data/processed/lp/indices/SummaryKeyRecommendations/docstore.json

{"docstore/ref_doc_info": {"b8c03d72-baa5-452b-b763-b7d0f5790bc3": {"node_ids": ["973b665b-c0f8-4876-a78c-eb163a41eb6b", "7c01f25f-7ff2-4e12-acaa-eebf94905500", "10e4e470-85fe-4ec8-bf0d-480d40ea6611", "88b47794-a076-4a78-900e-a2ea8f073684", "4aaec5a8-664b-4dc0-bdec-77227241d9d6", "776943e2-d82d-4a23-be05-34ed2684619a"], "metadata": {}}}, "docstore/data": {"973b665b-c0f8-4876-a78c-eb163a41eb6b": {"__data__": {"id_": "973b665b-c0f8-4876-a78c-eb163a41eb6b", "embedding": null, "metadata": {}, "excluded_embed_metadata_keys": [], "excluded_llm_metadata_keys": [], "relationships": {"1": {"node_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3", "node_type": "4", "metadata": {}, "hash": "d9b5b7b59617e96cf4c3935b0f633831994fd35e31c120b8787c829d8d3fc62a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "7c01f25f-7ff2-4e12-acaa-eebf94905500", "node_type": "1", "metadata": {}, "hash": "d05868751971131929f30efbef27157d889bd3272d3f3d4e087989d2f62dff16", "class_name": "RelatedNodeInfo"}}, "metadata_template": "{key}: {value}", "metadata_separator": "\n", "text": "# 1. Summary of Key Recommendations\n\n## 1.1 HIV Testing Services (HTS) and Linkage to Treatment and Prevention\n\n- HIV testing should be voluntary and conducted ethically in an environment where Consent, Confidentiality, Counselling, Correct results, Connection (linkage) and Creating an enabling environment can be assured\n\n- To optimize access to testing services, HIV testing can be conducted in 2 different settings:\n  - Facility-based\n  - Community-based\n\n- Targeted HIV testing is recommended which involves index client listing of contacts, HIV self-testing and use of HTS screening tool to identify people at risk of HIV infection as eligible for testing\n\n- Serial testing, using approved rapid HIV antibody testing kits, is used to diagnose HIV infection in children older than 18 months, adolescents, and adults. An HIV-positive diagnosis will be made using three consecutive reactive assays\n\n## 1.2 Initial Evaluation and Follow-up for PLHIV\n\n- Initial clinical evaluation of PLHIV entails CD4 monitoring, which is recommended for:\n  - Baseline investigation for all PLHIV\n  - Any patient with suspected treatment failure\n  - Any patient returning to care after interrupting treatment for >3 months\n  - Any patient on fluconazole maintenance therapy or on dapsone as prophylaxis, to determine when prophylaxis can be discontinued\n\n- Advanced HIV Disease is defined as:\n  - Adults, adolescents, and children five years and older as having a CD4 cell count of less than 200 cells/mm\u00b3 or\n  - WHO clinical stage 3 or 4 disease\n  - All children younger than five years\n\n- All PLHIV presenting with Advanced HIV Disease (AHD) should be offered a package of care that includes timely initiation of ART, screening, diagnosis, prophylaxis, and management of opportunistic infections.\n\n- Frequency of routine VL monitoring:\n  - For PCR positive HEIs: at baseline (at the time of ART initiation)\n  - Age 0-24 years old: 3 months after ART initiation, and then every 6 months\n\n\n\u25aa Pregnant or breastfeeding: at confirmation of pregnancy (if already on ART) or 3 months after ART initiation (if ART initiated during pregnancy/breastfeeding), and then every 6 months until complete cessation of breastfeeding\n\n\u25aa Before any drug substitution (if no VL result available from the prior 6 months)\n\n\u25aa Three months after any regimen modification (including single-drug substitution)\n\n\u25cf PLHIV should receive differentiated care based on initial evaluation (advanced vs. well) and follow up (established vs not established on ART)\n\n# 1.3 Standard Package of Care for PLHIV\n\nConsists of 8 components:\n\n1. Antiretroviral Therapy\n- All PLHIV are eligible for ART irrespective of CD4 cell count or percentage, WHO clinical stage, age, pregnancy status, or comorbidities\n- ART should be initiated as soon as the patient is ready to start, preferably within two weeks from time of HIV diagnosis (except for patients with cryptococcal meningitis or TB meningitis)\n2. Positive Health, Dignity, and Prevention, GBV/IPV & HIV Education and Counselling\n- All patients should be counselled and supported for disclosure of HIV status; partner/ family testing and engagement; condom use; family planning; sexually transmitted infections screening; treatment adherence; and pre-exposure prophylaxis for HIV-negative sexual partners\n- All females aged 15-49 years and emancipated minors accessing HIV care services should be screened for Intimate Partner Violence (IPV) as part of the standard package of care\n- 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 prophylaxis, and is only recommended in the following sub populations, unless they have an allergy to sulfur drugs or develop toxicity from CPT:\n\n- All HIV Exposed Infants\n- HIV infected children < 15 years of age\n- All PLHIV > 15 years of age:\n- Living in malaria-endemic zones (Refer to the National Guidelines for the Diagnosis, Treatment and Prevention of Malaria in Kenya for the current Kenya Malaria endemicity map)\n- Presenting with WHO stage 3 or 4 event, or meeting the AHD criteria\n- Suspected treatment failure\n- All Pregnant and Breast-feeding women", "mimetype": "text/plain", "start_char_idx": 2, "end_char_idx": 4267, "metadata_seperator": "\n", "text_template": "{metadata_str}\n\n{content}", "class_name": "TextNode"}, "__type__": "1"}, "7c01f25f-7ff2-4e12-acaa-eebf94905500": {"__data__": {"id_": "7c01f25f-7ff2-4e12-acaa-eebf94905500", "embedding": null, "metadata": {}, "excluded_embed_metadata_keys": [], "excluded_llm_metadata_keys": [], "relationships": {"1": {"node_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3", "node_type": "4", "metadata": {}, "hash": "d9b5b7b59617e96cf4c3935b0f633831994fd35e31c120b8787c829d8d3fc62a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "973b665b-c0f8-4876-a78c-eb163a41eb6b", "node_type": "1", "metadata": {}, "hash": "cab6e8a6f7b79b545031de1262b51fcf95eb9e1d994016df57320551f693cfb2", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "10e4e470-85fe-4ec8-bf0d-480d40ea6611", "node_type": "1", "metadata": {}, "hash": "2aebb07bd9ef9cc15aaa6132d121561a92690d1fbbf4a1925662912e118151c9", "class_name": "RelatedNodeInfo"}}, "metadata_template": "{key}: {value}", "metadata_separator": "\n", "text": "# 3. Prophylaxis and Screening\n\n- When dapsone (as a substitute for CPT) is being used as PCP prophylaxis, it is only recommended for patients in WHO Stage 4 and/or absolute CD4 count \u2264 200 cells/mm\u00b3 (or CD4% \u2264 25% for children \u2264 5 years old), and should be discontinued once a patient achieves viral suppression and a sustained CD4 count of > 200 cell/mm\u00b3 (or > 25% for children \u2264 5 years old) for at least 6 months.\n- All PLHIV should be screened for TB at every visit using the Intensified Case Finding (ICF) tool and assessed for TB Preventive Therapy (TPT) if screened negative for TB.\n- All adolescent and adult PLHIV with a baseline CD4 count of \u2264 200 cells/mm\u00b3 should be screened for cryptococcal infection using the serum CrAg test.\n\n# 4. Reproductive Health Services\n\n- All PLHIV should be screened for STI at every clinic visit.\n- Pregnancy status should be determined for all women of reproductive age at every visit and their contraception need determined and met.\n- All HIV positive women between the ages of 18 - 65 years should be screened for cervical cancer (HPV testing conducted every 2 years or Annually if using VIA-VILI).\n\n# 5. Screening for and Management of Non-Communicable Diseases\n\n- All PLHIV should be screened for hypertension, diabetes mellitus, dyslipidaemia, and renal disease annually.\n- Routine screening should be provided for early detection of cervical cancer, breast cancer, bowel cancer, and prostate cancer.\n\n# 6. Mental Health Screening and Management\n\n- All PLHIV should receive basic screening for depression and anxiety before initiating ART, and annually thereafter, and whenever there is a clinical suspicion.\n- All PLHIV should be provided for and linked with support structures to maintain general well-being addressing issues that could affect their mental health.\n- All adults and adolescents should be screened for alcohol and drug use before initiating ART and regularly during follow-up.\n- All caregivers should also receive baseline and follow-up screening for depression and alcohol/drug use.\n\n# 7. Nutrition Services\n\n- All PLHIV should receive nutritional assessment, counselling, and support tailored to the individual needs of the patients.\n- All infants irrespective of HIV status should be exclusively breastfed for the first 6 months of life, with timely introduction of appropriate complementary foods after 6 months, and continued breastfeeding up to 24 months or beyond.\n\n# 8. Prevention of Other Infections\n\n- PLHIV (including children) should receive vaccinations as recommended by the National Vaccines and Immunization Program.\n- All PLHIV should receive vaccination for COVID-19 following national guidelines for.", "mimetype": "text/plain", "start_char_idx": 4272, "end_char_idx": 6957, "metadata_seperator": "\n", "text_template": "{metadata_str}\n\n{content}", "class_name": "TextNode"}, "__type__": "1"}, "10e4e470-85fe-4ec8-bf0d-480d40ea6611": {"__data__": {"id_": "10e4e470-85fe-4ec8-bf0d-480d40ea6611", "embedding": null, "metadata": {}, "excluded_embed_metadata_keys": [], "excluded_llm_metadata_keys": [], "relationships": {"1": {"node_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3", "node_type": "4", "metadata": {}, "hash": "d9b5b7b59617e96cf4c3935b0f633831994fd35e31c120b8787c829d8d3fc62a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "7c01f25f-7ff2-4e12-acaa-eebf94905500", "node_type": "1", "metadata": {}, "hash": "d05868751971131929f30efbef27157d889bd3272d3f3d4e087989d2f62dff16", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "88b47794-a076-4a78-900e-a2ea8f073684", "node_type": "1", "metadata": {}, "hash": "f2b1e8cb15e4eb6dc924cb9db96e28b16ae0741cb637566674fb8571b461b51a", "class_name": "RelatedNodeInfo"}}, "metadata_template": "{key}: {value}", "metadata_separator": "\n", "text": "# 1.4 Adherence Preparation, Monitoring and Support\n\n- The adherence preparation, monitoring, and support that a patient requires should be tailored to their level of adherence and the stage of ART initiation and follow-up.\n- All patients with durable viral suppression (2 consecutive viral load results with <50 copies) should be offered messaging on Undetectable=Untransmittable (U=U).\n- Whenever possible, follow-up should be provided by the same care provider or team of care providers (e.g., same clinician and counsellor) at every visit. This is particularly important during the first 3 months in care.\n- For all children/adolescents, the level of disclosure should be assessed at the first visit. Ongoing care should include a plan for age-appropriate disclosure.\n- All patients are at risk of new or worsening barriers to adherence, so adherence monitoring, counselling and support should continue despite viral suppression.\n- Every service delivery point that is providing ARVs for patients (whether ART, PEP, or PrEP) must have a functional system for identifying patients who miss appointments and for taking action within 24 hours of a missed appointment.\n- In patients failing ART, do not change regimens until the reason/s for treatment failure have been identified and addressed (which should be done urgently using a case-management approach).\n\n# 1.5 Antiretroviral Therapy for Infants, Children, Adolescents, and Adults\n\n- The goal of ART is to suppress viral replication with the aim of reducing the patient\u2019s VL to undetectable levels (Viral Load <50 copies/LDL).\n- All individuals with confirmed HIV infection are eligible for ART, irrespective of CD4 count/%, WHO clinical stage, age, pregnancy or breastfeeding status, co-infection status, risk group, or any other criteria, provided that the individual is willing and ready to start ART.\n- ART should be started in all patients as soon as possible, even on the same day as confirming their HIV diagnosis (and preferably within 2 weeks).\n- Preferred first-line ART for infants, children, adolescents and adults:\n- Birth to 4 weeks: AZT + 3TC + NVP\n- > 4 weeks to < 15 years old:\n- < 30 kg: ABC + 3TC + DTG\n- \u2265 30 kg: TDF + 3TC + DTG\n- \u2265 15 years old: TDF + 3TC + DTG\n- Children and adolescents who are virally suppressed but are NOT on the preferred first-line ART regimen should be assessed for transition and transitioned to the preferred regimen.\n- Treatment failure is suspected when a patient has a VL \u2265 1000 copies/ml after at least 3 months of using ART. Treatment failure is only confirmed when VL is \u2265 1,000 copies/ml after assessing for and addressing poor adherence or other reasons for high VL, and then.", "mimetype": "text/plain", "start_char_idx": 6961, "end_char_idx": 9670, "metadata_seperator": "\n", "text_template": "{metadata_str}\n\n{content}", "class_name": "TextNode"}, "__type__": "1"}, "88b47794-a076-4a78-900e-a2ea8f073684": {"__data__": {"id_": "88b47794-a076-4a78-900e-a2ea8f073684", "embedding": null, "metadata": {}, "excluded_embed_metadata_keys": [], "excluded_llm_metadata_keys": [], "relationships": {"1": {"node_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3", "node_type": "4", "metadata": {}, "hash": "d9b5b7b59617e96cf4c3935b0f633831994fd35e31c120b8787c829d8d3fc62a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "10e4e470-85fe-4ec8-bf0d-480d40ea6611", "node_type": "1", "metadata": {}, "hash": "2aebb07bd9ef9cc15aaa6132d121561a92690d1fbbf4a1925662912e118151c9", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "4aaec5a8-664b-4dc0-bdec-77227241d9d6", "node_type": "1", "metadata": {}, "hash": "ae95dc7bbd0a106cfc43e02ad7535873459519becd77d566b6334962bd19a71d", "class_name": "RelatedNodeInfo"}}, "metadata_template": "{key}: {value}", "metadata_separator": "\n", "text": "Persistent low-level viremia (pLLV) is defined as having VL 200 - 999 copies/ml on two or more consecutive measures. These patients are at increased risk of progression to treatment failure, development of ARV resistance and death and therefore require a similar case management approach as patients with an initial VL \u2265 1,000 copies/ml.\n\nAll PLHIV with a detectable VL \u2265 200 copies/ml (unsuppressed): assess for and address potential reasons for viremia, including intensifying adherence support, and repeat the VL after 3 months of excellent adherence:\n\n- If the repeat VL is < 200 copies/ml (suppressed) then continue routine monitoring.\n- If the repeat VL is \u2265 1,000 copies/ml (suspected treatment failure), prepare for change to an effective regimen (Figure 5.2 and Table 6.10).\n- If the repeat VL is 200 - 999 copies/ml (low level viremia), reassess adherence and other causes of viremia and repeat VL after another 3 months of excellent adherence.\n\n# 1.6 Prevention of Mother to Child Transmission of HIV/Syphilis/HBV\n\nPrevention of mother-to-child transmission (PMTCT) of HIV, Syphilis and Hepatitis B (triple elimination) should be offered as part of a comprehensive package of fully integrated, routine antenatal care interventions.\n\nAll pregnant women, unless known positive, should be counseled and tested for HIV, Syphilis (using the HIV-Syphilis dual test) and HBV during their first ANC visit, and if negative a repeat HIV-Syphilis dual test should be performed in the 3rd trimester.\n\nLifelong ART should be initiated in all pregnant and breastfeeding women living with HIV, regardless of gestational age, WHO clinical stage or CD4 count.\n\nART should be started as soon as possible, ideally on the same day HIV diagnosis is made, with ongoing enhanced adherence support.\n\nThe preferred first line ART regimen for pregnant and breastfeeding women is TDF + 3TC + DTG.\n\nFor pregnant and breastfeeding women newly initiated on ART, obtain VL 3 months after initiation, and then every 6 months until complete cessation of breastfeeding.\n\nFor HIV positive women already on ART at the time of confirming pregnancy or breastfeeding, obtain a VL irrespective of when prior VL was done, and then every 6 months until complete cessation of breastfeeding.\n\nFor pregnant or breastfeeding women with a VL \u2265 200 copies/ml (unsuppressed): assess for and address potential reasons for viremia, including intensifying adherence support, and repeat the VL after 3 months of excellent adherence:\n\n- If the repeat VL is < 200 copies/ml (suppressed) then continue routine monitoring.\n- If the repeat VL is \u2265 1,000 copies/ml (treatment failure), prepare for change to an effective regimen.\n- If the repeat VL is 200 - 999 copies/ml (low level viremia), reassess adherence.", "mimetype": "text/plain", "start_char_idx": 9673, "end_char_idx": 12447, "metadata_seperator": "\n", "text_template": "{metadata_str}\n\n{content}", "class_name": "TextNode"}, "__type__": "1"}, "4aaec5a8-664b-4dc0-bdec-77227241d9d6": {"__data__": {"id_": "4aaec5a8-664b-4dc0-bdec-77227241d9d6", "embedding": null, "metadata": {}, "excluded_embed_metadata_keys": [], "excluded_llm_metadata_keys": [], "relationships": {"1": {"node_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3", "node_type": "4", "metadata": {}, "hash": "d9b5b7b59617e96cf4c3935b0f633831994fd35e31c120b8787c829d8d3fc62a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "88b47794-a076-4a78-900e-a2ea8f073684", "node_type": "1", "metadata": {}, "hash": "f2b1e8cb15e4eb6dc924cb9db96e28b16ae0741cb637566674fb8571b461b51a", "class_name": "RelatedNodeInfo"}, "3": {"node_id": "776943e2-d82d-4a23-be05-34ed2684619a", "node_type": "1", "metadata": {}, "hash": "3071df4402f9df5cd2a8f1b2f9c683688e090579fab9fa2aabb7a417889098df", "class_name": "RelatedNodeInfo"}}, "metadata_template": "{key}: {value}", "metadata_separator": "\n", "text": "- All HIV exposed infants (HEI) should be tested with DNA PCR within 6 weeks of age or first contact thereafter; if negative then another DNA PCR at 6 months, and if negative then repeat DNA PCR at 12 months.\n- All HEI should receive infant ARV prophylaxis consisting of 6 weeks of AZT + NVP and thereafter NVP should be continued until 6 weeks after complete cessation of breastfeeding.\n- All infants irrespective of HIV status should be exclusively breastfed for the first 6 months of life, with timely introduction of appropriate complementary foods after 6 months, and continued breastfeeding up to 24 months or beyond.\n\n# 1.7 TB/HIV Co-infection Prevention and Management\n\n- All healthcare settings should implement TB infection control recommendations to reduce the risk of transmission of TB among patients, visitors and staff.\n- Symptom-based TB screening using the ICF tool MUST be performed for all PLHIV at every clinic visit\n- Patients who screen negative should be assessed for and provided with TB preventive therapy (TPT).\n- Patients who screen positive (presumptive TB) must complete definitive diagnostic pathways.\n- The GeneXpert Ultra MTB/Rif test is the preferred test for diagnosis of TB and rifampicin resistance in all presumptive TB cases.\n- TB-LAM can be used as an adjunct rapid point-of-care diagnostic test for PLHIV: with advanced HIV disease (WHO stage 3 or 4 or CD4 count \u2264 200 cells/mm\u00b3 (or CD4% \u2264 25% for children \u2264 5 years)) with presumptive TB, or; any danger signs of severe illness, or; currently admitted to hospital.\n- Patients diagnosed with TB/HIV co-infection should start anti-TB treatment immediately and initiate ART as soon as anti-TB medications are tolerated, preferably within 2 weeks (unless they have TB meningitis, in which case ART should be deferred for 4 to 8 weeks).\n- Patients with TB/HIV co-infection who are already on ART should start anti-TB treatment immediately and continue ART, making any required adjustments to the ART regimen based on known drug-drug interactions and monitoring toxicity.\n- Always assess for ART failure in patients who develop TB after being on ART for \u2265 6 months.", "mimetype": "text/plain", "start_char_idx": 12453, "end_char_idx": 14603, "metadata_seperator": "\n", "text_template": "{metadata_str}\n\n{content}", "class_name": "TextNode"}, "__type__": "1"}, "776943e2-d82d-4a23-be05-34ed2684619a": {"__data__": {"id_": "776943e2-d82d-4a23-be05-34ed2684619a", "embedding": null, "metadata": {}, "excluded_embed_metadata_keys": [], "excluded_llm_metadata_keys": [], "relationships": {"1": {"node_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3", "node_type": "4", "metadata": {}, "hash": "d9b5b7b59617e96cf4c3935b0f633831994fd35e31c120b8787c829d8d3fc62a", "class_name": "RelatedNodeInfo"}, "2": {"node_id": "4aaec5a8-664b-4dc0-bdec-77227241d9d6", "node_type": "1", "metadata": {}, "hash": "ae95dc7bbd0a106cfc43e02ad7535873459519becd77d566b6334962bd19a71d", "class_name": "RelatedNodeInfo"}}, "metadata_template": "{key}: {value}", "metadata_separator": "\n", "text": "# 1.8 HBV/HIV and HCV/HIV Co-infection Prevention and Management\n\n- All HIV positive adolescents and adults should be screened for HBV infection, using serum HBsAg, as part of initial evaluation; children who did not complete routine childhood immunizations should also be screened for HBV and vaccinated if negative.\n- PLHIV without evidence of hepatitis B infection (HBsAg negative) should be vaccinated against hepatitis B.\n- The recommended first-line ART for adults with HIV/HBV co-infection is TDF+ 3TC + DTG.\n- HCV serology should be offered to individuals at risk of HCV infection.\n- Direct acting antiviral therapies (DAAs) for treatment of HCV have simplified the management of HIV/HCV co-infection.\n\n# 1.9 ARVs for Post-exposure Prophylaxis (PEP)\n\n- PEP should be offered as soon as possible (< 72 hours) after high-risk exposure.\n- The recommended ARV agents for PEP are:\n- <15 years old\n- < 30 kg: ABC + 3TC + DTG\n- \u2265 30 kg: TDF + 3TC + DTG\n- \u2265 15 years old\n- TDF + 3TC + DTG\n\n# 1.10 Pre-Exposure Prophylaxis (PrEP)\n\n- PrEP should be offered to HIV negative individuals at substantial ongoing risk of HIV infection (including the seronegative partner in a discordant relationship).\n- PrEP works if taken as prescribed. However, it does not prevent other STIs or unintended pregnancies, therefore, additional protection should be offered.\n- PrEP should only be offered to clients \u226515 years of age who are sexually active after eligibility assessment using the following parameters:\n- Laboratory: HIV negative\n- Medical (for oral PrEP): no contraindication to TDF; no severe renal diseases; weight \u2265 30 kg\n- Client readiness: client must be willing to take PrEP as prescribed, and adhere to associated follow up and HIV testing (at enrollment, at month 1 and thereafter every 3 months).\n- The recommended ARV regimen for Oral PrEP is TDF/FTC (alternative TDF/3TC), available in two dosing strategies:\n- Daily oral PrEP: TDF (300 mg) + FTC (200 mg) once daily.\n- Event-driven PrEP: Event driven PrEP is where oral PrEP is used in men having sex with men when an isolated sexual act is anticipated. The dose is two pills of TDF/FTC taken between 2 and 24 hours (preferably closer to 24h) before the anticipated.\n\n# 1.11 People Who Inject Drugs (PWID) and HIV\n\n- PWID should be offered regular HIV testing and counselling and be linked to comprehensive HIV treatment and prevention services including harm reduction counselling and support\n- The recommended first-line ART for adult PWID is TDF + 3TC + DTG\n- PWID should be offered screening, diagnosis, treatment and prevention of STIs as part of comprehensive HIV prevention and care\n- PWID should have the same access to TB prevention, screening and treatment services as other populations at risk of or living with HIV\n- PWID should be screened for HBV (by HBsAg) and HCV (by HCV serology) at first contact\n- All PWID should be linked to Needle and Syringe Programs (NSP) to access sterile injecting equipment\n- All PWID should be linked to Medically Assisted Therapy (MAT)", "mimetype": "text/plain", "start_char_idx": 14607, "end_char_idx": 17657, "metadata_seperator": "\n", "text_template": "{metadata_str}\n\n{content}", "class_name": "TextNode"}, "__type__": "1"}}, "docstore/metadata": {"973b665b-c0f8-4876-a78c-eb163a41eb6b": {"doc_hash": "cab6e8a6f7b79b545031de1262b51fcf95eb9e1d994016df57320551f693cfb2", "ref_doc_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3"}, "7c01f25f-7ff2-4e12-acaa-eebf94905500": {"doc_hash": "d05868751971131929f30efbef27157d889bd3272d3f3d4e087989d2f62dff16", "ref_doc_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3"}, "10e4e470-85fe-4ec8-bf0d-480d40ea6611": {"doc_hash": "2aebb07bd9ef9cc15aaa6132d121561a92690d1fbbf4a1925662912e118151c9", "ref_doc_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3"}, "88b47794-a076-4a78-900e-a2ea8f073684": {"doc_hash": "f2b1e8cb15e4eb6dc924cb9db96e28b16ae0741cb637566674fb8571b461b51a", "ref_doc_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3"}, "4aaec5a8-664b-4dc0-bdec-77227241d9d6": {"doc_hash": "ae95dc7bbd0a106cfc43e02ad7535873459519becd77d566b6334962bd19a71d", "ref_doc_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3"}, "776943e2-d82d-4a23-be05-34ed2684619a": {"doc_hash": "3071df4402f9df5cd2a8f1b2f9c683688e090579fab9fa2aabb7a417889098df", "ref_doc_id": "b8c03d72-baa5-452b-b763-b7d0f5790bc3"}}}