Scaling up with other HIV interventions and services
Q.31 How should national and district health authorities manage interventions during the period of scaling up revised recommendations on lifelong antiretroviral therapy?
Scaling up interventions across an entire national health system can be achieved using different approaches. Some national authorities will adopt phased implementation in order to maintain control over an expanding set of new interventions. More rapid, blanket implementation of new recommendations might also be considered. An approach that documents early learning about implementation, rapidly sharing those lessons with other districts/implementation sites and monitoring the consistency of service delivery is advisable.
WHO guidelines advocate that ARV interventions to prevent postnatal transmission of HIV make breastfeeding even more advantageous for child development and survival. While ARV interventions are being scaled up, national authorities that have decided to promote and support breastfeeding and ARVs should not be deterred from recommending HIV-infected mothers to breastfeed. It may not be possible to coordinate communication strategies in communities and training of health workers with the availability of ARVs in primary health care facilities. However, the absence of ARVs should not be a contraindication for HIV-infected mothers to breastfeed where environmental and social circumstances are not safe and supportive of replacement feeding. While it is essential to make every effort to ensure provision of ARVs, it is also important to prevent the misconception that HIV-infected mothers should only ever breastfeed if they, or their infants are taking ARVs.