IMAI/IMCI heath centre/primary care guideline modules
Chronic HIV care with ARV therapy and prevention
This guideline module includes patient education, psychosocial support, prevention for positives, clinical staging, prophylaxis (INH, cotrimoxazole, fluconazole), preparation for ARV treatment then clinical monitoring, response to side effects, adherence preparation and support, management of chronic problems, and data collection based on a simple treatment card. The Chronic HIV Care with ARV Therapy effectively integrates HIV care and prevention, increasing the potential for preventive interventions. The broader uptake of preventive interventions is essential for HIV control.
General principles of good chronic care
IMAI supports the introduction of an effective approach to chronic care (including a team approach, patient partnership, inclusion of “expert patients”/peer support staff on the clinical team, and effective adherence support). This approach could permit rapid expansion of human resources for HIV care while providing the skills and clinic capacity for effective management of other chronic illnesses. A short guideline module describes the General Principles of Good Chronic Care. These principles are used in the Chronic HIV Care guidelines.
Acute care presents a syndromic approach to the most common adult illnesses including most opportunistic infections. Clear instructions are provided so the health worker knows which patients can be managed at the first-level facility and which require referral to the district hospital or further assessment by a more senior clinician. Preparing first-level facility health workers to treat the common, less severe opportunistic infections will allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy without referral to the district.
Palliative care: symptom management and end-of-life care
The guideline module covers management of symptoms during acute or chronic illness, education of the patient, family and community caregiver to provide care at home, using the Caregiver Booklet; and end-of-life care. Symptom management is very important in patients on ARV treatment. In order to expand access to palliative care, this approach assumes that most of the care will be given by the patient’s family with back-up by multi-purpose health workers at first- level facilities. This module covers palliative care in both children and adults.
TB care with TB-HIV co-management
This new guideline module is fully integrated with the other IMAI guideline modules and addresses diagnosis and treatment of TB disease in both HIV-positive and HIV-negative patients for first-level facility health workers. Guidelines for diagnosis of smear negative patients according to the latest normative guideline are included. Clear guidelines are given for HIV testing in TB patients, as well as specific recommendations for co-management of TB-HIV including ART. Special attention is given to preparation for adherence to TB and HIV treatment, special considerations in children, as well as to the involvement of Treatment and DOTS supporters. Prevention includes positive prevention for PLHIV, prophylaxis as well as preventing spread of TB within the health facility. Recording on the treatment card, patient monitoring and determining TB treatment outcome are also included.
IMCI chart booklet for high HIV settings
The modified IMCI chart booklet for high HIV settings addresses the same common childhood illnesses as the original booklet (including pneumonia, malaria, diarrhoea, ear infections, severe malnutrition and measles) as well as identification and management of HIV-related conditions such as skin and mouth conditions. It has guidelines on HIV-exposed and infected infants and children on infant feeding, immunization, co-trimoxazole prophylaxis, Vitamin A, zinc and other micronutrient supplementation, as well as nutritional support. It provides general information on antiretroviral drugs for children, adherence to these drugs, side effects of these drugs and how to manage them. The IMCI chart booklet sits alongside the IMAI guideline modules for adults and adolescents.
Pre-ART, ART, ANC and L&D Registers
Training for clear data and training for district teams.
HIV care/ART card
Training for clinicians
These guidelines have been released for country adaptation and to help with the emergency scale-up of antiretroviral therapy (ART) in resource-limited settings. Interim guidelines are regularly revised based on early implementation experience. Please send comments, suggestions and requests for adaptation assistance to: email@example.com.
For country adaptation, most IMAI publications, modules and recording forms are also available in Word and/or InDesign formats. To request these formats please send an email to firstname.lastname@example.org.