TAC has a made a submission to the Department of Health (DoH) and the South African National AIDS Council (SANAC) on the new draft DoH Guidelines on the Management of HIV in Health Facilities (Guidelines). The submission presented yesterday (16 May) by Zackie Achmat at a meeting of SANAC's Techinal Task Team on HIV Treatment, Care and Support. Later this month the submission will also be presented at the SANAC Plenary.
TAC welcomes the release of the Guidelines and we are pleased with a number of positive features which will lead to further improvements in the standard and quality of care for people with HIV. Nevertheless, we have a number of concerns which we have asked the Department of Health to address before the document is finalised. Our key recommendations are:
• The CD4 count threshold for Highly Active Antiretroviral Treatment (HAART) treatment initiation should be raised from 250 to 350 cells/mm3.
• The time period between treatment assessment and treatment commencement is too long and should be kept to an absolute minimum. Patients with critically low CD4 counts or who are diagnosed with advanced AIDS illnesses must be initiated onto HAART immediately, unless contraindicated.
• Pap smears, recommended by the Guidelines for HIV-positive women at the time of treatment commencement, should be offered sooner.
• The paediatric treatment protocol must be revised to recommend immediate HAART initiation for all infants who are diagnosed with HIV.