Guideline

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations

Year of Publication

2014

Issuing Institution

WHO

Links

Google Scholar,WHO IRIS

Recommendations

48 included recommendations

The correct and consistent use of condoms with condom-compatible lubricants is recommended for all key populations to prevent sexual transmission of HIV and STIs

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

All individuals from key populations who inject drugs should have access to sterile injecting equipment through needle and syringe programmes

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

All people from key populations who are dependent on opioids should be offered opioid substitution therapy in keeping with WHO guidance, including those in prison and other closed settings

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

All key populations with harmful alcohol or other substance use should have access to evidence-based interventions, including brief psychosocial interventions involving assessment, specific feedback and advice

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

People likely to witness an opioid overdose should have access to naloxone and be instructed in its use for emergency management of suspected opioid overdose

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Naloxone is effective when delivered by intramuscular, intranasal, intravenous and subcutaneous routes. Persons administering naloxone should select the route based on formulation available, skills in administration, setting and local context

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

In suspected opioid overdose, first-responders should focus on maintaining an airway, assisting ventilation and giving naloxone

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

After successful resuscitation following administration of naloxone, the affected person’s level of consciousness and breathing should be closely observed – where possible, until the person has fully recovered.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Where serodiscordant couples can be identified and where additional HIV prevention choices for them are needed, daily oral PrEP (specifically tenofovir or the combination of tenofovir and emtricitabine) may be considered as a possible additional intervention for the uninfected partner

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

High

Among men who have sex with men, PrEP is recommended as an additional HIV prevention choice within a comprehensive HIV prevention package

Status

New

Recommended in favor

Strong

Certainty of evidence

High

The existing recommendation to offer daily oral PrEP as an additional HIV prevention choice for the negative partner in a serodiscordant relationship remains relevant for people who inject drugs and are in a serodiscordant relationship

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

High

The existing recommendation to offer daily oral PrEP as an additional HIV prevention choice for the HIV-negative partner in a serodiscordant couple remains relevant for sex workers who are in serodiscordant couple relationships

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

High

Where HIV transmission occurs among transgender women who have sex with men and additional HIV prevention choices for them are needed, daily oral PrEP (specifically the combination of tenofovir and emtricitabine) may be considered as a possible additional intervention

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

High

HIV post-exposure prophylaxis should be considered for people presenting within 72 hours of a sexual assault. Use shared decision-making with the survivor to determine whether HIV post-exposure prophylaxis is appropriate

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Individuals with HIV and active TB disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Individuals coinfected with HIV and hepatitis B virus (HBV) with evidence of severe chronic liver disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: For programmatic and operational reasons, particularly in generalized epidemics, all pregnant and breastfeeding women with HIV should initiate antiretroviral therapy (ART) as lifelong treatment

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Partners with HIV in serodiscordant couples should be offered antiretroviral therapy (ART) to reduce HIV transmission to uninfected partners

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Community-based HIV testing and counselling for key populations, with linkage to prevention, care and treatment services, is recommended, in addition to provider-initiated testing and counselling

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

HIV testing services, with linkages to prevention, treatment and care, are recommended for adolescents from key populations

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Adolescents with HIV should be counselled about the potential benefits and risks of disclosure of their HIV status and empowered and supported to determine if, when, how and to whom to disclose

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Children of school age should be told their HIV positive status; younger children should be told their status incrementally to accommodate their cognitive skills and emotional maturity, in preparation for full disclosure.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

antiretroviral therapy (ART) should be initiated in all adults living with HIV, regardless of WHO clinical stage and at any CD4 cell count

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Individuals with HIV and active TB disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

ART should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Individuals coinfected with HIV and hepatitis B virus (HBV) with evidence of severe chronic liver disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: For programmatic and operational reasons, particularly in generalized epidemics, all pregnant and breastfeeding women with HIV should initiate antiretroviral therapy (ART) as lifelong treatment

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

antiretroviral therapy (ART) should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 count with priority of the following groups: Partners with HIV in serodiscordant couples should be offered antiretroviral therapy (ART) to reduce HIV transmission to uninfected partners

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

For programmatic and operational reasons, particularly in generalized epidemics, all pregnant and breastfeeding women living with HIV should initiate ART and maintain it as lifelong treatment (option B+)

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

All pregnant and breastfeeding women living with HIV should initiate triple antiretrovirals (ARV), which should be maintained at least for the duration of risk of mother-to-child transmission. Women meeting treatment eligibility criteria should continue antiretroviral therapy (ART) for life (CD4 <500 cells/mm3)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Routine HIV testing should be offered to all people with presumptive and diagnosed TB

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

People from key populations with HIV and HBV coinfection who have severe chronic liver disease should be offered ART with a tenofovir (TDF) and lamivudine (3TC) (or emtricitabine (FTC))-based regimen irrespective of CD4 count or WHO clinical stage

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

HCV serology testing should be offered to individuals from populations with high HCV prevalence or who have a personal history of HCV risk exposure/behaviour

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

An alcohol intake assessment is recommended for all persons with HCV infection, followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Assessment for antiviral treatment of all adults and children with chronic HCV infection is recommended, including for people who inject drugs

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Periodic screening of people from key populations for asymptomatic STIs is recommended

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Programmes should implement a package of interventions to enhance community empowerment among sex workers

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In generalized epidemic settings antiretroviral therapy (ART) should be initiated and maintained in eligible pregnant and postpartum women and in infants at maternal, newborn and child health-care settings, with linkage and referral to ongoing HIV care and antiretroviral therapy (ART) where appropriate

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In settings with a high HIV prevalence (≥5%) among TB patients, antiretroviral therapy (ART) should be initiated for HIV-positive individuals with TB in TB treatment settings, with linkage to ongoing HIV care and antiretroviral therapy (ART)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In settings with a high burden of HIV and TB, TB treatment should be provided for individuals with HIV in HIV care settings where TB diagnosis has also been made

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In settings where opioid substitution therapy is provided, antiretroviral therapy (ART) should be initiated and maintained in people with HIV who are eligible for antiretroviral therapy (ART)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Decentralization of HIV treatment and care should be considered as a way to increase access to and improve retention in care: initiation of ART in hospitals with maintenance of ART in peripheral health facilities

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Decentralization of HIV treatment and care should be considered as a way to increase access to and improve retention in care: initiation and maintenance of antiretroviral therapy (ART) in peripheral health facilities

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Decentralization of HIV treatment and care should be considered as a way to increase access to and improve retention in care: Initiation of antiretroviral therapy (ART) at peripheral health facilities, with maintenance at the community level between regular clinic visits (i.e. outside of health facilities, in settings such as outreach sites, health posts, home-based services or community-based organizations)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Trained non-physician clinicians, midwives and nurses can initiate first-line ART

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Trained non-physician clinicians, midwives and nurses can maintain antiretroviral therapy (ART)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Trained and supervised community health workers can dispense antiretroviral therapy (ART) between regular clinical visits

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In all HIV epidemic settings, WHO recommends community-based HIV testing and counselling with linkage to prevention, care and treatment services for key populations in addition to provider-initiated testing and counselling

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Community-based approaches can improve treatment adherence and retention in care of adolescents living with HIV

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low