Guideline

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

Year of Publication

2016

Issuing Institution

WHO

Links

Google Scholar,WHO IRIS

Recommendations

36 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 sexually transmitted infections (STIs)

Status

New

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

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

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

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

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 ART as lifelong treatment

Status

Maintained

Recommended in favor

Conditional

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: Partners with HIV in serodiscordant couples should be offered ART to reduce HIV transmission to uninfected partners

Status

Retired

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

As a priority ART should be initiated in all individuals with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4 counts of ≤350 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

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 ART for life (CD4 <500 cells/mm3)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

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 sexually transmitted infections (STIs) is recommended

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Oral PrEP (containing tenofovir disoproxil fumarate (TDF)) should be offered as an additional prevention choice for key populations at substantial risk of HIV infection as part of combination prevention approaches

Status

New

Recommended in favor

Strong

Certainty of evidence

High

We suggest offering periodic presumptive treatment (PPT) for asymptomatic sexually transmitted infections (STIs) to female sex workers in settings with high prevalence and limited clinical services

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

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 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 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, ART should be initiated for HIV-positive individuals with TB in TB treatment settings, with linkage to ongoing HIV care and 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, ART should be initiated and maintained in people with HIV who are eligible for ART

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Initiation of ART in hospitals, with maintenance of ART in peripheral health facilities

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Initiation of ART and maintenance of ART in peripheral health facilities

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

Initiation of 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

Moderate

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 ART

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Trained and supervised community health workers can dispense ART between regular clinical visits (strong recommendation, moderate quality of evidence)

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