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Acute care

7 January 2009

Acute care

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.

This third revision includes the updated treatment guidelines for pneumonia, smear negative tuberculosis, sexually transmitted infections, cervical cancer, and depression (to include fluoxetine); revised testing and counselling guidelines to make these consistent with current provider-initiated testing and counselling recommendation; and other changes. New sections on prevention for MSM and on wound care (IMEESC) have been included. The section on lab tests has been removed from this module, and is now included in the Operations manual for delivery of HIV prevention, care and treatment at primary health centres in high-prevalence, resource-constrained settings.

2009 version

2004 version

These guidelines are for country adaptation in resource-limited settings. Interim guidelines are regularly revised based on implementation experience as well as revised WHO treatment guidelines. Please send comments, suggestions and requests for adaptation assistance to

For country adaptation, most IMAI publications, modules and recording forms are available either on the HIV website; the module in InDesign as well as a spreadsheet summarizing all the changes from Revision 2, are available on the IMAI Workspace. To request access to this site, please send an email to