identified during the session and assist the patient \nto modify their original adherence plan to address each of the issues. It is important to let the \npatient come up with the solutions so that they own them  \n\u2022 Give another short motivati onal speech on how you believe in the patient! You know they \ncan do this! Together you will make sure that they suppress their viral load!!  \n\u2022 Agree on a follow -up date for the next session  \n \nRepeat Viral Load  \n\u2022 If the adherence is good: plan for the next VL testing after 3 months and explain possible ways \nforward, emphasizing the roles of the patient, the support systems and the health facility. You \ncan continue follow -up adherence counselling sessions during the 3 -month period if you and \nthe patient think th ere would be a benefit to them  \n\u201cIf your results come back and your VL is undetectable then you will be able to continue with same ART. \nIf your viral load is still greater than 1,000 copies/ml then you will need to switch to a new regimen, \nprobably after do ing some additional testing to see which regimen may work best for you. If your viral \nload is detectable but less than 1,000 copies/ml we will discuss options, including changing regimens \nor continuing to monitor.\u201d (Adapt to individual patient/context)  \n\u2022 If adherence challenges persist: plan further Enhanced Adherence Counselling Sessions before \nrepeating the VL", "start_char_idx": 3, "end_char_idx": 2503, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7185b3d8-d70f-4980-9603-8571e026505b": {"__data__": {"id_": "7185b3d8-d70f-4980-9603-8571e026505b", "embedding": null, "metadata": {"page_label": "243", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8099688b-3dda-4520-9ab6-3dc3d32c3d01", "node_type": "4", "metadata": {"page_label": "243", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ccf3572a3bbfadcb36f0f2d6d151424c5b62bbb2ae074794c9204797a664570b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "27a2e45b-d307-4de0-9998-33f03fc7a408", "node_type": "1", "metadata": {"page_label": "242", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0bb1f0ec1d5efe84c58053a2e9afd88c676436d0f04c8b58cfb4e7b51f297d5a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "166514ad-804a-4dd7-990d-699c30663bde", "node_type": "1", "metadata": {}, "hash": "62f7c3ad5bf1b8ee0586c3291d18f57f020a9627d1f64772da768f88520cecba", "class_name": "RelatedNodeInfo"}}, "hash": "ba73abf398f0f09acff6f87d889eaf0a676d52f61b57354cda2c3d36fd50502c", "text": "Annexes  \n \n13 - 21 Annex 9A: Cont.  \nSession to Discuss Repeat Viral Load Results (after the repeat VL results are back, preferably with \nthe same provider)  \nDiscuss Viral Load Results  \n\u2022 If suppressed (VL < 50 copies/ml) CONGRATULATE the patient!!!  \n- Explain the way forward: will continue with same ART regimen and repeat the VL again in 6 \nmonths  \n\u2022 If viral load is \u2265 1,000 copies/ml  \n- Explain the way forward: will probably need to switch to a new ART regimen after discussing \nas an MDT, and additional testing to see which regimen may work for the patient  \n- Summarize the case with the MDT; if the patient cannot switch to standard 2nd line ART, or \nis failin g 2nd line ART, forward to the Regional or National HIV Clinical Technical Working \nGroup for next steps  \n\u2022 If viral load is 50 - 999 copies/ml  \n- Explain the way forward: will reassess barriers to adherence, support systems, and other \nreasons for viremia; once reason/s for viremia have been addressed then will repeat the viral \nload after another 3 months of excellent adherence", "start_char_idx": 3, "end_char_idx": 1064, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "166514ad-804a-4dd7-990d-699c30663bde": {"__data__": {"id_": "166514ad-804a-4dd7-990d-699c30663bde", "embedding": null, "metadata": {"page_label": "244", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ae2575e0-a2e3-42da-b729-308d342e9d4e", "node_type": "4", "metadata": {"page_label": "244", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "522d4d99e2e30b3fbcc913f82476c3640c972ef0f02bdd6e0d4f53578258c79c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7185b3d8-d70f-4980-9603-8571e026505b", "node_type": "1", "metadata": {"page_label": "243", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ba73abf398f0f09acff6f87d889eaf0a676d52f61b57354cda2c3d36fd50502c", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "16a7958f-321c-4467-b246-bb8caf2c825f", "node_type": "1", "metadata": {}, "hash": "87e85c1a0fe24fbac5148ac58a8fe2207e105ed4f8f35019d490a0f5bc246e02", "class_name": "RelatedNodeInfo"}}, "hash": "62f7c3ad5bf1b8ee0586c3291d18f57f020a9627d1f64772da768f88520cecba", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 22 Annex 9 B: Case Summary Form  \n \n \nMINISTRY OF HEALTH  \nNATIONAL AIDS AND STI CONTROL PROGRAMME  \nCLINICAL SUMMARY FORM  \nName of \nFacility   MFL \nCode   \nPatient CCC \nno.  \n(Do not write \nname )  Date   \nPatient \nDetails  Date of Birth:                  Enrollment Date:  \n \nGender:   Current Weight (Kg):                      Height (cm):  \nClinician\u2019s \nName   \nFacility \nContacts  Tel:  Email:  \n \nWhat is the primary reason for this consultation:  \n \nClinical Evaluation: history, physical, diagnostics, working diagnosis ( excluding the information in \nthe table below  \n \n \n \n \n \n \nComplete the table below chronologically, including all ART regimens and laboratory results (and \nany previous history available for transfer -in patients)  \nDate  CD4  HB CrCl/  \neGFR  Viral \nLoad  Weight  \n(z-score/BMI \nfor children)  ARV \nRegimen  Reason for \nSwitch  New OI or other \nclinical event", "start_char_idx": 3, "end_char_idx": 958, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "16a7958f-321c-4467-b246-bb8caf2c825f": {"__data__": {"id_": "16a7958f-321c-4467-b246-bb8caf2c825f", "embedding": null, "metadata": {"page_label": "245", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a1ffac7c-b1e2-4b47-a7d7-3787cc620d40", "node_type": "4", "metadata": {"page_label": "245", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3ddbc701e695b9f8d548874f11c6fc095c8ffbb7f3452c2d691296b3660d7bcf", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "166514ad-804a-4dd7-990d-699c30663bde", "node_type": "1", "metadata": {"page_label": "244", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "62f7c3ad5bf1b8ee0586c3291d18f57f020a9627d1f64772da768f88520cecba", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "5410d57d-cc32-4210-9c20-aee9a9376ba2", "node_type": "1", "metadata": {}, "hash": "60c0d4689d2635d9c539f20f8a9b84e0fb913944a8e0d9c19c381e94fbbbd226", "class_name": "RelatedNodeInfo"}}, "hash": "87e85c1a0fe24fbac5148ac58a8fe2207e105ed4f8f35019d490a0f5bc246e02", "text": "Annexes  \n \n13 - 23 Annex 9 B: Cont.  \nAdherence and Treatment Failure Evaluation  \nParameters of Evaluation  Findings  \n\u25cf Number and findings of adherence counseling/assessment \nsessions done in the last 3 -6 months including the following:  \no Findings from MMAS -8 \no Adherence barriers identified  \no Recommendations   \nNumber of home visits conducted in last 3 -6 months, and findings   \nDescribe support structures (e.g., treatment buddy, support group \nattendance, caregivers) in place for this patient   \nEvidence of adherence concerns (e.g., missed appointments, pill counts)   \nDescribe daily witnessed ingestion done in last 3 -6 months (Who performed \nit, which tool was used, how long was session done etc.)   \nDescribe likely root cause/s of poor adherence for this patie nt (e.g., stigma, \ndisclosure, side effects, alcohol or other drugs, mental health issues, \ncaregiver changes, religious beliefs, inadequate preparation, etc.)   \nEvaluation for other causes of treatment failure, e.g.:  \n\u25cf Inadequate dosing/dose adjustments (particularly for children)  \n\u25cf Drug -drug interactions  \n\u25cf Drug -food interactions  \n\u25cf Impaired absorption (e.g., chronic severe diarrhea)   \nOther Relevant ART History  \nComment on treatment interruptions, if any   \nHas Drug Resistance Testing been done for this patient? If yes, state date \ndone and attach the detailed results   \nHas facility multidisciplinary team discussed the patient\u2019s case? If yes, \ncomment on date, deliberations and recommendations (indicate how \ntreatment failure was established and con firmed, proposed regimen and \ndosage, current source of drugs if patient already on 3rd line)   \nMDT members who participated in the case discussion (names and titles)", "start_char_idx": 3, "end_char_idx": 1731, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "5410d57d-cc32-4210-9c20-aee9a9376ba2": {"__data__": {"id_": "5410d57d-cc32-4210-9c20-aee9a9376ba2", "embedding": null, "metadata": {"page_label": "246", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "c7d3e4b1-4806-4415-b311-8ea74369400d", "node_type": "4", "metadata": {"page_label": "246", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "db563a704e42c8741875dea44eb44c028dfeb0b6bb78bdbd47433fa44dbcaaa9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "16a7958f-321c-4467-b246-bb8caf2c825f", "node_type": "1", "metadata": {"page_label": "245", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "87e85c1a0fe24fbac5148ac58a8fe2207e105ed4f8f35019d490a0f5bc246e02", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "0cc89967-f5e7-4812-bce4-88b6278f7ade", "node_type": "1", "metadata": {}, "hash": "960b6218b0464332de79e3135a72cc848cdf40db949b431bcf67533149e27b6e", "class_name": "RelatedNodeInfo"}}, "hash": "60c0d4689d2635d9c539f20f8a9b84e0fb913944a8e0d9c19c381e94fbbbd226", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 24 Annex 9 C: Enhanced Adherence Counselling Form  \nENHANCED ADHERENCE COUNSELLING FORM  \n(To be completed by the counsellor)  \n\u2022 Start each session by reviewing the adherence barriers and action plan from the previous session  \n\u2022 For each session assess major barriers to adherence (cognitive, behavioral, emotional, socio -economic)  \nSession #:   Date:   Adherence % (from pill count):   MMAS -8 Score:   \nTreatment \nmotivation:   \n \n \n \n \n \n \n \nBarriers to \nadherence:   \n \n \n \nYour impression about patient\u2019s \ncurrent adherence:    \u25a2 Excellent                \u25a2 Unsure            \u25a2 Inadequate  \nAdherence plan:   \n \n \n \n \n \n \nNext appointment date:", "start_char_idx": 3, "end_char_idx": 717, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "0cc89967-f5e7-4812-bce4-88b6278f7ade": {"__data__": {"id_": "0cc89967-f5e7-4812-bce4-88b6278f7ade", "embedding": null, "metadata": {"page_label": "247", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8b1fc21d-4ffd-48d1-872f-4ffc0f57a162", "node_type": "4", "metadata": {"page_label": "247", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "93adccf5c23ba954ffe1f3b6d5b9175da03bfb80d337a65cbfeb5ffd6a6109f6", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "5410d57d-cc32-4210-9c20-aee9a9376ba2", "node_type": "1", "metadata": {"page_label": "246", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "60c0d4689d2635d9c539f20f8a9b84e0fb913944a8e0d9c19c381e94fbbbd226", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "99dc8be5-6304-4709-8341-2175ed8ad548", "node_type": "1", "metadata": {}, "hash": "5a669ebf922a7ea15ac4c9ffde4a5e785db705599497f1e82923cf2854ce11c7", "class_name": "RelatedNodeInfo"}}, "hash": "960b6218b0464332de79e3135a72cc848cdf40db949b431bcf67533149e27b6e", "text": "Annexes  \n \n13 - 25 Annex 9 D: Home Visit Checklist  \nHOME VISIT CHECKLIST  \nPatient Name  Tel No:  Sex: M            F     \nFamily Member  Tel No:  Sex: M            F     \nPhysical Landmark:   File No.  \n \nThis checklist is not all -inclusive but highlights critical areas that can affect adherence.  \n Areas to Assess and Discuss  Comments  \nI Is the patient independent in the activities of daily living (e.g., \nfeeding, grooming, toileting) l  \n2 Are the patient\u2019s basic needs being met (e.g., clothing, shelter, food) l  \n3 Has the patient disclosed their HIV status to other household members   \n4 How are the patient\u2019s ARVs stored and taken?   \n5 Does the patient receive social support from household members   \n6 Does the patient receive social support in the community e.g., linked to \nOVC, income generating activities, community -based support group, CBO, \ncash transfer program?   \n7 Is the patient linked to non -clinical services (e.g., spiritual, legal \nor nutritional)    \n8 Does the patient have mental health issues that need to be addressed (use \nPHQ9 to screen for depression), or use drugs or alcohol?   \n9 Is the patient suffering from a stressful situation or significant loss/grief?   \n10 Is the patient having any side -effects from the medications?", "start_char_idx": 3, "end_char_idx": 1279, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "99dc8be5-6304-4709-8341-2175ed8ad548": {"__data__": {"id_": "99dc8be5-6304-4709-8341-2175ed8ad548", "embedding": null, "metadata": {"page_label": "248", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "8e0ac6e7-0e93-47ff-8b30-95cb7ecb38a9", "node_type": "4", "metadata": {"page_label": "248", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ea3ea22ea6dcfb043fb5413cb5359ad45323a0febeb515588007fab1ce8413be", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "0cc89967-f5e7-4812-bce4-88b6278f7ade", "node_type": "1", "metadata": {"page_label": "247", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "960b6218b0464332de79e3135a72cc848cdf40db949b431bcf67533149e27b6e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "6aa4f157-c03a-44a1-b86b-0871e88353e4", "node_type": "1", "metadata": {}, "hash": "738362da8e51c9ab68684c937879579b62e46f267ab05f3edf45d38ca1313ce1", "class_name": "RelatedNodeInfo"}}, "hash": "5a669ebf922a7ea15ac4c9ffde4a5e785db705599497f1e82923cf2854ce11c7", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n 13 - 26 Annex 9 E: Management Protocol for Patients Switching to 3rd Line ART  \nManagement Protocol for patients switching to 3rd line ART  \n \nPre \u2013 Initiation MDT Meeting  \n\u2022 Confirm what 3rd line ARV regimen is prescribed, its availability and the management plan  \n\u2022 Assign a case manager to patient  \nInitiation of 3rd Line ART  \n\u2022 Triage  \no Record vital signs and take actions as needed  \n \n\u2022 Adherence support  \no Conduct patient education on the new ART regimen: Treatment goals, dosing, drug \ninteractions and potential side effects and adverse events  \no Conduct adherence assessment and counselling  \no Link patient to adherence support systems  \n \n\u2022 Clinical assessment  \no Take history and conduct physical examination  \no Complete clinical encounter form and MOH 257 (Green Card)  \no Manage any co -infection and co -morbidities  \no Review for potential drug interactions and contraindications  \no Conduct adherence assessment and review adherence support systems including \ndaily witnessed ingestion plan  \no Reinforce patient education messages on new regimen  \n\u25aa Currently limited future treatment options  \n\u25aa Need for perfect adherence (>95%)  \n\u25aa Dosing schedule and timing  \n\u25aa Potential side effects and what the patient should do  \no Prescribe new regimen  for 2 weeks  \no Confirm dosing as per the weight (for \u226415)  \no Continue other medication e.g., CPT, OI treatment etc.  \n \n\u2022 Dispensing  \no Confirm ARV dosing as per the weight (for \u226415)  \no Conduct medication use counselling  \no Dispense 3rd Line ARVs for 2 weeks  \no Check for possible drug interaction  \n \n\u2022 Community follow up  \no Link all patients to support group, CHV/CHA  \no Plan for home visits as required", "start_char_idx": 3, "end_char_idx": 1751, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "6aa4f157-c03a-44a1-b86b-0871e88353e4": {"__data__": {"id_": "6aa4f157-c03a-44a1-b86b-0871e88353e4", "embedding": null, "metadata": {"page_label": "249", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "810b4672-4e79-4764-8804-dec1b6a7d036", "node_type": "4", "metadata": {"page_label": "249", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7f440305e6e365318100ae289b1d672e56891efbc9ea7446208b4043404ca3ee", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "99dc8be5-6304-4709-8341-2175ed8ad548", "node_type": "1", "metadata": {"page_label": "248", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5a669ebf922a7ea15ac4c9ffde4a5e785db705599497f1e82923cf2854ce11c7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "741b83d3-f691-4f52-99d7-c0f9c2a5be28", "node_type": "1", "metadata": {}, "hash": "5fd1d2c894791a44b17a35e5a17c4f58c389c409bfd9432465a7a090da57e545", "class_name": "RelatedNodeInfo"}}, "hash": "738362da8e51c9ab68684c937879579b62e46f267ab05f3edf45d38ca1313ce1", "text": "Annexes  \n \n13 - 27 Annex 9 E: cont.  \nPatient Follow Up after Treatment Initiation  \n\u25cf Frequency  \no First follow -up should be within 2 weeks of initiation of 3rd line ART  \no Subsequent visits should be monthly (or more frequent) until confirmed viral sup - \npression at 6 months  \no Thereafter, follow -up can be 1 -3 monthly  \n \n\u25cf Triage  \no Record vital signs and take action as needed  \n \n\u25cf Adherence Support (adherence should be reinforced during every clinic visit, in addition to \nenhanced adherence counselling sessions)  \no Review and address knowledge deficits on new regimen  \no Confirm understanding of adherence, conduct adherence assessment, and reinforce key \nadherence messages  \no Document reasons for missed doses and manage obstacles to perfect adherence. Review \nand reinforce adherence support systems  \n \n\u25cf Clinical Assessment  \no Take history and conduct physical examination  \no Complete Clinical Encounter Form and MOH 257 (blue card)  \no Manage any co -infections and co -morbidities  \no Evaluate for potential drug interactions  \no Evaluate for and manage any drug side effects and adverse events  \no Conduct adherence assessment and review adherence  support systems  \no Reinforce patient education messages on new regimen  \n\u25aa Review and address knowledge gaps on ART regimen  \n\u25aa Need for perfect adherence (>95%)  \n\u25aa Dosing schedule and timing  \n\u25aa Potential side effects and what the patient should do  \no Prescribe 3rd line ARVs  \n \n\u25cf Viral load should be conducted 3 months after change of regimen  \n \n\u25cf Dispensing  \no Confirm ARV dosing as per the weight  \no Conduct medication use counselling  \no Dispense 3rd line ARVs  \n \n\u25cf Community Follow up  \no Review linkage to community adherence support systems  \no Conduct home visits as required  \no Continue DOTS  \n \n\u25cf NOTE: 3rd line annual report with viral load, adherence, and outcomes to be sent to NASCOP", "start_char_idx": 3, "end_char_idx": 1893, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "741b83d3-f691-4f52-99d7-c0f9c2a5be28": {"__data__": {"id_": "741b83d3-f691-4f52-99d7-c0f9c2a5be28", "embedding": null, "metadata": {"page_label": "250", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "88161875-a5bd-4b47-ad25-7c82140d5b15", "node_type": "4", "metadata": {"page_label": "250", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6c21602883167f886af3f68eaa0572ee08f19b7a3e7b4d09bde62733c4adf924", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "6aa4f157-c03a-44a1-b86b-0871e88353e4", "node_type": "1", "metadata": {"page_label": "249", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "738362da8e51c9ab68684c937879579b62e46f267ab05f3edf45d38ca1313ce1", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "8a3189c0-8cfb-424a-b721-d9a0d3f8488a", "node_type": "1", "metadata": {}, "hash": "282b0f956d2f2b1f6f0360a026fe1aeab2f6cd1ef70642038ae8dbe6fda56951", "class_name": "RelatedNodeInfo"}}, "hash": "5fd1d2c894791a44b17a35e5a17c4f58c389c409bfd9432465a7a090da57e545", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 28 Annex 10 A: Dosing of Solid and Liquid Formulations for Twice -Daily Dosing in Infants and Children 4 Weeks of Age \nand Older  1\n \nDrug  Strength of tablets  Number of tablets by weight band morning and evening  Strength of adult \ntablet  Number of tablets \nby weight band  \n3\u20135.9 kg  6\u20139.9 kg  10\u201313.9 kg  14\u201319.9 kg  20\u201324.9 kg  25\u201334.9 kg  \nAM PM AM PM AM PM AM PM AM PM AM PM \nAZT/3TC  Tablet (dispersible) 60/30 mg  1 1 1.5 1.5 2 2 2.5 2.5 3 3 300 /150 mg  1 1 \nAZT/3TC/NVP2 Tablet (dispersible) 60/30 mg/50 mg  1 1 1.5 1.5 2 2 2.5 2.5 3 3 300 /150 /200 mg  1 1 \nABC/3TC  Tablet (dispersible) 120/60 mg  0.5 0.5 0.5 1 1 1 1 1.5 1.5 1.5 600 /300 mg  0.5 0.5 \nABC/3TC/LPV/r  30/15/40/10 mg  2 2 3 3 4 4 5 5 6 6    \nSOLID SINGLE FORMULATIONS  \nAZT  Tablet (dispersible) 60 mg  1 1 1.5 1.5 2 2 2.5 2.5 3 3 300 mg 1 1 \nABC  Tablet (dispersible) 60 mg  1 1 1.5 1.5 2 2 2.5 2.5 3 3 300 mg  1 1 \nNVP2 Tablet (dispersible) 50 mg  1 1 1.5 1.5 2 2 2.5 2.5 3 3 200 mg  1 1 \nTablet 200 mg  \u2013 \u2013 \u2013 \u2013 0.5 0.5 1 0.5 1 0.5 200 mg  1 1 \n \nLPV/r3 Tablet 100/25 mg  \u2013 \u2013 \u2013 \u2013 2 1 2 2 2 2 100/25 mg  3 3 \nTablet 200/50 mg  \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 1 1 1 1 200/50 mg  2 1 \nGranules4 40/10 mg per sachet  2 2 3 3 4 4 5 5 6 6    \nDRV5 Tablet 75 mg  \u2013 \u2013 \u2013 \u2013 3 3 5 5 5 5    \n \nRAL6 Chewable tablets 25 mg  \u2013 \u2013 \u2013 \u2013 3 3 4 4 6 6 400 mg  1 1 \nChewable tablets 100 mg  \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 1 1 1.5 1.5 400 mg  1 1 \nGranules (100 mg/sachet)  0.25  0.25  0.5 0.5 \u2013 \u2013 \u2013 \u2013 \u2013 \u2013  \u2013 \u2013 \nLIQUID SINGLE FORMULATIONS  \nAZT  10 mg/ml  6 ml  6 ml  9 ml  9 ml  12 ml  12 ml  \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \nABC  20 mg/ml  3 ml  3 ml  4 ml  4 ml  6 ml  6 ml  \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \n3TC  10 mg/ml  3 ml  3 ml  4 ml  4 ml  6 ml  6 ml  \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \nNVP2 10 mg/ml  5 ml  5 ml  8 ml  8 ml  10 ml  10 ml  \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \u2013 \nDRV5 100 mg/ml  \u2013 \u2013 \u2013 \u2013 2.5 ml  2.5 ml  3.5 ml  3.", "start_char_idx": 3, "end_char_idx": 1842, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "8a3189c0-8cfb-424a-b721-d9a0d3f8488a": {"__data__": {"id_": "8a3189c0-8cfb-424a-b721-d9a0d3f8488a", "embedding": null, "metadata": {"page_label": "250", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "88161875-a5bd-4b47-ad25-7c82140d5b15", "node_type": "4", "metadata": {"page_label": "250", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6c21602883167f886af3f68eaa0572ee08f19b7a3e7b4d09bde62733c4adf924", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "741b83d3-f691-4f52-99d7-c0f9c2a5be28", "node_type": "1", "metadata": {"page_label": "250", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5fd1d2c894791a44b17a35e5a17c4f58c389c409bfd9432465a7a090da57e545", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e25701a3-c4b9-439d-a092-cfddb0ec264a", "node_type": "1", "metadata": {}, "hash": "a880eb7fade0a90a8feba7168ace48006f731feffcc79534475b5c7e490032d6", "class_name": "RelatedNodeInfo"}}, "hash": "282b0f956d2f2b1f6f0360a026fe1aeab2f6cd1ef70642038ae8dbe6fda56951", "text": "5 ml  2.5 ml  3.5 ml  3.5 ml  \u2013 \u2013    \nNotes  1 For infants younger than 4 weeks of age refer to Table 10C for more accurate dosing information  \n2 NVP dose escalation with half dose for 2 weeks when initiating ART is still recommended for infants > 2 weeks of age and not already on NVP prophylaxis to avoid toxicity from high initial \nNVP levels. HEI already on NVP prophylaxis who are confirmed positive can initiate full dose (twice daily) NVP without dose escalation  \n3 The LPV/r heat -stable tablet formulation must be swallowed whole and should not be split, chewed, dissolved or crushed. The adult 200/50 mg tablet may be used for patients 14 -24.9kg (1 \ntab am and 1 tab pm) and for patients 25 -34.9kg (2 tabs am and 1 tab pm) who are able to swallow them whole. The 100/25 mg tablet is smaller than the adult formulatio n and may be used \nby children of lower weight  bands able to swallow tablets whole.  \n4 LPV/r granule formulation can be used in infants over 2 weeks of age. Transition to tablets as soon as a child is able to swa llow tablets whole. The 4 -in-1 ABC/3TC/LPV/r may be used after \n1 month of age if the combin ation is appropriate and once it becomes available.  \n5 DRV must be administered with 0.5 ml of RTV 80 mg/mL oral suspension if less than 15 kg and with RTV 50 mg solid formulation in children 15 to 30 kg", "start_char_idx": 1818, "end_char_idx": 3162, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e25701a3-c4b9-439d-a092-cfddb0ec264a": {"__data__": {"id_": "e25701a3-c4b9-439d-a092-cfddb0ec264a", "embedding": null, "metadata": {"page_label": "251", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2f928400-f47d-49f6-a3cc-4b6fd9c037f1", "node_type": "4", "metadata": {"page_label": "251", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b2bdea7f7fd06effc5e6923cd54655b6f2d6bbfa0c0066a4d9cb835ffdb1c5b7", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "8a3189c0-8cfb-424a-b721-d9a0d3f8488a", "node_type": "1", "metadata": {"page_label": "250", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "282b0f956d2f2b1f6f0360a026fe1aeab2f6cd1ef70642038ae8dbe6fda56951", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "16ead144-9478-4920-864e-6e9771322f3d", "node_type": "1", "metadata": {}, "hash": "c96280b68242207f5a9025e81b2fd7e634ef13999b5274a62082fab0dd19fec8", "class_name": "RelatedNodeInfo"}}, "hash": "a880eb7fade0a90a8feba7168ace48006f731feffcc79534475b5c7e490032d6", "text": "Annexes  \n13 - 29 6RAL granules are approved for use in newborn childre n, however the administration procedure is complex and the formulation has very limited availability. If this RAL must be use d, consult \nthe regional/national clinical support center  \n Annex 10 B: Simplified Dosing of Child -Friendly Solid and Oral Liquid For mulations for Once -Daily Dosing in \nInfants and Children 4 Weeks of Age and Older1 \nDrug  Strength of tablet  Number of tablets or capsules by weight band once \ndaily  Strength of adult \ntablet  Number of tablets or capsules \nby weight band once daily  \n3\u20135.9 \nkg 6\u20139.9 \nkg 10\u201313.9 \nkg 14\u201319.9 \nkg 20\u201324.9 kg   25\u201334.9 kg  \nEFV2 Tablet (scored) 200 mg  \u2013 \u2013 1 1.5 1.5 200 mg  2 \nABC/3TC  Tablet (dispersible) 120/60 \nmg 1 1.5 2 2.5 3 600 mg/300 mg  1 \nDTG  Tablet (dispersible) 10 mg  0.5 1.5 2 2.5 33   \nDTG  Tablet 50 mg  - - - - 1 50 mg  1 \nDTG/TDF/  \n3TC   - - - - - 50/300/300  1 \nATV4 Capsules 100 mg  \u2013 \u2013 1 2 2 300 mg  2 (100 mg) or 1 (300 mg)  \n \nTDF5 Oral powder 40 mg/scoop  \u2013 \u2013 3 \u2013 \u2013  \n300 mg  1 (200 mg) d or 1 (300 mg)  \nTablets 150 mg or 200 mg  \u2013 \u2013 \u2013 1 (150 mg)  1 (200 mg)  \nNotes  1For infants younger than 4 weeks of age refer to Table 10C for more accurate dosing information  \n2EFV is not recommended for children younger than 3 years and weighing less than 10 kg. Where there are no suitable alternativ es, EFV may be used in children le ss than 3 years \nweighing more than 3.5 kg (3.5 -5 kg two 50 mg capsules; 5 -7.5 kg three 50 mg capsules; 7.5 -15 kg one 200 mg capsule).  \n3 DTG dispersible tablets have higher bioavailability than film tablets and doses are not interchangeable. Children can tr ansition to the 50 mg film tablet once they reach 20 kg. If unable to \nswallow the tablets whole, the dispersible tablets may be given at a dose of 30 mg daily.  \n4ATV is only approved for use in children 3 months and older. ATV single strength capsules shoul d be administered with RTV 100 mg for all weight bands. ATV powder formulation \nenables administration of ATV to infants and children as young as 3 months. Infants and children 5 -10 kg should be given 200 mg of ATV powder (4 packets, 50 mg/ packet) with 80 \nmg of RTV oral solution (1 ml)  \n5TDF is can be used in children 2 years and older. Target dose: 8 mg/kg or 200 mg/m2 (maximum 300 m", "start_char_idx": 3, "end_char_idx": 2310, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "16ead144-9478-4920-864e-6e9771322f3d": {"__data__": {"id_": "16ead144-9478-4920-864e-6e9771322f3d", "embedding": null, "metadata": {"page_label": "252", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "25a8228c-6e7c-442d-901d-b0b60d02413c", "node_type": "4", "metadata": {"page_label": "252", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "50544fa8458245d5c660d1c0a5877d92d500e44d9c88f3a0e97468207263d19c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "e25701a3-c4b9-439d-a092-cfddb0ec264a", "node_type": "1", "metadata": {"page_label": "251", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "a880eb7fade0a90a8feba7168ace48006f731feffcc79534475b5c7e490032d6", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7a43077d-503e-4dc8-b849-7845d0bfb3f4", "node_type": "1", "metadata": {}, "hash": "57e13f628d15995b88fd51218eed7de71b9401c6c802bb0f966c7ace36c33935", "class_name": "RelatedNodeInfo"}}, "hash": "c96280b68242207f5a9025e81b2fd7e634ef13999b5274a62082fab0dd19fec8", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 30 Annex 10 C: Drug Dosing of Liquid Formulations for Twice -Daily Dosing in Infants Less than 4 Weeks of Age  \nDrug  Strength of oral liquid  2-3 kg  3-4 kg  4-5 kg  \nAZT  10 mg/mL  1 mL  1.5 mL  2 mL  \nNVP1 10 mg/mL  1.5 mL  2 mL  3 mL  \n3TC  10 mg/mL  0.5 mL  0.8 mL  1 mL  \nNotes  1 NVP for treatment can be initiated with twice daily dosing for infants < 2 weeks of age (they do not require once -daily lead -in dosing)  \n \nAnnex 10 D: Simplified Dosing of INH and CTX Prophylaxis for Infants and Children Who Are at Least 4 Weeks of \nAge \nDrug  Strength of tablet or oral \nliquid  Number of tablets or ml by weight band once daily  Strength of adult \ntablet  Number of tablets \nby weight band  \n \n3\u20135.9 kg   \n6\u20139.9 kg   \n10\u201313.9 kg   \n14\u201319.9 kg   \n20\u201324.9 kg    \n25\u201334.9 kg  \nINH  100 mg  0.5 1 1.5 2 2.5 300 mg 1 \nCTX  Suspension 200/40 per 5 ml  2.5 ml  5 ml  5 ml  10 ml  10 ml  \u2013 \u2013 \nTablets (dispersible) 100/20 mg  1 2 2 4 4 \u2013 \u2013 \nTablets (scored) 400/80 mg  \u2013 0.5 0.5 1 1 400 mg/80 mg  2 \nTablets (scored) 800/160 mg  \u2013 \u2013 \u2013 0.5 0.5 800 mg/160 mg  1", "start_char_idx": 3, "end_char_idx": 1124, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7a43077d-503e-4dc8-b849-7845d0bfb3f4": {"__data__": {"id_": "7a43077d-503e-4dc8-b849-7845d0bfb3f4", "embedding": null, "metadata": {"page_label": "253", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "fc8e61b9-fa7f-40cc-ae5c-b8e307b54cf9", "node_type": "4", "metadata": {"page_label": "253", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "34c0d680f2e4a9c44738dc50ab890f6f290ad39cb689ce7c9a07727ced3362c9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "16ead144-9478-4920-864e-6e9771322f3d", "node_type": "1", "metadata": {"page_label": "252", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c96280b68242207f5a9025e81b2fd7e634ef13999b5274a62082fab0dd19fec8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "43897aee-4f6c-48b6-aae8-7ca601b445bc", "node_type": "1", "metadata": {}, "hash": "1a0727cd367e9493592c89410eff6083019224243ac288e03cdfbdf85bf273fe", "class_name": "RelatedNodeInfo"}}, "hash": "57e13f628d15995b88fd51218eed7de71b9401c6c802bb0f966c7ace36c33935", "text": "Annexes  \n \n13 - 31 Annex 10 E: TB Preventive Therapy dosing  \nA. Daily INH for 6 months (6H)  \nWeight (Kg)  Dose (mg)  Number of 100mg INH tablets  Number of 300mg (Adult) tablet  \n<5 50 \u00bd tablet  - \n5.1-9.9 100  1 tablet  - \n10-13.9  150  1\u00bd tablet  \u00bd tablet  \n 14-19.9  200  2 tablets  - \n20-24.9  250  2 \u00bd tablets  - \n\u226525  300  3 tablets  1 tablet  \nAdult  300  3 tablets  1 tablet", "start_char_idx": 3, "end_char_idx": 388, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "43897aee-4f6c-48b6-aae8-7ca601b445bc": {"__data__": {"id_": "43897aee-4f6c-48b6-aae8-7ca601b445bc", "embedding": null, "metadata": {"page_label": "254", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "30184d93-633a-4ee2-ae93-739dc0c6e2a3", "node_type": "4", "metadata": {"page_label": "254", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "0c695a8bf1b7530733b6a9a2c48ba91e33d82d63d04b60021fb801ebdc624d4c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7a43077d-503e-4dc8-b849-7845d0bfb3f4", "node_type": "1", "metadata": {"page_label": "253", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "57e13f628d15995b88fd51218eed7de71b9401c6c802bb0f966c7ace36c33935", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a7b0d73b-443f-4aa2-89cd-373f0211deeb", "node_type": "1", "metadata": {}, "hash": "d8f86b4dbaa225f178ba1e17787b023c3e26ad6b920d9cb9f27f74ed5a73af68", "class_name": "RelatedNodeInfo"}}, "hash": "1a0727cd367e9493592c89410eff6083019224243ac288e03cdfbdf85bf273fe", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 32 Annex 10 E: Cont.  \nB1. Daily INH for 6 months (6H)  \nWeight (Kg)  Number of tablets (RH \n75/50mg  How to reconstitute the medicine  \nLess than 2  \u00bc  Dissolve one (1) tablet of RH in 20 ml of safe drinking water. Once fully \ndissolved. Give 5ml (\u00bc) of this solution measured with a syringe.  \n2-2.9 \u00bd  Dissolve one (1) tablet of RH is 20 ml of safe drinking water. Once fully \ndissolved, give 10ml (\u00bd) of this solution measure d with a syringe.  \n3-3.9 \u00be  Dissolve one (1) tablet of RH in 20 ml of safe drinking water. Once fully \ndissolved, give 15 ml (\u00be) of this solution measured with a syringe.  \nAfter giving the child their dose for that day, discard the rest of the solution. Pre pare a fresh solution. Prepare a fresh solution every day.  \n4-7.9 1 Dissolve the tablet(s) of RH in 20mls of safe drinking water.  \n \nOnce fully dissolved, give ALL this solution to the child  8-11.9  2 \n12-15.9  3 \n16-24.9  4 \nB2. Daily RH for 3 months (3RH) for children \u226525kgs (To use adult formulation)  \nWeight (Kg)  Number of tablets (RH 150/75mg)  \n25-39.9  2 \n40-54.9  3 \n55kg and above  4 \nC.  Weekly 3HP (3HP) (For adults and adolescents \u226515 years)  \n3HP products  No of Tablets  \nRifapentine 150mg tabs  6 \nIsoniazid 300mg tabs  3 \nRifapentine 300mg+Isoniazid 200mg (FDC)  3", "start_char_idx": 3, "end_char_idx": 1340, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a7b0d73b-443f-4aa2-89cd-373f0211deeb": {"__data__": {"id_": "a7b0d73b-443f-4aa2-89cd-373f0211deeb", "embedding": null, "metadata": {"page_label": "255", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "24c4a018-3b31-4766-96fa-94560b1b92a0", "node_type": "4", "metadata": {"page_label": "255", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5853fbc6642c2f56d5853473517cdfd542e096283a12866c7856a49649adc42a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "43897aee-4f6c-48b6-aae8-7ca601b445bc", "node_type": "1", "metadata": {"page_label": "254", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1a0727cd367e9493592c89410eff6083019224243ac288e03cdfbdf85bf273fe", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "975efc77-5e83-4594-9c49-22c5bcbba2a8", "node_type": "1", "metadata": {}, "hash": "8d57b56fa2a6786c98d04bc03b3e4a5aa8794e1e275a8bc66478ab556fcbd870", "class_name": "RelatedNodeInfo"}}, "hash": "d8f86b4dbaa225f178ba1e17787b023c3e26ad6b920d9cb9f27f74ed5a73af68", "text": "Annexes  \n \n13 - 33 Annex 10 E: Cont.  \nD. Dosage of Pyrldoxine (Vitamin B6)  \nWeight (Kgs)  Dosage In mg  Number of 25mg tablets  Number of 50mg tablets  \n<5 6.25mg  \u00bd Tablet 3 times a week, alternate days  - \n5.0-79 12.5mg  Half a tablet  - \n8.0-14.9  25mg  One tablet  Half of 50mg tablet  \n15kg and above  50mg  Two tablets  One 50mg tablet  \nAdults  50mg  Two tablets  One 50mg tablet", "start_char_idx": 3, "end_char_idx": 392, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "975efc77-5e83-4594-9c49-22c5bcbba2a8": {"__data__": {"id_": "975efc77-5e83-4594-9c49-22c5bcbba2a8", "embedding": null, "metadata": {"page_label": "256", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "e44e2189-e468-4f38-b5c0-9e02ce1dc911", "node_type": "4", "metadata": {"page_label": "256", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "96e80d9b6282361dd8b7b995371be533b2d8ad0b31361b1f3fca06e96b1208fc", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a7b0d73b-443f-4aa2-89cd-373f0211deeb", "node_type": "1", "metadata": {"page_label": "255", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d8f86b4dbaa225f178ba1e17787b023c3e26ad6b920d9cb9f27f74ed5a73af68", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "f901390f-cf5a-4422-81a4-8a48b4773aa0", "node_type": "1", "metadata": {}, "hash": "872ad409787744be3aedae40783dfecb073312aefcf92580dea147b6685dfb0d", "class_name": "RelatedNodeInfo"}}, "hash": "8d57b56fa2a6786c98d04bc03b3e4a5aa8794e1e275a8bc66478ab556fcbd870", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 34 Annex 10 F: Ritonavir Dosing for Super -Boosting LPV/r in Children Taking Rifampicin  \nDosing for RTV super -boosting of LPV/r for children receiving rifampicin -containing TB treatment*  \nDrug  Strength of paediatric \ntablets or oral liquid  Number of tablets or MLS by weight -band morning (AM) and evening (PM)  Strength of \nadult tablet  Number of tablets \nby weight band  \n3\u20135.9 kg  6\u20139.9 kg  10\u201313.9 kg  14\u201319.9 kg  20\u201324.9 kg   25\u201334.9 kg  \nAM PM AM PM AM PM AM PM AM PM  AM PM \nFor children able to swallow tablets  \nLPV/rb Tablet 100/25 mg  \u2013 \u2013 \u2013 \u2013 2 1 2 2 2 2 100/25 mg  3 3 \nRTV  Tablet 100 mg  \u2013 \u2013 \u2013 \u2013 1 1 1 2 1 2  \n \n100 mg   \n2  \n2 Tablet 50 mg  \u2013 \u2013 \u2013 \u2013 2 2 3 3 3 3 \nTablet 25 mg  \u2013 \u2013 \u2013 \u2013 4 4 6 6 6 6 \nFor children unable to swallow tablets  \nLPV/r  Oral solution 80/20 mg/ml  1 ml  1 ml  1.5 \nml 1.5 ml  2 ml  2 ml  2.5 \nml 2.5 \nml 3 ml  3 ml  - - - \nPellets 40 mg/10 mg  2 2 3 3 4 4 5 5 6 6 - - - \nGranules 40 mg/10 mg \nsachet  2 2 3 3 4 4 5 5 6 6 - - - \nRTVe Oral solution 80 mg/ml  0.8 ml  0.8 ml  1.2 ml  1.2 ml  1.5 ml  1.5 ml  2 ml  2 ml  2.3 ml  2.3 ml  - - - \nPowder 100 mg/packet  - - 1 1 1 1 1 2 1 2 - - - \na Suggested RT V dose for super -boosting to achieve the same dose as LPV in mg, in a ratio equal or approaching to 1:1. This dosing approach is supported by a study which explored this \napproach in young children receiving LPV/r12. \nb the LPV/r heat -stable t ablet formulation must be swallowed whole and should not be split, chewed, dissolved or crushed. Adult 200 / 50 tablet could be used for patients 14 -24.9kg (1 \ntab am and 1 tab pm) and for patients 25 -34.9kg (2 tab am and 1 tab pm).  \nc LPV/r liquid requires a cold chain during transport and storage.  \nd LPV/r pellets formulation should not be used in infants younger than 3 months. More details on the administration of LPV/r pe llets can be found at \nhttps://www.who.int/hiv/pub/toolkits/iattfactsheet -lopinavir -ritonavir/en/. The dosing schedule provided applies to equivalent solid dosage forms that may become available such as \nLPV/r granules, which are approved by US FDA for use from 2 weeks of life.  \n  e RT V oral solution dosing is ba sed on the dosing tested in the trial that supports the use of super boosting", "start_char_idx": 3, "end_char_idx": 2290, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "f901390f-cf5a-4422-81a4-8a48b4773aa0": {"__data__": {"id_": "f901390f-cf5a-4422-81a4-8a48b4773aa0", "embedding": null, "metadata": {"page_label": "257", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "98d95e9e-d149-4afe-a949-fa889830defa", "node_type": "4", "metadata": {"page_label": "257", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "82ba8e20cf77e40b7ea58f48a4aee0292eb20155980f08968867cc6687c8451f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "975efc77-5e83-4594-9c49-22c5bcbba2a8", "node_type": "1", "metadata": {"page_label": "256", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8d57b56fa2a6786c98d04bc03b3e4a5aa8794e1e275a8bc66478ab556fcbd870", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "215a3409-68a2-403e-a8b7-752c970cd4b0", "node_type": "1", "metadata": {}, "hash": "c3553ccb1cd4fbb9c1689162c14873e00c0ae434c8a4edd38d70a78c84a31e50", "class_name": "RelatedNodeInfo"}}, "hash": "872ad409787744be3aedae40783dfecb073312aefcf92580dea147b6685dfb0d", "text": "Annexes  \n \n13 - 35 Annex 11: Overlapping toxicities between ARVs  \nBone marrow \nsuppression  Peripheral \nneuropathy  Pancreatitis  Nephrotoxicity  Hepatotoxicity  Rash  Diarrhoea  Ocular effects  \nAmphotericin B \nCotrimoxazole \nDapsone Flucytosine \nGanciclovir \nHydroxyurea \nInterferon - \nPrimaquine \nPyrimethamine \nZidovudine  Didanosine \nIsoniazid \nVincristine  Didanosine \nLamivudine  \n(esp. in \nchildren)  \nStavudine \nCotrimoxazole \nRitonavir \nPentamidine  Acyclovir  \nAdefo vir high dose \nAminoglycosides \nAmphotericin B \nCidofovir  \nFoscarnet \nPentamidine \nTenofovir  Abacavir  \nAtazanavir \nAtovaquone \nCotrimoxazole \nDapsone \nEfavirenz \nNevirapine \nSulfadiazine \nVoriconazole  Abacavir \nAtazanavir \nAtovaquone \nCotrimoxazole \nDapsone \nEfavirenz \nNevirapine \nSulfadiazine \nVoriconazole  Atovaquone \nClindamycin \nLPV/r Ritonavir  Cidofovir Ethambutol \nLinezolid Rifabutin \nVoriconazole", "start_char_idx": 3, "end_char_idx": 894, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "215a3409-68a2-403e-a8b7-752c970cd4b0": {"__data__": {"id_": "215a3409-68a2-403e-a8b7-752c970cd4b0", "embedding": null, "metadata": {"page_label": "258", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b0f723fb-1093-4b35-9453-ef43b70bd119", "node_type": "4", "metadata": {"page_label": "258", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "131a53c02ce753afd64f5be667a5124ca94c8146ffcd8f611709cbeca5ee7221", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "f901390f-cf5a-4422-81a4-8a48b4773aa0", "node_type": "1", "metadata": {"page_label": "257", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "872ad409787744be3aedae40783dfecb073312aefcf92580dea147b6685dfb0d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9145447f-91ac-443c-89da-3989bb90d2f4", "node_type": "1", "metadata": {}, "hash": "305c85600290c28df0cecf9912bb26c4015a4ee74b32b22a631b1d2dbce16c0a", "class_name": "RelatedNodeInfo"}}, "hash": "c3553ccb1cd4fbb9c1689162c14873e00c0ae434c8a4edd38d70a78c84a31e50", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 36 Annex 12 A: Use of Nucleoside & Nucleotide Reverse Transcriptase Inhibitors \nin Adults  \nDrug name  Dose (in \nadults)  Dietary \nrestrictions  Major side effects  Comments  \nZidovudine  \n(AZT or ZDV)  \n \nAvailable in 300mg \ntablets and as FDC \nwith 3TC and 3TC/ \nNVP  300mg/  \ndose BD  No food \nrestrictions  Bone marrow suppression), \nincluding anaemia; \ngranulocytopenia; headache; \ngastrointestinal intolerance; \nmyopathy; myositis; liver toxicity; \ndiscoloured nails; lactic acidosis \nand severe  \nhepatomegaly with steatosis (fatal \ncases have been reported)  Monitor for anaemia in  the \nfirst 3 months of treatment  \nLamivudine (3TC) \nAvailable in 150mg  \ntablet and as FDC \nwith AZT and \nAZT/NVP, D4T and \nD4T/NVP and with \nTDF and TDF/ EFV  150mg/ \ndose BD \nOR 300 \nmg/dose \nOD No food \nrestrictions  Headache; fatigue; nausea; \ndiarrhoea; skin rash; pancreatitis; \nperipheral neuropathy; \nhepatotoxicity/ hepatitis; lactic \nacidosis and severe hepatomegaly \nwith steatosis (rare fatal cases \nhave been reported).  A well -tolerated drug. \nAdjust dose in renal \nimpairment.  \nAlso active against hepatitis B. \nIdeally, patients should be  \nscreened for hepatitis B virus  \n(HBV) before starting therapy; \nexacerbation of hepatitis B has \nbeen reported in patients on \ndiscontinuation of 3TC.  \nAbacavir (ABC) \nAvailable in 300mg  \ntablets and in \ncombination with  \n3TC and DTG  300mg/  \ndose BD  \n or 600mg \nOD No food \nrestrictions. \nAlcohol \nincreases \nABC levels \nby 41%  Hypersensitivity reaction \n(potentially fatal) whose \nsymptoms include fever, \nfatigue, malaise, nausea, \nvomiting, diarrhoea  \nand abdominal pain or \nrespiratory symptoms such as \nshortness of breath, \nlymphadenopathy, ulceration of \nmucous  \nmembranes and skin rash. Patients \nsuspected of having \nhypersensitivity reaction should \nhave ABC stopped and never be \nrestarted. Pancreatitis; lactic \nacidosis with hepatic steatosis is \nrare  Educate patient on \nhypersensitivity reaction. \nOnce hypersensitivity has \noccurred, the patient should \nnever be re -challenged with \nABC.  \n \nAvoid alcohol while on ABC.", "start_char_idx": 1, "end_char_idx": 2160, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9145447f-91ac-443c-89da-3989bb90d2f4": {"__data__": {"id_": "9145447f-91ac-443c-89da-3989bb90d2f4", "embedding": null, "metadata": {"page_label": "259", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ad63a4be-f556-4bb4-a291-05fb3edadc94", "node_type": "4", "metadata": {"page_label": "259", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5abd4e5fd004cf0df587eda2bf96750c6eb26e1e3efc11d740589619acb0cc5f", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "215a3409-68a2-403e-a8b7-752c970cd4b0", "node_type": "1", "metadata": {"page_label": "258", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c3553ccb1cd4fbb9c1689162c14873e00c0ae434c8a4edd38d70a78c84a31e50", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "29e4f65c-2708-4343-bf6a-498308cb9d6c", "node_type": "1", "metadata": {}, "hash": "4ac1d4b7c1a7741d9bbc29a7cac53b128afbd505ae1588dda1de79d06a78e9b7", "class_name": "RelatedNodeInfo"}}, "hash": "305c85600290c28df0cecf9912bb26c4015a4ee74b32b22a631b1d2dbce16c0a", "text": "Annexes  \n \n13 - 37 Table 12 A: Cont.  \nDrug name  Dose (in \nadults)  Dietary \nrestrictions  Major side effects  Comments  \nEmtricitabine  \n(FTC)  \n \nAvailable in 200mg \ncapsules and as FDC \nwith TDF and \nTDF/EFV  200mg/  \ndose OD  No food \nrestrictions  Well tolerated. Lactic \nacidosis and severe \nhepatomegaly with \nsteatosis (fatal cases have \nbeen reported); headache; \ndiarrhoea; nausea; rash; \nskin discoloration  Effective against hepatitis B. \nIdeally, patients should be \nscreened for chronic hepatitis B \nvirus (HBV) before starting \ntherapy; exacerbation of Hepatitis \nB has been reported in patients on \ndiscontinuation of FTC  \nDecrease dosage in patients with \nrenal impairment Monitor renal \nfunction if combined with TDF.  \nWhen used in combination with \nTDF, should not be given to \npatients with a creatinine \nclearance of <30ml/min. Should \nnot be used with or aft er failure of \n3TC  \nTenofovir \ndisoproxil fumarate \n(TDF)  \n \nAvailable in 300mg \ntablets and as FDC \nwith 3TC and 3TC/ \nEFV  300mg/  \ndose OD  No food \nrestrictions  Lactic acidosis and severe \nhepatomegaly with \nsteatosis (fatal cases have \nbeen reported with \nnucleoside analogues); \nrenal toxicity; Pancreatitis  Should not be used with ddI. \nShould never be used in triple \nnucleoside combinations  \nwith 3TC+ddI/ABC.  Renal function \nshould be monitored while on TDF  \nIdeally, patients should be \nscreened for chronic hepatitis B \nvirus (HBV) before starting \ntherapy; Exacerbation of hepatitis \nB has been reported in patients on \ndiscontinuation of TDF  \nWhen used in combination with \n3TC, should not be given to \npatients with a creatinine \nclearance of <30ml/min.  \nWhen used with ATV levels of ATV \nreduced significantly therefore \ncombine with RTV  \nTenofovir \nalafenamide (TAF)  \n \nVarious co -\nformulations \navailable or being \ndeveloped  As TAF 25 \nmg alone or \nas part of \nco-\nformulated \nFDC  No food \nrestrictions  Well tolerated. GIT upsets, \nraised serum creatinine, \nproteinuria and renal \ntoxicity (but to a lesser \ndegree than TDF)  RTV and cobicistat increase TAF \nlevels. DRV decreases TAF levels. \nBoosted PI increase TAF levels but \nthe PI levels are not affected.  \nAvoid co -administration with \nrifabutin, rifampicin and phenytoin", "start_char_idx": 1, "end_char_idx": 2249, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "29e4f65c-2708-4343-bf6a-498308cb9d6c": {"__data__": {"id_": "29e4f65c-2708-4343-bf6a-498308cb9d6c", "embedding": null, "metadata": {"page_label": "260", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "eabfacd8-7d97-45e1-8393-5bad6c51a8b4", "node_type": "4", "metadata": {"page_label": "260", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4d12f5821dd312867d4fd8bf48f13fcecd6b21019850a68bfbb14083b0d0b3c9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9145447f-91ac-443c-89da-3989bb90d2f4", "node_type": "1", "metadata": {"page_label": "259", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "305c85600290c28df0cecf9912bb26c4015a4ee74b32b22a631b1d2dbce16c0a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "310c7171-82a8-4bff-a2b3-79cc888c895d", "node_type": "1", "metadata": {}, "hash": "7be0dc4222b73b99fddd275474227f260af6b124054db8a03ac431d225bcc7f8", "class_name": "RelatedNodeInfo"}}, "hash": "4ac1d4b7c1a7741d9bbc29a7cac53b128afbd505ae1588dda1de79d06a78e9b7", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 38 Annex 12 B: Use of Non -Nucleoside Reverse Transcriptase Inhibitors for Adults  \nDrug name  Dose (in \nadults)  Dietary \nrestrictions  Major side effects  Comments  \nEfavirenz (EFV) \nAvailable in 200mg  \n& 600mg tablets \nand as FDC with \nTDF/3TC  600mg \nOD Best \ntaken  \nat \nbedtime  Preferably \ntaken on an \nempty \nstomach.  \nCan be given \nwith food, \nbut avoid \nhigh fat  \nmeals which \nincrease \nabsorption.  CNS symptoms \n(somnolence, insomnia, \nabnormal dreams, \nconfusion, \nhallucination, amnesia, \netc. Avoid in patients \nwith history of \npsychiatric disease);  \nSkin rash; avoid use in \nduring the first \ntrimester  Can be used with rifampicin in TB \npatients  \nEtravirine (ETR) \nAvailable in tablets  \nof 200 mg   \n200 mg \nBD  \nTake with \nfood  Severe but rare: SJS and \nerythema multiforme \nCommon & minor: \nRash, nausea, vomiting, \ndiarrhoea, abdominal \npain, hepatotoxicity, \ndyslipidaemia and CNS \ndisturbances (less than \nEFV)  Avoid concurrent use with \nrifampicin, and boosted tipranavir.", "start_char_idx": 1, "end_char_idx": 1067, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "310c7171-82a8-4bff-a2b3-79cc888c895d": {"__data__": {"id_": "310c7171-82a8-4bff-a2b3-79cc888c895d", "embedding": null, "metadata": {"page_label": "261", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "72c0c7f5-62c9-4edb-b5d7-87e09ac6afa0", "node_type": "4", "metadata": {"page_label": "261", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c01d81e422aece431f61ca645d9e1c327fdc3575ea4cfa18acb5e1a2d6ceed1c", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "29e4f65c-2708-4343-bf6a-498308cb9d6c", "node_type": "1", "metadata": {"page_label": "260", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4ac1d4b7c1a7741d9bbc29a7cac53b128afbd505ae1588dda1de79d06a78e9b7", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d1797b7f-8e89-4d1f-83a3-39b3d78284be", "node_type": "1", "metadata": {}, "hash": "5f5dd3d529878e29795b9621faa6c173c250f8e72349410540f152ca062115a6", "class_name": "RelatedNodeInfo"}}, "hash": "7be0dc4222b73b99fddd275474227f260af6b124054db8a03ac431d225bcc7f8", "text": "Annexes  \n \n13 - 39 Annex 12 C: Use of Protease Inhibitors in Adults  \nDrug name  Dose (in \nadults)  Dietary \nrestrictions  Major side effects  Comments  \nLopinavir/ritonav\nir (LPV/r) \nAvailable as \n200mg  \n+ 50mg RTV  [LPV 400 mg \n+ RTV  \n100 mg] 2 \ntablets BD  Take with food. \nModerate  \nfat increases \nbioavailability.  GI intolerance; \nnausea; vomiting; \ndiarrhoea  Tablets should be \nswallowed whole  \nAtazanavir  \n(ATV)  \n \nAvailable in  \n100mg, 150mg, \n200 mg capsules  \n \nAvailable as FDC  \nwith RTV  ATV 300mg / \nRTV 100mg \nOD Take with food. \nTake 2 hours \nbefore or 1  \nhour after \nantacids and \nbuffered \nmedications \nsuch as buffered \nddI (reduced \nATV \nconcentrations  \nif administered \ntogether)  Jaundice; headache; \nfever; depression; \nnausea; diarrhoea \nand vomiting; \nparaesthesia; \nspontaneous \nbleeding episodes \nin haemop hiliacs.  Indirect \nhyperbilirubinaemia. \nWhen used with TDF \nshould always be given \nwith RTV. Experienced \npatients should also be \ngiven ATV/RTV.  \nRitonavir  \n(RTV)  \n \nAvailable as 100mg \ncapsules  \nCapsules should be \nrefrigerated until \ndispensed; stable \nat room (up to \n25\u00baC) for 30 days  Recommended \nfor use as a \nbooster of \nother PIs  Administration \nwith food \nincreases \nabsorption and \nhelps reduce \ngastrointestinal \nside effects.  Exacerbation of liver \ndisease; fat \nredistribution and \nlipid abnormalities; \ndiarrhoea; \nabdom inal \ndiscomfort; \nheadache; nausea; \nparaesthesia;  \nskin rash; \nspontaneous \nbleeding episodes in \nhaemophiliacs.  Potent CYP450 inhibitor, \nthus its use as a booster \nof other PIs  \nDarunavir (DRV)  DRV 600 \nmg/ RTV \n100 mg BID \nOR \n \nDRV 800 \nmg/ RTV 100 \nmg OD (only \nif PI na\u00efve)  Take with a \nmeal to limit \nADR  GIT upsets, rash, \ndyslipidaemia, \nhepatitis. Caution \nin patients with \nsulphur allergy.  Metabolized by CYP3A \nand is an inhibitor of \nCYP3A. Contains sulphur \nmoiety. Monitor liver \nfunctions especially in \npatients at risk  or with \npre-existing liver  \ndisease.  May cause \nhormonal contraceptive \nfailure.", "start_char_idx": 1, "end_char_idx": 2023, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d1797b7f-8e89-4d1f-83a3-39b3d78284be": {"__data__": {"id_": "d1797b7f-8e89-4d1f-83a3-39b3d78284be", "embedding": null, "metadata": {"page_label": "262", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "723e5b8c-fff0-4f5a-a1ac-bb1400aeacae", "node_type": "4", "metadata": {"page_label": "262", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3618fa078c1aaf71c32a5b7606e66736596eed39bc3cac95bf3bd98c30703d15", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "310c7171-82a8-4bff-a2b3-79cc888c895d", "node_type": "1", "metadata": {"page_label": "261", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7be0dc4222b73b99fddd275474227f260af6b124054db8a03ac431d225bcc7f8", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "ac969408-0e41-4e21-8b21-71309c2b2a98", "node_type": "1", "metadata": {}, "hash": "fbce14f09331f001be8d14c8d74a87efbed3327a3594e4f4ddccc09b6e7d0d8f", "class_name": "RelatedNodeInfo"}}, "hash": "5f5dd3d529878e29795b9621faa6c173c250f8e72349410540f152ca062115a6", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 40 Annex 12 D: Integrase Strand Transfer Inhibitors - INSTIs  \nDrug name  Dose (in adults)  Dietary \nrestrictions  Major side effects  Comments  \nDolutegravir \n(DTG) Available \nas DTG 50mg, \n10mg dispersible \ntablet  \n \nOr FDCs:  \nABC/3TC/DTG \n(600/300/50mg)  \n \nand \n \nTDF/3TC/DTG \n(300/300/50mg)  50 mg once daily  \n \nIf co - \nadministering with \nEFV, \ncarbamazepine, or \nrifampicin, use \nDTG 50 mg BD  \n \nIf suspected or \nconfirmed INSTI \nresistance use DTG \n50 mg BD  No food \nrestrictions  Rare - \nHypersensitivity; \nHepatotoxicity \nespecially in those  \nwith HBV and HCV  \ninfection, fatigue  \n \nInsomnia, headache, \ndiarrhea, nausea is \ncommon but usually \nminor and resolve \nwith continued use  Interacts with  carbamazepine, \nphenobarbital and phenytoin, \nuse alternative \nanticonvulsants.  \n \nAdminister DTG at least 2 \nhours before or 6 hours after \ntaking supplements or \nantacids containing Mg, Al, Fe, \nCa and Zn. For Ca or Fe, if DTG \nis taken with a meal then dose \nsepa ration is not required  \nRaltegravir (RAL)  ADULT and CHILD \nover 16 years, 400 \nmg BD  No food \nrestrictions  Nausea, vomiting, \ndiarrhoea, \nflatulence, \nconstipation  \nSevere skin (SJS \nand TEN) and \nhypersensitivity \nreactions have \nbeen reported  Contraindicated in \nbreast - feeding mothers  \nSafety in paediatric patients \nhas not been established", "start_char_idx": 1, "end_char_idx": 1402, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "ac969408-0e41-4e21-8b21-71309c2b2a98": {"__data__": {"id_": "ac969408-0e41-4e21-8b21-71309c2b2a98", "embedding": null, "metadata": {"page_label": "263", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "dd583f07-bf9e-470d-823f-c33cbd65c198", "node_type": "4", "metadata": {"page_label": "263", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "403743f65a95d300488a22b5fa5d1df22361bd67787be4d1d07a2b8a28e04645", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d1797b7f-8e89-4d1f-83a3-39b3d78284be", "node_type": "1", "metadata": {"page_label": "262", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5f5dd3d529878e29795b9621faa6c173c250f8e72349410540f152ca062115a6", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2c1d2be8-97fd-4222-a94b-96187ca79479", "node_type": "1", "metadata": {}, "hash": "67178051370f32f841e882def1bd0bce1b051fd9ae3d20ead6a5ba0af318bc67", "class_name": "RelatedNodeInfo"}}, "hash": "fbce14f09331f001be8d14c8d74a87efbed3327a3594e4f4ddccc09b6e7d0d8f", "text": "Annexes  \n \n13 - 41 Annex 13 A: Drug -Drug Interactions - NNRTIs  \nDrugs Affected  Nevirapine (NVP)  Efavirenz (EFV)  \nANTIRETROVIRALS  \nDolutegravir  Co-administration not recommended because NVP \ndecreases levels of DTG  Co-administration not recommended because EFV decreases \nlevels of DTG.  If must be used together then increase DTG to \n50 mg BD when co -administered with EFV  \nRaltegravir  No interaction or not studied  Efavirenz decreases RAL plasma levels but it is unlikely to be \nclinically sign ificant  \nAtazanavir/ritonavir  Co-administration not recommended because ATV/r may \nincrease the serum concentration of NVP leading to \nincreased risk of toxicity, and NVP decreases the serum \nconcentration of ATV/r which may lead to resistance and \ntreatment failure  Co-administration not recommended because EFV decreases \nthe serum concentration of ATV/r which may lead to \nresistance and treatment failure  \nLopinavir/ritonavir  Co-administration not recommended because NVP \ndecreases levels of LPV/r  AVOID : this combination increased risk of prolonged -QT \nsyndrome and sudden cardiac death  \nDarunavir/ ritonavir  No significant interaction when NVP is combined with \nritonavir -boosted darunavir  Co-administration not recommended because DRV/r may \nincrease the seru m concentration of EFV leading to increased \nrisk of toxicity, and EFV decreases the serum concentration of \nDRV/r which may lead to resistance and treatment failure", "start_char_idx": 1, "end_char_idx": 1455, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2c1d2be8-97fd-4222-a94b-96187ca79479": {"__data__": {"id_": "2c1d2be8-97fd-4222-a94b-96187ca79479", "embedding": null, "metadata": {"page_label": "264", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f4f5f9ce-aa7a-4475-a2fd-340507b7f0ba", "node_type": "4", "metadata": {"page_label": "264", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "651f65e74f5d79bebffe93d51fc803ff7f1300d0c1984dd18f99d1507ea92609", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "ac969408-0e41-4e21-8b21-71309c2b2a98", "node_type": "1", "metadata": {"page_label": "263", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "fbce14f09331f001be8d14c8d74a87efbed3327a3594e4f4ddccc09b6e7d0d8f", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "31e4ef0a-5d7f-4026-a1d0-a5c5bd36a1c8", "node_type": "1", "metadata": {}, "hash": "1abcdac8a8ab847d9070155d2efc9484955b470a0d5008f7a0a495a2f5d95a2e", "class_name": "RelatedNodeInfo"}}, "hash": "67178051370f32f841e882def1bd0bce1b051fd9ae3d20ead6a5ba0af318bc67", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 42 Annex 13 A: Cont.  \nANTIFUNGALS  \nKetoconazole  Levels: ketoconazole \u2193 63%  \nNVP \u2191 15 \u2013 30%  \nDose: Not recommended  No data  \nVoriconazole  Metabolism of Voriconazole may be induced by NVP. \nVoriconazole may inhibit NNRTI metabolism. Frequently \nmonitor for NNRTI toxicity and antifungal outcome  Levels: EFV \u2191 44%  \nVoriconazole \u2193 77%  \nThis combination is not recommended  \nFluconazole  NVP Levels: Cmax, AUC, and Cmin \u2191 100%  \nFluconazole Levels: No change  \nRisk of hepatotoxicity may increase with this combination. If \nconcomitant use is necessary, recommend monitoring NVP \ntoxicity  No clinically significant changes in EFV or \nFluconazole concentrations  \nANTI -MYCOBACTERIALS  \nRifampicin  Levels: NVP \u2193 20% -58%. Virologic consequences are uncertain; \nthe potential for additive hepatotoxicity exists. Use of this \ncombination is not recommended; however, if used, co \nadministration should be done with careful monitoring  Levels: EFV \u2193 25%.  \nDose: Consider \u2191 EFV to 800 mg QD  \nClarithromycin  Levels: NVP \u2191 26%. Clarithromycin \u2193 30%. Monitor for efficacy \nor use alternative agent  Levels: Clarithromycin \u2193 39%.  \nMonitor for efficacy or use alternative agent  \nBedaquiline (BDQ)  No dose adjustment required  Do not co -administer  \nDelamanid (DLM)  No interaction expected  No interaction  \nORAL CONTRACEPTIVES  \n Levels: ethinyl estradiol approx. 20%. Use alternative or \nadditional methods.  Levels: Ethinyl estradiol   37%. No data on other \ncomponents. Use alternative or additional methods", "start_char_idx": 1, "end_char_idx": 1577, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "31e4ef0a-5d7f-4026-a1d0-a5c5bd36a1c8": {"__data__": {"id_": "31e4ef0a-5d7f-4026-a1d0-a5c5bd36a1c8", "embedding": null, "metadata": {"page_label": "265", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "30e49970-b5f1-48d2-977d-149920a906b0", "node_type": "4", "metadata": {"page_label": "265", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "2e2b378b32fe4bf6a5b618c038806b70d772bd27806c8c705fa1a2b0f7c2adcd", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2c1d2be8-97fd-4222-a94b-96187ca79479", "node_type": "1", "metadata": {"page_label": "264", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "67178051370f32f841e882def1bd0bce1b051fd9ae3d20ead6a5ba0af318bc67", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "799a97f7-cf48-474e-8889-b682e5b187a4", "node_type": "1", "metadata": {}, "hash": "4f63639b97cbf6bf2822e6b2ca69ce4bb2f5accc9596057de5213e5fd650fa18", "class_name": "RelatedNodeInfo"}}, "hash": "1abcdac8a8ab847d9070155d2efc9484955b470a0d5008f7a0a495a2f5d95a2e", "text": "Annexes  \n \n13 - 43 Annex 13 A: Cont.  \nLIPID -LOWERING AGENTS  \nSimvastatin  \nLovastatin  No data  Levels: Simvastatin AUC    by 58%; EFV unchanged  \nDose: Adjust simvastatin dose according to lipid responses, \nnot to exceed the maximum recommended dose  \nAtorvastatin  No data  Levels: Atorvastatin AUC   43%; EFV unchanged.  \nDose: Adjust atorvastatin dose according to lipid responses, \nnot to exceed the maximum recommended dose  \nPravastatin  No data  No data  \nANTI -HYPERTENSIVES   \nAngiotensin -converting enzyme \ninhibitors (ACEIs): E.g.  - Enalapril, \nLisinopril  No known interactions  No known interactions  \nAngiotensin II receptor blockers \n(ARBs): e.g., Losartan, Telmisartan  Telmisartan, Candesartan: None  \nLosartan: Potential interactions with all NNRTIs, net effect \nof interaction difficult to predict, use with caution  Telmisartan, Candesartan: None  \nLosartan: Potential interactions with all NNRTIs, net effect \nof interaction difficult to predict, use with caution  \nBeta blockers: e.g., Atenolol, \nCarvedilol and Propranolol  No known interactions  No known interactions  \nCalcium channel blockers (CCBs): \ne.g., Nifedipine, Amlodipine and \nFelodipine  Potential interaction with all NNRTIs: Metabolism of CCBs \nis induced by EFV or NVP, blunting antihypertensive \neffect: higher starting dose of CCB may be required  Potential intera ction with all NNRTIs: Metabolism of CCBs \nis induced by EFV or NVP, blunting antihypertensive effect: \nhigher starting dose of CCB may be required  \nDiuretics: E.g., HCTZ, Indapamide. \nFurosemide and Spironolactone  No known interactions  No known interactions  \nOthers: Alpha blockers:  \nMethyldopa, Hydralazine   No known interactions  No known interactions", "start_char_idx": 1, "end_char_idx": 1724, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "799a97f7-cf48-474e-8889-b682e5b187a4": {"__data__": {"id_": "799a97f7-cf48-474e-8889-b682e5b187a4", "embedding": null, "metadata": {"page_label": "266", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "dc206cc4-e527-469e-933d-56be572cbc24", "node_type": "4", "metadata": {"page_label": "266", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "8d99107e1def789f8c3da73cd94d51151a9ae8d78c033a93a45baa2167157ba5", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "31e4ef0a-5d7f-4026-a1d0-a5c5bd36a1c8", "node_type": "1", "metadata": {"page_label": "265", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "1abcdac8a8ab847d9070155d2efc9484955b470a0d5008f7a0a495a2f5d95a2e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2e37f7a4-3daf-4d10-be61-5c4b2d8a38f7", "node_type": "1", "metadata": {}, "hash": "260dd35ecf449a40b3f67fe95683677a15753e7a286b90a3b1a8dc4812306072", "class_name": "RelatedNodeInfo"}}, "hash": "4f63639b97cbf6bf2822e6b2ca69ce4bb2f5accc9596057de5213e5fd650fa18", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 44 Annex 13 A: Cont.  \nANTICONVULSANTS  \nCarbamazepine Phenobarbital \nPhenytoin  Unknown  \nUse with caution.  \nMonitor anticonvulsant levels  Use with caution  \nMonitor anticonvulsant levels  \nMETHADONE  Levels: NVP unchanged. Methadone significantly. \nOpiate withdrawal common when this combination \nis used. Increased methadone dose often necessary. \nTitrate methadone dose to effect  Levels: Methadone   60%  \nOpiate withdrawal common, increase methadone dose often \nnecessary. Titrate methadone dose to effect  \nMISCELLANEOUS  No data  Monitor warfarin when used concomitantly", "start_char_idx": 1, "end_char_idx": 642, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2e37f7a4-3daf-4d10-be61-5c4b2d8a38f7": {"__data__": {"id_": "2e37f7a4-3daf-4d10-be61-5c4b2d8a38f7", "embedding": null, "metadata": {"page_label": "267", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6d092960-66ef-468a-8e6e-d9327b3d0599", "node_type": "4", "metadata": {"page_label": "267", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "5222961e5072eb929637faa88a0e3a18ee81f8e4bd0ef938cd2da6a5bc25190b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "799a97f7-cf48-474e-8889-b682e5b187a4", "node_type": "1", "metadata": {"page_label": "266", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "4f63639b97cbf6bf2822e6b2ca69ce4bb2f5accc9596057de5213e5fd650fa18", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "1bfba98f-2c1c-4ce2-a1ff-4330823c9e24", "node_type": "1", "metadata": {}, "hash": "b781d67cca12d228bb21f20aac92b59e46067a38919446fe7c11694903724d75", "class_name": "RelatedNodeInfo"}}, "hash": "260dd35ecf449a40b3f67fe95683677a15753e7a286b90a3b1a8dc4812306072", "text": "Annexes  \n \n13 - 45 Annex 13 B: Drug -Drug Interactions \u2013 PIs \nDrugs Affected  Atazanavir (ATV)  Ritonavir  \n(RTV)  Darunavir (DRV)  Lopinavir (LPV)  \nANTIRETROVIRALS  \nEFV  Co-administration not \nrecommended because EFV \ndecreases the serum \nconcentration of ATV/r which \nmay lead to resistance and \ntreatment failure  See interaction with specific \nritonavir -boosted PI  Co-administration not \nrecommended because DRV/r \nmay increase the serum \nconcentration of EFV leading to \nincreased risk of toxicity, and EFV \ndecreases the serum \nconcentration of DRV/r which \nmay lead to resistance and \ntreatment failure  AVOID: this combination \nincreased risk of \nprolonged -QT syndrome \nand sudden cardiac death  \nETR  No significant interaction  See interaction with specific \nritonavir -boosted PI  No significant interaction  \n No significant interaction  \nDTG  No significant interaction  See interaction with specific \nritonavir -boosted PI  No significant interaction  No significant interaction  \nRAL  ATV/r may increase RAL levels \nbut interaction in not clinically \nsignificant  See interaction with specific \nritonavir -boosted PI  No sign ificant interaction  No significant interaction", "start_char_idx": 1, "end_char_idx": 1195, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "1bfba98f-2c1c-4ce2-a1ff-4330823c9e24": {"__data__": {"id_": "1bfba98f-2c1c-4ce2-a1ff-4330823c9e24", "embedding": null, "metadata": {"page_label": "268", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "ae462694-9a64-454a-b417-df4e97a4c829", "node_type": "4", "metadata": {"page_label": "268", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "d9f416bf61e6142238c7217ac84088179a942d7571f364e29f04be0646b20a7b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "2e37f7a4-3daf-4d10-be61-5c4b2d8a38f7", "node_type": "1", "metadata": {"page_label": "267", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "260dd35ecf449a40b3f67fe95683677a15753e7a286b90a3b1a8dc4812306072", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "dbc82e0c-fa41-4e4b-8d35-60a89e1f0e11", "node_type": "1", "metadata": {}, "hash": "c32d4059bb47bf4ec8ee90e1478d4e47164775c58cd118cd14ed94ba97e11633", "class_name": "RelatedNodeInfo"}}, "hash": "b781d67cca12d228bb21f20aac92b59e46067a38919446fe7c11694903724d75", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 46 Annex 13 B: Cont.  \nANTIFUNGALS  \nItraconazole  Limited data, minimal effect  No data, but potential for bi - \ndirectional inhibition between \nItraconazole and RTV, monitor for \ntoxicities  \n \nDose: dose adjustment for patients \nreceiving  \n>400 mg Itraconazole may be \nneeded, or consider monitoring \nItraconazole level  \u2191 Levels of azoles and DRV  \u2191 Levels: itraconazole when \nadministered with LPV/r  \n \nDose: itraconazole  \n\u2013 consider not to exceed \n200 mg/day or monitor \nlevel and toxicity  \nKetoconazole  Limited data, minimal effect  Levels: Ketoconazole \u2191 3X \nDose: Use with caution; do not \nexceed 200 mg ketoconazole daily  \u2191 levels of azoles and DRV  Levels: LPV AUC \u2193 \n13% Azole \u2191 3-fold.  \nDose: Use with caution; do \nnot exceed 200 mg \nketoconazole daily  \nANTI -MYCOBACTERIALS  \nRifampicin  Atazanavir AUC: decreased 72%; \nCmax: decreased  \n53%; Cmin:  \ndecreased 98%  Levels: RTV \u2193 35%.  \n \nDose: No change. Increased liver \ntoxicity possible. Co-administration \nmay lead to loss of virologic response \nis RTV sole PI. Alternate anti - \nmycobacterial agents, such as \nrifabutin, should be considered  \u2193 levels of DRV  Levels: LPV AUC \u2193 \n75%. Should not be co \nadministered as  \na safe and effective dose of \nLPV/ r that can be given \nwith rifampicin has not \nbeen established  \nRifapentine  Do NOT co -administer  Do NOT co -administer  Do NOT co -administer  Do NOT co -administer", "start_char_idx": 1, "end_char_idx": 1463, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "dbc82e0c-fa41-4e4b-8d35-60a89e1f0e11": {"__data__": {"id_": "dbc82e0c-fa41-4e4b-8d35-60a89e1f0e11", "embedding": null, "metadata": {"page_label": "269", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "6bc22192-74bb-468a-8170-23e52328e215", "node_type": "4", "metadata": {"page_label": "269", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c38238c9696b5cc71c9873ded6a6582ce487998d61e3cf648b9bd6cf0b323b91", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "1bfba98f-2c1c-4ce2-a1ff-4330823c9e24", "node_type": "1", "metadata": {"page_label": "268", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b781d67cca12d228bb21f20aac92b59e46067a38919446fe7c11694903724d75", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7b600f31-d3c9-4541-8674-42e0ee2a956f", "node_type": "1", "metadata": {}, "hash": "97cf5529212a58a78adc64973eecd579986af82078d49120d6bc41a0ee455e7e", "class_name": "RelatedNodeInfo"}}, "hash": "c32d4059bb47bf4ec8ee90e1478d4e47164775c58cd118cd14ed94ba97e11633", "text": "Annexes  \n \n13 - 47 Annex 13 B: Cont.  \nClarithromycin  Clarithromycin AUC:  \nincreased 94%;  Levels; Clarithromycin  \n\u2191 77%  \n \nDose: Adjust clarithromycin \ndose for moderate and severe \nrenal impairment  \u2191 levels of clarithromycin by  \n59%  Levels: \u2191  \nClarithromycin AUC 77%  \nDose: Adjust clarithromycin \ndose for moderate and \nsevere renal impairment  \nBedaquiline \n(BDQ)  Increases BDQ exposure and \nincreases risk of prolonged QT \nsyndrome, monitor for increased \ntoxic effects by frequent ECG and \ntransaminases assessment  Increases BDQ exposure, \nmonitor for increased toxic \neffects by frequent ECG and \ntransamin ases assessment  Increases BDQ exposure, \nmonitor for increased toxic \neffects by frequent ECG and \ntransaminases assessment  Do NOT co -administer \nbecause of increased risk of \nprolonged QT syndrome  \n \nIncreases BDQ exposure, \nmonitor for increased toxic \neffects  \nDelamanid \n(DLM)  Increases DLM exposure, monitor \nfor increased toxic effects by \nfrequent ECG and transaminases \nassessment  Increases DLM exposure, \nmonitor for increased toxic \neffects by frequent ECG and \ntransaminases assessment  Increases DLM exposur e, \nmonitor for increased toxic \neffects by frequent ECG and \ntransaminases assessment  Do NOT co -administer \nbecause of increased risk of \nprolonged QT syndrome  \n \nIncreases DLM exposure, \nmonitor for increased toxic \neffects  \nORAL CONTRACEPTIVES  \n Ethinyl estradiol  \nAUC: \u2193 Levels: Ethinyl estradiol  \n\u2193 40%.  \n \nUse alternative or additional \nmethod  Ethinyl estradiol  \nAUC:  \u2193 44%  Levels: Ethinyl estradiol  \n\u2193 42%  \nUse alternative or \nadditional method", "start_char_idx": 1, "end_char_idx": 1618, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "7b600f31-d3c9-4541-8674-42e0ee2a956f": {"__data__": {"id_": "7b600f31-d3c9-4541-8674-42e0ee2a956f", "embedding": null, "metadata": {"page_label": "270", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "5464fc8b-12c5-49ff-90bb-51b7be4f6622", "node_type": "4", "metadata": {"page_label": "270", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "23b2a062d9ee373c25e69586e95334b643405f3ba8410eae8aa8c6fca0b7f8d6", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "dbc82e0c-fa41-4e4b-8d35-60a89e1f0e11", "node_type": "1", "metadata": {"page_label": "269", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c32d4059bb47bf4ec8ee90e1478d4e47164775c58cd118cd14ed94ba97e11633", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "3e0ec887-a619-47c7-8de6-9958df1b11bd", "node_type": "1", "metadata": {}, "hash": "59a521b2ffc6ff95111fe80591263ada269fc35cb38c53baabb3e0c82b2a7822", "class_name": "RelatedNodeInfo"}}, "hash": "97cf5529212a58a78adc64973eecd579986af82078d49120d6bc41a0ee455e7e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 48 Annex 13 B: Cont.  \nLIPID -LOWERING AGENTS  \nSimvastatin  \nLovastatin  Avoid co - administration  Levels: potential  \nfor large increase in statin \nlevels. Avoid concomitant use  Avoid  Levels: Potential  \nfor large increase in statin \nlevels  \nAvoid concomitant use  \nAtorvastatin  Minimal interaction  Levels:  450% \u2191 \nwhen administered with \nSQV/RTV combination. Use \nlowest possible starting dose of \natorvastatin with careful \nmonitoring  \u2191 AUC four -fold  Atorvastatin AUC \u2191 \n5.88 -fold. Use lowest possible \nstarting  \ndose of atorvastatin with \ncareful monitoring  \nPravastatin  Minimal interaction  Levels: 50% \u2193 when \nadministered  \nwith SQV/RTV  \ncombination  \n \nDose: Pravastatin dosage \nadjustment based on lipid \nresponse  \u2191 AUC 81%  Pravastatin AUC  \n\u2191 33%; no dosage adjustment \nnecessary  \nANTI -HYPERTENSIVES  \nAngiotensin -\nconverting enzyme \ninhibitors (ACEIs): \nE.g. - Enalapril, \nLisinopril  No known interactions  No known interactions  No known interactions  No known interactions", "start_char_idx": 1, "end_char_idx": 1069, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "3e0ec887-a619-47c7-8de6-9958df1b11bd": {"__data__": {"id_": "3e0ec887-a619-47c7-8de6-9958df1b11bd", "embedding": null, "metadata": {"page_label": "271", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "53097351-49a9-48d7-87ac-660478a0f8f6", "node_type": "4", "metadata": {"page_label": "271", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "170da4757b9ef6b54f989d6dbcc6d4a0a7172092b04e455ac0db092b81774b60", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7b600f31-d3c9-4541-8674-42e0ee2a956f", "node_type": "1", "metadata": {"page_label": "270", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "97cf5529212a58a78adc64973eecd579986af82078d49120d6bc41a0ee455e7e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "42347089-e6b2-4b2b-8212-2c5ffb0238c0", "node_type": "1", "metadata": {}, "hash": "f7f010add0ad3d53e352093562a7b987334c5f8b1b970daa34520faf69986f9a", "class_name": "RelatedNodeInfo"}}, "hash": "59a521b2ffc6ff95111fe80591263ada269fc35cb38c53baabb3e0c82b2a7822", "text": "Annexes  \n \n13 - 49 Annex 13 B: Cont.  \nAngiotensin II \nreceptor blockers \n(ARBs): e.g., \nLosartan, \nTelmisartan  Telmisartan, Candesartan:  \nNone  \nLosartan: Potential \ninteractions with all PIs, net \neffect of interaction difficult \nto predict, use with caution  Telmisartan, Candesartan:  None  \nLosartan: Potential interactions \nwith all PIs, net effect of \ninteraction difficult to predict, \nuse with caution  Telmisartan, Candesartan:  None  \nLosartan: Potential interactions \nwith all PIs, net effect of \ninteraction difficult to predict, \nuse with caution  Telmisartan, Candesartan:  \nNone  \nLosartan: Potential \ninteractions with all PIs, net \neffect of interaction difficult to \npredict, use with caution  \nBeta blockers: e.g., \nAtenolol, Carvedilol \nand Propranolol  Potential increase in B -\nblocker effect, careful dose \nadjustment and ECG where \nindicated  Potential increase in B -blocker \neffect, careful dose adjustment \nand ECG where indicated  Potential increase in B -blocker \neffect, careful dose adjustment \nand ECG where indicated  Potential increase in B -blocker \neffect, careful dose adjustment \nand ECG where indicated  \nCalcium channel \nblockers (CCBs): e.g., \nNifedipine, \nAmlodipine and \nFelodipine  Potential interaction with all \nPIs: Metabolism of CCBs \ninhibited, increasing \nantihypertensive effect: \nlower starting dose  of CCB \nmay be required, monitor for \nexcessive reduction in BP  Potential interaction with all \nPIs: Metabolism of CCBs \ninhibited, increasing \nantihypertensive effect: lower \nstarting dose of CCB may be \nrequired, monitor for excessive \nreduction in BP  Potential  interaction with all \nPIs: Metabolism of CCBs \ninhibited, increasing \nantihypertensive effect: lower \nstarting dose of CCB may be \nrequired, monitor for excessive \nreduction in BP  Potential interaction with all \nPIs: Metabolism of CCBs \ninhibited, increasing \nanti hypertensive effect: lower \nstarting dose of CCB may be \nrequired, monitor for excessive \nreduction in BP  \nDiuretics: E.g., HCTZ, \nIndapamide. \nFurosemide and \nSpironolactone  No known interactions  No known interactions  No known interactions  No known interactions  \nOthers: Alpha \nblockers:  \nMethyldopa, \nHydralazine   No known interactions  No known interactions  No known interactions  No known interactions", "start_char_idx": 1, "end_char_idx": 2305, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "42347089-e6b2-4b2b-8212-2c5ffb0238c0": {"__data__": {"id_": "42347089-e6b2-4b2b-8212-2c5ffb0238c0", "embedding": null, "metadata": {"page_label": "272", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "f99b3712-8948-4926-b671-bce9280bb2b0", "node_type": "4", "metadata": {"page_label": "272", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ce9e0867c61390c8b682551a850257fea1d3112505db93cfa2a3c766d8c87cc9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "3e0ec887-a619-47c7-8de6-9958df1b11bd", "node_type": "1", "metadata": {"page_label": "271", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "59a521b2ffc6ff95111fe80591263ada269fc35cb38c53baabb3e0c82b2a7822", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "afee6688-f6d9-41f7-82ca-53f1b360ad5b", "node_type": "1", "metadata": {}, "hash": "b4480501cb78e181144dbfa3b34329a5749cb797eacc5aeb0b22a560d61e4b09", "class_name": "RelatedNodeInfo"}}, "hash": "f7f010add0ad3d53e352093562a7b987334c5f8b1b970daa34520faf69986f9a", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 50 Annex 13 B: Cont.  \nANTICONVULSANTS  \nCarbamazepine \nPhenobarbital \nPhenytoin  Reduce ATV levels  Carbamazepine; \u2191 \nserum levels when  \nco-administered with  \nRTV  \n \nUse with caution  \n \nMonitor anticonvulsant levels  Avoid  Many possible  \ninteractions: Carbamazepine:  \n\u2191 levels when  \nco-administered with RTV. Use \nwith caution. Monitor \nanticonvulsant levels. \nPhenytoin : levels of LPV, RTV, \nand \u2193 levels of Phenytoin when \nadministered together  \nAvoid concomitant use or \nmonitor LPV level  \nOTHER DRUG  \nMethadone  No interaction with unboosted \nATV Increased metabolism of \nmethadone with boosted ATV  Methadone \u2193 37%. Monitor and \ntitrate dose if needed  \n \nMay require \u2191  \nmethadone dose  \u2193 levels of methadone by 16%  Methadone AUC  \n\u2191 53%. Opiate withdrawal may \noccur  \nMonitor and titrate dose if \nneeded.  \nMay require \u2191  \nmethadone dose", "start_char_idx": 1, "end_char_idx": 921, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "afee6688-f6d9-41f7-82ca-53f1b360ad5b": {"__data__": {"id_": "afee6688-f6d9-41f7-82ca-53f1b360ad5b", "embedding": null, "metadata": {"page_label": "273", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "985e41bf-ba44-4e66-b3a1-be343fd720b8", "node_type": "4", "metadata": {"page_label": "273", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9c46f5850ab32e78ee48c38c162ee46d491df86299e650598696085ed1b3f357", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "42347089-e6b2-4b2b-8212-2c5ffb0238c0", "node_type": "1", "metadata": {"page_label": "272", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f7f010add0ad3d53e352093562a7b987334c5f8b1b970daa34520faf69986f9a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "12e6c1c8-7892-451b-95e7-f06de572e145", "node_type": "1", "metadata": {}, "hash": "c39187c26f2f21c0e9d9ea726dfa43c35b574557a50c8eba36928943f6594a4d", "class_name": "RelatedNodeInfo"}}, "hash": "b4480501cb78e181144dbfa3b34329a5749cb797eacc5aeb0b22a560d61e4b09", "text": "Annexes  \n \n13 - 51 Annex 13 B: Cont.  \nERECTILE DYSFUNCTION AGENTS  \nSildenafil  Use reduced dose of sildenafil  Sildenafil AUC \u2191 11-fold. Use \ncautiously Start with reduced \ndose of 25 mg every  \n48 hours and monitor for \nadverse effects   Sildenafil AUC \u2191 11- fold in \ncombination with RTV. Do not \nexceed 25 mg every  \n48 hours  \nMiscellaneous  Decreased GI absorption of \natazanavir due to reduced acidity  Theophylline \u2193 47%  \nmonitor theophylline levels  \n \nRTV 100 mg bid significantly \nincrease systemic exposure  \nof inhaled (oral or nasal \nfluticasone, may predispose \npatients to systemic  \ncorticosteroid effects. Co -\nadministration not \nrecommended unless benefit of \nfluticasone outweighs the risk  Warfarin levels", "start_char_idx": 1, "end_char_idx": 731, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "12e6c1c8-7892-451b-95e7-f06de572e145": {"__data__": {"id_": "12e6c1c8-7892-451b-95e7-f06de572e145", "embedding": null, "metadata": {"page_label": "274", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "2df50dc8-b91a-406f-8c9c-f9fb92840dec", "node_type": "4", "metadata": {"page_label": "274", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "249e0fd7c940f95fe8259ce2e80e08c76e44200d46f4b6114154270ded8e02ff", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "afee6688-f6d9-41f7-82ca-53f1b360ad5b", "node_type": "1", "metadata": {"page_label": "273", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b4480501cb78e181144dbfa3b34329a5749cb797eacc5aeb0b22a560d61e4b09", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "307caae5-5011-4495-a07b-7b4bcdfe26b0", "node_type": "1", "metadata": {}, "hash": "f2742c2bd611f802604ed2fa2a9dc2e2b25294746eaea041ecbda1c584ca6d97", "class_name": "RelatedNodeInfo"}}, "hash": "c39187c26f2f21c0e9d9ea726dfa43c35b574557a50c8eba36928943f6594a4d", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 52 Annex 13 C: Drug -Drug Interactions \u2013 INSTIs  \nDrugs Affected  Dolutegravir (DTG)  Raltegravir (RAL)  \nEfavirenz  Co-administration not recommended because \nEFV decreases levels of DTG.  If must be used \ntogether then increase DTG to 50 mg BD when \nco-administered with EFV.  Efavirenz decreases RAL \nplasma levels but it is unlikely \nto be clinically significant  \nEtravirine  Co-administration not recommended because \nETR decreases levels of DTG, unless used in \ncombination with a PI/r (which counteracts the \ninteraction between DTG and ETR)  \n \nIf must be used together without a PI/r then \nincrease DTG to 50 mg BD when co -\nadministered with ETR. If used together with a \nPI/r then standard dose DTG is sufficient  Etravirine decreases RAL \nplasma levels so co -\nadministration when using \nonce -daily RAL is not \nrecommended.  Co -\nadministration when using \nstandard BD RAL dosing is \nacceptable  \nRifampicin  Increase DTG to 50 mg BD when co -\nadministered with rifampicin (for children, use \ndouble the standard weight -based DTG dose by \nadministering twice daily).  \n \nThere is no known drug interaction between \nDTG and rifabutin.  Increase RAL to 800 mg BD \nwhen co -administered with \nrifampicin (for children, use \ndouble the standard weight -\nbased RAL dose).  \n \nRifabutin may alter RA L \nplasma levels but it is unlikely \nto be clinical significant.  \nRifapentine  Potential decreased DTG levels when co -\nadministered with once -weekly rifapentine \u2013 no \ndose adjustment required unless viral load \nbecomes detectable, in which case increase DTG \nto twice daily until two weeks after completion \nof rifapentine -based TPT  Potential increased RAL \nlevels when co -administered \nwith once -weekly rifapentine \n\u2013 no dose adjustment \nrequired but monitor for RAL \ntoxicity  \nBedaquiline (BDQ)  No interactions expected  No interactions expected  \nDelamanid (DLM)  No interactions expected  No interactions expected  \nMetformin  DTG may increase metformin plasma levels so \nmetformin dose may need to be decreased. Limit \ndaily metformin dose to 1,000mg.  \n \nDTG does NOT require a dose adjustment is when \nused with metformin.  No interaction", "start_char_idx": 1, "end_char_idx": 2225, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "307caae5-5011-4495-a07b-7b4bcdfe26b0": {"__data__": {"id_": "307caae5-5011-4495-a07b-7b4bcdfe26b0", "embedding": null, "metadata": {"page_label": "275", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "162ab010-3a0b-479b-b848-aff1fdb93343", "node_type": "4", "metadata": {"page_label": "275", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6c5447d2562324c24ee7cef5b238c822371a35939338d6179b11c5fb83e07c0d", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "12e6c1c8-7892-451b-95e7-f06de572e145", "node_type": "1", "metadata": {"page_label": "274", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c39187c26f2f21c0e9d9ea726dfa43c35b574557a50c8eba36928943f6594a4d", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "30610e63-f6a2-4e1a-8955-ca727b3ed3e1", "node_type": "1", "metadata": {}, "hash": "ca4bc49f387e73d42ba69c79d47441338f75dd305c7957651f39c2177baf1365", "class_name": "RelatedNodeInfo"}}, "hash": "f2742c2bd611f802604ed2fa2a9dc2e2b25294746eaea041ecbda1c584ca6d97", "text": "Annexes  \n \n13 - 53 Annex 13 C: Cont.  \nDrugs Affected  Dolutegravir (DTG)  Raltegravir (RAL)  \nAnticonvulsants  \n-Carbamazepine  \n-Phenobarbital  \n-Phenytoin  Avoid use of DTG with carbamazepine, \nphenobarbital, or phenytoin because they \ndecrease DTG plasma levels.  \n \nIf the DTG must be used in combination with any \nof these anticonvulsants than increase DTG dose \nto 50mg BD and monitor viral load.  No interaction  \nMineral \nsupplements and \nantacids \ncontaining cations \n(e.g., calcium, iron, \nzinc, magnesium, \naluminum), \nincluding prenatal \nvitamins  Administer DTG at least 2 hours before or 6 \nhours after taking any of these supplements \n(note: if taking DTG with a meal then it is safe to \ntake at th e same time as prenatal vitamins, \ncalcium, or iron)  \n \nThere are no drug -drug interactions between \nDTG and proton pump inhibitors or H2 blockers \nused for gastritis.  Do not use calcium, \nmagnesium and aluminum \ncontaining antacids with RAL.  \nMethadone  No inter action  No interaction", "start_char_idx": 1, "end_char_idx": 1007, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "30610e63-f6a2-4e1a-8955-ca727b3ed3e1": {"__data__": {"id_": "30610e63-f6a2-4e1a-8955-ca727b3ed3e1", "embedding": null, "metadata": {"page_label": "276", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "234319fd-41e8-48cd-bcef-dd8ef97e3960", "node_type": "4", "metadata": {"page_label": "276", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cb03eb7c3cb829e8054986a6be425814e50bc4e72fd1fb90681d967af294a6a0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "307caae5-5011-4495-a07b-7b4bcdfe26b0", "node_type": "1", "metadata": {"page_label": "275", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "f2742c2bd611f802604ed2fa2a9dc2e2b25294746eaea041ecbda1c584ca6d97", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "a29983df-4047-4e31-b837-cefec59f4f3d", "node_type": "1", "metadata": {}, "hash": "cbf32eaaeb0cb8ffcf9da3e680855391cff3d6aec0ea1a6c577aa0223d17a874", "class_name": "RelatedNodeInfo"}}, "hash": "ca4bc49f387e73d42ba69c79d47441338f75dd305c7957651f39c2177baf1365", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 54 Annex 14: Health Facility Assessment to Provide Community ART Distribution  \nHealth Facility Assessment to Provide Community ART Distribution*  \nFacility name:  MFL code:  Date of assessment:  \nHealth system domains for community ART distribution  Yes/No  \nLeadership:  \nHas the facility identified a focal person to oversee community -based ART distribution?   \nFinance:  \nDoes the facility have resources to implement and monitor community -based ART distribution?   \nHuman Resources for Health:  \nHas the facility identified appropriate personnel to distribute ART (peer educators, lay \ncounselors and /or Community Health Volunteers)?   \nDoes the facility have capacity to train ART distributors?   \nService Delivery:  \nHas the facility achieved a routine viral load monitoring uptake of \u2265 90%?   \nHas the facility established a facility -based system for fast -track ART distribution?   \nCommodity Management:  \nDoes the facility have \u2265 three months of ART available on site?   \nHas the facility identified a focal person to pre -pack and label ART for community distribution?   \nHealth Information Systems:  \nDoes the facility have an established system to monitor patient level outcomes, specifically \nretention, loss to follow -up, mortalities an d viral load suppression?   \nIs the facility able to establish recording and reporting systems for community ART?   \nAssessors\u2019 recommendations:  \n \nFinal assessment outcome:  \nFacility can initiate community ART distribution \u25a2  \nFacility to implement assessors\u2019 recommendations and be re -assessed thereafter \u25a2  \nNames of assessors:  Signature of \nassessors:  Name of health facility manager: \nSignature of health facility manager:  \n*None of these criteria are absolute requirements for implementation of community -based ART \ndistribution; implementation can be considered even if some criteria are not met, as long as a plan is in \nplace to address and monitor gaps", "start_char_idx": 1, "end_char_idx": 1989, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "a29983df-4047-4e31-b837-cefec59f4f3d": {"__data__": {"id_": "a29983df-4047-4e31-b837-cefec59f4f3d", "embedding": null, "metadata": {"page_label": "277", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "756070bd-d0fd-4753-a811-7012cccd96fd", "node_type": "4", "metadata": {"page_label": "277", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "b406335e9cf11e9bd22325b5b488d89471fadbf0a64f58935eda02ba281b5627", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "30610e63-f6a2-4e1a-8955-ca727b3ed3e1", "node_type": "1", "metadata": {"page_label": "276", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ca4bc49f387e73d42ba69c79d47441338f75dd305c7957651f39c2177baf1365", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "eeb9e929-729b-4ae3-857e-969880d80935", "node_type": "1", "metadata": {}, "hash": "35d478dd1d84e8b775f3a0260f89b394c59ebb5480d999dd82295f53d7012a53", "class_name": "RelatedNodeInfo"}}, "hash": "cbf32eaaeb0cb8ffcf9da3e680855391cff3d6aec0ea1a6c577aa0223d17a874", "text": "Annexes  \n \n13 - 55 \n Annex 15: Creatinine Clearance  \nFormula for calculating creatinine clearance for adults : \n \n \n \n \nFormula for calculating creatinine clearance for children and adolescents (up to 19 years \nold):  \n \neGFR = k x height (cm)/ serum creatinine (mg/dL)  \n \nk = 0.45 for infants < 1 year old  \nk = 0.55 for children (1 \u2013 10 years)  \nk = 0.55 for female adolescents (11 -19 years)  \nk = 0.70 for male adolescents (11 -19 years)", "start_char_idx": 1, "end_char_idx": 445, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "eeb9e929-729b-4ae3-857e-969880d80935": {"__data__": {"id_": "eeb9e929-729b-4ae3-857e-969880d80935", "embedding": null, "metadata": {"page_label": "278", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "a6b5f3b9-e31d-4d96-b2c7-0eb9506b4d80", "node_type": "4", "metadata": {"page_label": "278", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "3c5c5daaf7495fdb301dea4ffb7aa86c152d54ac61b56f1f0636eac285559bb9", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "a29983df-4047-4e31-b837-cefec59f4f3d", "node_type": "1", "metadata": {"page_label": "277", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "cbf32eaaeb0cb8ffcf9da3e680855391cff3d6aec0ea1a6c577aa0223d17a874", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "9f80ceef-4566-44ee-930f-3e073d4c0a5b", "node_type": "1", "metadata": {}, "hash": "7a8b48c41a2ded2c02dde82755bf279d3eaf3c9974123f0aa1ffdb2727d0c272", "class_name": "RelatedNodeInfo"}}, "hash": "35d478dd1d84e8b775f3a0260f89b394c59ebb5480d999dd82295f53d7012a53", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 56 Annex 16: Immune Reconstitution Inflammatory Syndrome  \nImmune Reconstitution Inflammatory Syndrome (IRIS)  \nDefinition:  \nIRIS is a paradoxical inflammatory reaction against a foreign antigen (alive or dead) in patients who \nhave started ART with reconstitution (improved functioning) of their immune system. The immune \nsystem, once it regains some function, is now able to respond against the foreign antigen.  \nClassification:  \n\u25cf Unmasked IRIS: appearance of a previously undiagnosed opportunistic infection (OI) following \nART initiation (or switch of ART to a suppressive regimen)  \n\u25cf Paradoxical IRIS: worsening of a previously diagnosed disease after ART initiation (or switch of \nART to a suppressive regimen)  \nRisk Factors for IRIS:  \n\u25cf 10-20% of patients who start ART with advanced immunosuppression (refer to Chapter 3) \nexperience clinical deterioration during the first few months due to IRIS  \n\u25cf High risk patients include:  \no Advanced immunosuppression (WHO Stage 3 or 4, or CD4 count \u2264 200 cell/mm3 ( or CD4% \u2264 \n25% for children \u2264 5 years old))  \no Patients with a diagnosed opportunistic infection like TB, MAC, CMV, and PCP  \no Low baseline CD4 (CD4 count \u2264 50 cell/mm3 or CD4% \u2264 10%)  \no High baseline viral load  \no Substantial increase in CD4 count and drop in viral load after starting ART  \nPatient evaluation:  \nIn addition to the clinical evaluation for PLHIV outlined in Table 3.1, emphasis should be placed on the \nfollowing areas during the patient evaluation:  \nHistory:  \nSymptoms and current ARV history:  \n\u2022 Specific systemic symptomatology  \n\u2022 Date of ARV initiation  \n\u2022 Regimen  \n\u2022 Reason for substitution / switch from previous ART if not first line  \n\u2022 Adherence to ART and other ongoing treatment  \n\u2022 HIV viral load  \n\u2022 CD4 count  \nPrior History:  \n\u2022 ARV toxicity  \n\u2022 Drug -drug interaction  \n\u2022 CD4 count  \n\u2022 HIV viral load  History of treatment of opportunistic infections:  \n\u2022 Date of initiation of treatment  \n\u2022 Duration of therapy  \n\u2022 Clinical response to treatment  \n\u2022 Adherence to the OI treatment  \n\u2022 Any default to treatment  \n\u2022 Resistance to treatment", "start_char_idx": 1, "end_char_idx": 2167, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "9f80ceef-4566-44ee-930f-3e073d4c0a5b": {"__data__": {"id_": "9f80ceef-4566-44ee-930f-3e073d4c0a5b", "embedding": null, "metadata": {"page_label": "279", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "342117cb-dffb-424c-bde1-b4bf2a92bfb1", "node_type": "4", "metadata": {"page_label": "279", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "9d983e3edd4a575853e7f4556734fc769521018c842356fe67c83dbdcaa1eded", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "eeb9e929-729b-4ae3-857e-969880d80935", "node_type": "1", "metadata": {"page_label": "278", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "35d478dd1d84e8b775f3a0260f89b394c59ebb5480d999dd82295f53d7012a53", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "37ec96b3-bfb3-416b-bb39-ceec55b24c3b", "node_type": "1", "metadata": {}, "hash": "c9d0aaf02187250687a47c1991df646266cfff1826f052bd6d0a458fa9b18a96", "class_name": "RelatedNodeInfo"}}, "hash": "7a8b48c41a2ded2c02dde82755bf279d3eaf3c9974123f0aa1ffdb2727d0c272", "text": "Annexes  \n \n13 - 57 Annex 16: Cont.  \nPhysical Examination:  \nVital signs assessment:  Temperature, Heart Rate, Blood Pressure, Respiratory rate  \nConduct a detailed systemic examination:  \n\u2022 Emphasis should be placed on the system(s) which are primarily affected (Table 3.1)  \n \nInvestigations  \n\u2022 All patients with advanced HIV disease should be screened for common OIs including TB, \ncryptococcal meningitis and other common OIs depending of their presenting signs and \nsymptoms  \n. \nDiagnosis of IRIS  \n\u25cf IRIS should be suspected any time a patient has clinical deterioration weeks to months after \nstarting ART (or switching to a suppressive ART regimen)  \n\u25cf Clinical deterioration usually occurs within 4 -8 weeks of initiation or change of ART (but can be \nmonths afterwards)  \n\u25cf IRIS has varied clinical presentations due to multiple possible pathogens that the immune system \nmay be reacting to, and various immune system reactions; there are generally clinical \nmanifestations consistent with an inflammatory condition  \n\u25cf A high level of suspicion is required when making a diagnosis of IRIS, which is generally one of \nexclusion  \n\u25cf Rule out the possibility of drug reaction, patient non -adherence to OI treatment, persistently active \ninfection and/or drug resistance to OI treatment  \n\u25cf There could be localized tissue inflammation with or without systemic inflammatory response  \n \nMajor and Minor Presentations of IRIS  \nMajor presentation  Minor presentation  \nTuberculosis (TB)  \nMycobacterium avium complex (MAC)  \nCryptococcal meningitis  \nCytomegalovirus (CMV) retinitis  \nHepatitis B or C virus  \nProgressive multifocal leukoencephalopathy \n(PML)  \nKaposi\u2019s sarcoma  \nCerebral toxoplasmosis  \nAutoimmune diseases  Herpes simplex virus (HSV) and varicella \nzoster virus (VZV)  \nNonspecific dermatologic complic ations such \nas folliculitis, oral and genital warts", "start_char_idx": 1, "end_char_idx": 1886, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "37ec96b3-bfb3-416b-bb39-ceec55b24c3b": {"__data__": {"id_": "37ec96b3-bfb3-416b-bb39-ceec55b24c3b", "embedding": null, "metadata": {"page_label": "280", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "b51b79fa-9700-40ac-b3ec-b6f57bb95b13", "node_type": "4", "metadata": {"page_label": "280", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "6b057c9dd61d50d50dfd1950d093f5d2f59ddd03d49ba96307fd79239fec03d0", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "9f80ceef-4566-44ee-930f-3e073d4c0a5b", "node_type": "1", "metadata": {"page_label": "279", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "7a8b48c41a2ded2c02dde82755bf279d3eaf3c9974123f0aa1ffdb2727d0c272", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "31d74e7d-5242-490f-9e8d-52c1f347cfc2", "node_type": "1", "metadata": {}, "hash": "c859880467a977b650187e20ae679bbf4d043899cce1c3df5c5ec8bb2090bbd0", "class_name": "RelatedNodeInfo"}}, "hash": "c9d0aaf02187250687a47c1991df646266cfff1826f052bd6d0a458fa9b18a96", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 58 Annex 16: Cont.  \nManagement of IRIS  \nIRIS management is dependent on severity of symptoms and the following general guidance is \nrecommended:  \nSeverity of \nIRIS  Definition  Management  \nMild  \u2022 Resolves over time \nin most patients  \n\u2022 Symptomatic \ntreatment is often \nsufficient  \n \u2022 Treat the OI and manage the associated \nsymptoms  \n\u2022 Treat IRIS -associated inflammation:  \no NSAIDS for discomfort associated with mild \ninflammation / fevers  \no Inhaled steroids for bronchospasm or \ncough associated with mild pulmonary \ninflammation  \n\u2022 Surgical intervention:  \no Drainage of abscesses  \no Excision of inflamed and painful lymph \nnodes  \nSevere  \u2022 Threatens a \npatient\u2019s \nfunctional state  \n\u2022 Cause permanent \ndisability  \n\u2022 Potentially lead to \ndeath  \nExamples:  \n\u2022 Decline in \npulmonary \ncapacity from TB \nor MAC infection  \n\u2022 Neurologic \ncomplications \nfrom cryptococcal \ninfection  \n\u2022 Loss of vision from \nCMV retinitis \ninfection  \u2022 Treat the OI and manage the associated \nsymptoms  \n\u2022 Manage t he IRIS -associated inflammation:  \no If NOT KS: give 1 to 2 mg/kg prednisone for \n1 to 2 weeks. Follow with a period of \nindividualized tapering of the dose  \no Do not use corticosteroids for the \nmanagement of KS -related IRIS  \n\u2022 Closely monitor patients on corticosteroid \ntherapy for:  \no Hyperglycemia  \no Hypertension  \no Mental status changes  \no Avascular necrosis  \no Worsening of an existing infection  \no Predisposition to a new infection (e.g., TB \nand CMV)", "start_char_idx": 1, "end_char_idx": 1544, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "31d74e7d-5242-490f-9e8d-52c1f347cfc2": {"__data__": {"id_": "31d74e7d-5242-490f-9e8d-52c1f347cfc2", "embedding": null, "metadata": {"page_label": "281", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "652c824c-c3b7-4618-9999-443b52fa9d6e", "node_type": "4", "metadata": {"page_label": "281", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "971ecfb9ca1a931ecaf9cbab1ccaaf45a1baa0cacbda0db2b9e3da8a378c6c81", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "37ec96b3-bfb3-416b-bb39-ceec55b24c3b", "node_type": "1", "metadata": {"page_label": "280", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c9d0aaf02187250687a47c1991df646266cfff1826f052bd6d0a458fa9b18a96", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "d40e482e-6bc4-4050-aa94-1c6299b0eafb", "node_type": "1", "metadata": {}, "hash": "57336d12a54c759ed717cfc4b6a48cad848652633329bfd186d7cf279bf25c8e", "class_name": "RelatedNodeInfo"}}, "hash": "c859880467a977b650187e20ae679bbf4d043899cce1c3df5c5ec8bb2090bbd0", "text": "Annexes  \n \n13 - 59 Annex 17: HTS Adult Screening Tool Enhancement  \n  \nCounty: \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. Sub -County Name: \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.  \n \nFacility Name:\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026 Facility MFL Code: \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026  \n1 Today\u2019s Date                                              Gender                                             AGE  \n \n\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.                            \n2 Have you ever tested for HIV Before?  \nIf yes, what was the HIV result?         Positive                      Negative  \nIf positive, Date of ART initiation. \u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026. (Not eligible for testing)  \nIf Negative, when is the most recent HIV test?   Months              Years  \n \n3 If negative or status unknown, determine  behavioural risk of HIV acquisition  by \nasking the following questions:  \n\u2022 Unprotected sex within the last 3 months  \n\u2022 Unknown status of the sexual partners  \n\u2022 New sexual partner within the last 3 months  \n\u2022 Multiple sexual partners  \n\u2022 intergenerational relationships  \n\u2022 Symptoms of sexually transmitted infection (refer to MoH syndromic \nchart) or history of STI  \n\u2022 Pregnancy for females  \n\u2022 Assessing h istory of recurrent illnesses without resolution of symptoms, \nacute or chronic febrile illness (symptoms \u2265 14 days) and any other \nconditions suggestive of HIV  \n4 Possible Risk exposures:  \n\u2022 Defilement  \n\u2022 Traditional /non -medical procedures e.g., scarification, plastic tooth \nextraction , Circumcision, uvulectomy etc.  \n5 If Risk noted or clinical assessment suggest HIV, eligible for testing  \n6. If No risk noted and assessment does not suggest, not eligible  \nName  Institutions  \n \n  \n M\nM\nM  F", "start_char_idx": 1, "end_char_idx": 1597, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "d40e482e-6bc4-4050-aa94-1c6299b0eafb": {"__data__": {"id_": "d40e482e-6bc4-4050-aa94-1c6299b0eafb", "embedding": null, "metadata": {"page_label": "282", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "adef37f6-828b-4b78-849d-a5a41cfb70c0", "node_type": "4", "metadata": {"page_label": "282", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "dba7d3160107f6d3d054b061d375bf3429f810f0deddc56ea6cbf298c31c8524", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "31d74e7d-5242-490f-9e8d-52c1f347cfc2", "node_type": "1", "metadata": {"page_label": "281", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "c859880467a977b650187e20ae679bbf4d043899cce1c3df5c5ec8bb2090bbd0", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "e700be4b-e475-4ad7-b3b3-c9cd1936f03c", "node_type": "1", "metadata": {}, "hash": "f84492397eae04725c3271c2a7e183de205d1f6a8d7d790db793386c8be67eb3", "class_name": "RelatedNodeInfo"}}, "hash": "57336d12a54c759ed717cfc4b6a48cad848652633329bfd186d7cf279bf25c8e", "text": "Kenya HIV Prevention and Treatment Guidelines, 2022  \n \n13 - 60 Annex 1 8: List of Contributors and Affiliation  \n  Name  Affiliation    Name  Affiliation  \n1 Abraham Katana  CDC  61 Jonah Magare  MOH NASCOP  \n2 Adrian Gardner  Moi University  62 Jonah Maswai   DoD  \n3 Agnes Langat  CDC  63 Jonah Onentiah  MOH NASCOP  \n4 Alice Njoroge  Kajiado County  64 Jonathan Mwangi  CDC  \n5 Ambrose Juma  MOH NASCOP  65 Joseph Mbuthia  Mater Hospital  \n6 Anne Marie \nMacharia  KNH  66 Joseph Nkuranga  UON  \n7 Anthony Wachira  MOH NASCOP  67 Judith Lusike  CHAI  \n8 Appolonia Aoko  CDC  68 Julius Kisio  Murang'a County  \n9 Barbara Mambo  MOH NASCOP  69 Julius Oliech  CDC  \n10 Brandwell Mwangi  CHAI  70 Justine Odionyi  EGPAF  \n11 Brenda Opanga  MOH NASCOP  71 Justus Ogada  CHAI  \n12 Celestine \nImuuraget  DOD  72 Kenneth Masamaro  CDC  \n13 Christine Kisia  WHO  73 Lazarus Momanyi  MOH NASCOP  \n14 Claver Kimathi  Isiolo County  74 Lennah Nyabiage  CDC  \n15 Collins Etemesi  MOH NASCOP  75 Leonard Kingwara  MOH NHRL  \n16 Dalton Wamalwa  UON  76 Leonard Soo  USAID  \n17 Daniel Kimani  CDC  77 Loice Achieng Ombajo  UON  \n18 Daniel Were  JHPIEGO  78 Margaret Ndubi  UNAIDS  \n19 Davis Karambi  CHAI  79 Mary Mugambi  MOH NASCOP  \n20 Deborah Carpenter  CDC  80 Mary Nyangasi  MOH NCCP  \n21 Deborah Goldstein  USAID  81 Marybeth Maritim  UON  \n22 Deborah Ikonge  MOH NASCOP  82 Maureen Inimah  MOH NASCOP  \n23 Dennis Osiemo  USAID  83 Maureen Syowai  ICAP at Columbia \nUniversity  \n24 Diana Marangu  UoN  84 Mike Ekisa  Kakamega County  \n25 Dinah Mamai   CHS  85 Muthoni Karanja  DOD  \n26 Dorcus Abuya  UNICEF  86 Nancy Bowen  MOH NHRL  \n27 Doreen Muriithi  JHPIEGO  87 Nandita Sugandhi  ICAP at Columbia \nUniversity  \n28 Dorothy Mwagae  MOH NASCOP  88 Natella Rakhmanina  EGPAF  \n29 Douglas Gaitho  AKUH  89 Nelson Otwoma  NEPHAK  \n30 Dunstan Achwoka  USAID  90 Newton Omale  MOH NASCOP  \n31 Edith Apondi  AMPATH Plus  91 Odylia Muhenje  CDC  \n32 Elaine Abrams   ICAP at Columbia \nUniversity  92 Pacific Akinyi  MOH NASCOP  \n33 Elizabeth Irungu  JHPIEGO  93 Patricia Oluoch  USAID  \n34 Elizabeth Katiku  CDC  94 Patricia Ongwen  JHPIEGO", "start_char_idx": 1, "end_char_idx": 2129, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e700be4b-e475-4ad7-b3b3-c9cd1936f03c": {"__data__": {"id_": "e700be4b-e475-4ad7-b3b3-c9cd1936f03c", "embedding": null, "metadata": {"page_label": "283", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "excluded_llm_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", "last_modified_date", "last_accessed_date"], "relationships": {"1": {"node_id": "eb269166-4663-4f8c-bdd8-cbec66698ee0", "node_type": "4", "metadata": {"page_label": "283", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "ccb39181e6a5ef18d1f0de8ffcc32d8a4f081b77d656303ddc38a5877b7d152b", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "d40e482e-6bc4-4050-aa94-1c6299b0eafb", "node_type": "1", "metadata": {"page_label": "282", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "hash": "57336d12a54c759ed717cfc4b6a48cad848652633329bfd186d7cf279bf25c8e", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "2b93d7bf-8bd0-4f8f-987c-c8a16020511d", "node_type": "1", "metadata": {}, "hash": "ade8ba238fac596a294e4c8d316a09e8a17075088bea80ed1d34cf1a58c20f97", "class_name": "RelatedNodeInfo"}}, "hash": "f84492397eae04725c3271c2a7e183de205d1f6a8d7d790db793386c8be67eb3", "text": "Annexes  \n \n13 - 61 35 Elizabeth Mueni  NMS  95 Philip Kimani  CHAI  \n36 Elizabeth Onyango  MOH NCD  96 Rogers Simiyu  EGPAF  \n37 Elizabeth Washika  MOH NASCOP  97 Rose Ayugi  MOH NASCOP  \n38 Emma Momanyi  CIHEB  98 Rose Wafula  MOH NASCOP  \n39 Eric Mutua  MOH NASCOP  99 Ruby Fayorsey                  ICAP at Columbia \nUniversity  \n40 Evelyn Ngugi  CDC  100  Ruth Kamau  MOH NASCOP  \n41 Everline Ashiono  USAID Dumisha Afya  101  Ruth Korir  Mathari Hospital  \n42 Felicistas Makokha  NyaWest RTWG  102  Ruth Musyoki  MOH NASCOP  \n43 Francis Ndwiga  MOH NASCOP  103  Ruth Nduati  UoN  \n44 Frank Basiye  CDC  104  Salome Okutoyi  USAID  \n45 George Siberry  USAID  105  Sarafuina Sikwata  MOH NASCOP  \n46 Grace Rabut  MOH NASCOP  106  Sarah Masyuko  MOH NASCOP  \n47 Helen Chun  CDC  107  Shobha Vakil                     ICAP at Columbia \nUniversity  \n48 Herb Herwell  CHAI  108  Sospeter Gitonga  MOH NASCOP  \n49 Herman Wayenga  CDC  109  Steve Oyule  DoD  \n50 Immaculate \nMutisya  CDC  110  Susan Njogo  ARC Kenya  \n51 Irene Mukui  DnDI  111  Teresa Simiyu  USAID  \n52 Isabella Yonga  USAID  112  Terezah Alwar  UNICEF  \n53 Ivy Kasirye  WHO  113  Vakil, Shobha  ICAP  \n54 Jafred Mwangi  MOH NASCOP  114  Valeria Makory  MOH NASCOP  \n55 James Wagude  NyaWest RTWG  115  Valerie Obare  MOH NASCOP  \n56 Janet Muema  MOH NASCOP  116  Veronica Irungu  CHS  \n57 Japheth Gituku  MOH NASCOP  117  Virginia Karanja  CHS  \n58 Jeremy Penner  UBC  118  Wangui Kamau  KNH  \n59 Joan -Paula Bor  MOH NCCP  119  Wanjiku Ndegwa  MOH NASCOP  \n60 John Mungai  CHAI  120  Winifred Nyanya  MOH NASCOP", "start_char_idx": 1, "end_char_idx": 1581, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "2b93d7bf-8bd0-4f8f-987c-c8a16020511d": {"__data__": {"id_": "2b93d7bf-8bd0-4f8f-987c-c8a16020511d", "embedding": null, "metadata": {"page_label": "284", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", 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Mathari National TRH  \nMOH Department of NCD  \nMOH Division of NCCP  \nMOH NASCOP  \nMOH NHRL  \nMOH NLTP  \nMoi University  \nNairobi Metropolis Services  \nNEPHAK  \nUCSF  \nUNICEF  \nUniversity of British Columbia  \nUniversity of Nairobi  \nUSAID  \nWorld Health Organization", "start_char_idx": 1, "end_char_idx": 735, "text_template": "{metadata_str}\n\n{content}", "metadata_template": "{key}: {value}", "metadata_seperator": "\n", "class_name": "TextNode"}, "__type__": "1"}, "e814a041-8f65-496d-bf56-af2579d9c9ae": {"__data__": {"id_": "e814a041-8f65-496d-bf56-af2579d9c9ae", "embedding": null, "metadata": {"page_label": "285", "file_name": "Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_path": "data\\Kenya-ARV-Guidelines-2022-Final-1.pdf", "file_type": "application/pdf", "file_size": 4093801, "creation_date": "2024-01-09", "last_modified_date": "2024-01-18", "last_accessed_date": "2024-01-25"}, "excluded_embed_metadata_keys": ["file_name", "file_type", "file_size", "creation_date", 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