If you or someone you know has been diagnosed with HIV in Kenya, it’s important to understand the guidelines for antiretroviral therapy (ART) set forth by the National AIDS and STI Control Programme (NASCOP).
These guidelines outline the most effective and up-to-date approaches to HIV treatment, including ART eligibility criteria, initiation processes, and regimen selection. By following these guidelines, individuals living with HIV can better manage their condition and improve their overall health.
NASCOP is a division of the Kenyan Ministry of Health that is responsible for developing and implementing policies and programs related to HIV and other sexually transmitted infections (STIs).
The organization’s HIV Treatment Guidelines are regularly updated to reflect the latest research and best practices in HIV care. These guidelines are designed to help healthcare providers and individuals living with HIV make informed decisions about ART, including when to initiate treatment, which regimens to use, and how to monitor and manage side effects.
Background on NASCOP
The National AIDS and STI Control Program (NASCOP) is a division of the Ministry of Health in Kenya responsible for coordinating the national response to HIV and other sexually transmitted infections (STIs).
NASCOP was established in 1987 and has since been at the forefront of HIV prevention, care, and treatment in Kenya.
NASCOP has been instrumental in developing and implementing various policies, guidelines, and strategies aimed at reducing the prevalence of HIV and improving the quality of life for people living with HIV in Kenya.
These policies and guidelines have been developed in consultation with stakeholders, including healthcare workers, civil society organizations, and people living with HIV.
Some of the key areas of focus for NASCOP include HIV prevention, HIV testing and counseling, HIV treatment and care, and STI management.
NASCOP also provides technical assistance to healthcare facilities and partners to ensure that they are equipped to provide quality HIV and STI services. NASCOP has been recognized globally for its innovative approaches to HIV prevention and treatment.
For example, Kenya was among the first countries in sub-Saharan Africa to implement a national policy of providing antiretroviral therapy (ART) to all people living with HIV, regardless of their CD4 cell count.
This policy, known as “test and treat,” was implemented in 2016 and has since been adopted by several other countries in the region.
HIV Treatment Guidelines
If you are living with HIV in Kenya, it is important to know the current guidelines for antiretroviral therapy (ART) provided by the National AIDS and STI Control Program (NASCOP).
These guidelines aim to provide the best possible treatment for people living with HIV in Kenya, with the ultimate goal of achieving viral suppression and improving overall health outcomes.
The most recent version of the Kenya HIV Prevention and Treatment Guidelines was released in 2022 and is aligned with the UNAIDS 95-95-95 testing and treatment targets.
These guidelines provide recommendations for the initiation and monitoring of ART, management of opportunistic infections, and prevention of mother-to-child transmission, among other aspects of HIV care.
One of the key recommendations in the guidelines is the initiation of ART as soon as possible after diagnosis, regardless of CD4 count or clinical stage.
This is known as “test and treat” and has been shown to improve health outcomes and reduce transmission of HIV. The guidelines also provide specific recommendations for ART regimens based on factors such as age, pregnancy status, and comorbidities.
In addition to ART, the guidelines recommend regular monitoring of viral load and CD4 count to assess treatment efficacy and identify treatment failure.
They also provide guidance on the management of side effects and adverse reactions to ART, as well as the use of prophylaxis for opportunistic infections.
ART Eligibility Criteria
The NASCOP ART guidelines for HIV treatment in Kenya provide clear and specific criteria for determining ART eligibility. These criteria are based on the CD4 count and WHO clinical stage of the patient.
According to the guidelines, all HIV-positive individuals, regardless of their CD4 count or clinical stage, are eligible for ART. However, there are specific criteria that determine when treatment should be initiated.
The following table outlines the ART eligibility criteria based on CD4 count and clinical stage:
| CD4 Count | Clinical Stage | ART Eligibility |
|---|---|---|
| ≤350 cells/mm3 | Any stage | Immediate |
| 351-500 cells/mm3 | Any stage | Consider |
| >500 cells/mm3 | Any stage | Deferred |
| Any count | Stage 3 or 4 | Immediate |
In addition to these criteria, the guidelines also recommend immediate ART initiation for certain populations, including:
- Pregnant and breastfeeding women
- Children under the age of 15
- Patients with tuberculosis (TB)
- Patients with hepatitis B virus (HBV) coinfection
- Patients with HIV-associated nephropathy (HIVAN)
- Patients with HIV-associated dementia (HAD)
It is important to note that these eligibility criteria are subject to change as new evidence emerges. Therefore, it is essential to stay up-to-date with the latest guidelines and recommendations from NASCOP.
The NASCOP ART guidelines provide clear and evidence-based criteria for determining ART eligibility in Kenya. By following these guidelines, healthcare providers can ensure that patients receive the appropriate treatment at the right time.
ART Initiation Process
If you are HIV positive and meet the criteria for ART initiation, your healthcare provider will start you on treatment. The NASCOP ART guidelines for HIV treatment in Kenya recommend that ART should be initiated as soon as possible after diagnosis, regardless of CD4 count or clinical stage.
The initiation process involves several steps, including a clinical evaluation, laboratory testing, and counseling.
During the clinical evaluation, your healthcare provider will assess your overall health and check for any signs of opportunistic infections or other conditions that may affect your treatment.
Laboratory testing will include a CD4 count and viral load test to determine the level of HIV in your blood. Counseling will help you understand the benefits and risks of ART and address any concerns you may have.
Once you have completed the evaluation and testing, your healthcare provider will prescribe a combination of antiretroviral drugs that is appropriate for your individual needs.
The NASCOP ART guidelines recommend a preferred first-line regimen of tenofovir, lamivudine, and dolutegravir for most adults and adolescents. However, alternative regimens may be used in certain situations, such as for pregnant women or individuals with drug resistance.
After starting ART, you will need to have regular follow-up appointments with your healthcare provider to monitor your response to treatment and manage any side effects.
The NASCOP ART guidelines recommend that viral load testing be performed at 6 months and 12 months after ART initiation, and then annually thereafter if viral suppression is achieved. CD4 count testing is recommended every 6-12 months for the first two years of treatment, and then annually thereafter if CD4 count is stable.
It is important to adhere to your ART regimen as prescribed by your healthcare provider to achieve and maintain viral suppression and improve your overall health outcomes.
The NASCOP ART guidelines recommend that adherence support be provided to all individuals on ART, including counseling, pill counting, and other adherence monitoring strategies.
ART Regimen Selection
When selecting an initial ART regimen for HIV treatment in Kenya, the NASCOP guidelines recommend considering patient preferences and clinical characteristics.
A preferred regimen should be used whenever possible. The guidelines provide several preferred, alternative, and other initial ART regimens for nonpregnant adults, each with different tolerability, possible toxicities, and convenience.
According to the guidelines, the preferred regimens for nonpregnant adults include:
- Dolutegravir (DTG) + Lamivudine (3TC) or Emtricitabine (FTC) + Tenofovir Disoproxil Fumarate (TDF)
- Dolutegravir (DTG) + Abacavir/Lamivudine (ABC/3TC)
- Efavirenz (EFV) 400mg + Lamivudine (3TC) or Emtricitabine (FTC) + Tenofovir Disoproxil Fumarate (TDF)
The guidelines recommend that healthcare providers consider the following factors when selecting an ART regimen:
- Comorbidities and concomitant medications
- Potential for drug-drug interactions
- Adherence and potential for resistance
- Patient’s preferences and potential for toxicity
The guidelines also provide specific recommendations for ART regimen selection in special populations, such as pregnant women, children, and adolescents.
For example, for pregnant women, the preferred regimen is DTG + 3TC or FTC, as it has a lower risk of neural tube defects compared to other regimens.
Monitoring and Adherence to ART
Once you have started ART, it is important to monitor your progress and adhere to the treatment plan. The NASCOP ART guidelines for HIV treatment in Kenya provide recommendations for monitoring and adherence to ART.
Monitoring
Regular monitoring is important to assess the effectiveness of ART and detect any adverse effects. The guidelines recommend the following monitoring schedule:
- Clinical evaluation: every 3-6 months
- CD4 count: every 6 months for the first year, then annually
- Viral load: every 6 months for the first year, then annually
In addition to these routine tests, the guidelines recommend additional monitoring for specific populations, such as pregnant women and children.
Adherence
Adherence to ART is crucial for the success of treatment. The guidelines recommend the following strategies to improve adherence:
- Education and counseling: healthcare providers should educate patients about ART and the importance of adherence. Counseling should be provided to address any concerns or barriers to adherence.
- Pill counts: patients should bring their medication to each clinic visit for a pill count to assess adherence.
- Adherence support: healthcare providers should provide support to patients who are struggling with adherence, such as reminders or referral to adherence support groups.
Non-adherence to ART can lead to treatment failure, drug resistance, and poor health outcomes. Therefore, it is important to monitor and address adherence issues to ensure the success of treatment.
Management of ART Side Effects
When you start ART treatment, you may experience some side effects. These side effects can vary depending on the type of medication you are taking.
It is important to note that not everyone will experience side effects, and they can be managed with the right care. Here are some common side effects of ART and how to manage them:
Nausea and Vomiting
Nausea and vomiting are common side effects of ART, especially during the first few weeks of treatment. You can manage these side effects by:
- Taking your medication with food
- Drinking plenty of fluids
- Eating small, frequent meals throughout the day
- Avoiding spicy and greasy foods
If your nausea and vomiting persist, talk to your healthcare provider. They may be able to prescribe medication to help manage these side effects.
Diarrhea
Diarrhea is another common side effect of ART. To manage diarrhea, you can:
- Drink plenty of fluids to avoid dehydration
- Eat foods that are low in fiber and easy to digest, such as rice, bananas, and toast
- Avoid dairy products, caffeine, and alcohol
- Take over-the-counter medication, such as loperamide, to help control diarrhea
If your diarrhea persists for more than a few days, or you notice blood in your stool, contact your healthcare provider.
Fatigue
Fatigue is a common side effect of ART, especially during the first few weeks of treatment. To manage fatigue, you can:
- Get plenty of rest
- Take short naps throughout the day
- Exercise regularly
- Eat a healthy, balanced diet
If your fatigue persists or becomes severe, talk to your healthcare provider. They may be able to adjust your medication or recommend other treatments to help manage your fatigue.
Skin Rash
Some people may experience a skin rash as a side effect of ART. To manage a skin rash, you can:
- Keep the affected area clean and dry
- Avoid scratching the rash
- Apply a cool, damp cloth to the affected area
- Use over-the-counter creams or ointments, such as hydrocortisone, to help relieve itching
If your skin rash persists or becomes severe, contact your healthcare provider. They may recommend other treatments, such as prescription medication, to help manage your rash.
Transitioning and Switching ART Regimens
When transitioning from one ART regimen to another, it is important to consider the following factors:
- Viral suppression: Before switching, ensure that the patient is virally suppressed (i.e., viral load <1000 copies/mL).
- Adherence: Ensure that the patient has been adherent to their current regimen and is likely to adhere to the new regimen.
- Drug interactions: Check for potential drug interactions between the current regimen and the new regimen.
- Resistance: Check for potential resistance to the new regimen based on previous treatment history and viral resistance testing.
NASCOP recommends the following regimens for transitioning from one ART regimen to another:
- If the patient is on a first-line regimen and has been adherent but is experiencing toxicity, switch to an alternative first-line regimen.
- If the patient is on a first-line regimen and has virologic failure, switch to a second-line regimen.
- If the patient is on a second-line regimen and has been adherent but is experiencing toxicity, switch to an alternative second-line regimen.
- If the patient is on a second-line regimen and has virologic failure, switch to a third-line regimen.
When switching regimens, it is important to ensure that the new regimen is available and accessible to the patient. Additionally, it is important to provide counseling and support to the patient to ensure adherence to the new regimen.
It is also important to note that switching ART regimens can lead to drug resistance and treatment failure. Therefore, switching should only be done when necessary and under the guidance of a healthcare provider.
Special Populations and ART
When it comes to HIV treatment, special populations require specialized care. The NASCOP ART guidelines for HIV treatment in Kenya recognize the importance of providing tailored care to key populations.
These populations include men who have sex with men, sex workers, people who inject drugs, and adolescents.
For men who have sex with men, the guidelines recommend providing pre-exposure prophylaxis (PrEP) as an option to prevent HIV transmission.
In addition, healthcare providers should take into consideration the unique challenges that this population faces, such as stigma and discrimination, and provide appropriate support.
For sex workers, the guidelines recommend offering PrEP as well as post-exposure prophylaxis (PEP) in case of a potential exposure to HIV. Healthcare providers should also provide HIV testing and counseling, as well as screening for other sexually transmitted infections (STIs).
For people who inject drugs, the guidelines recommend offering opioid substitution therapy (OST) as a harm reduction strategy. This can help reduce the risk of HIV transmission through shared injection equipment.
In addition, healthcare providers should offer HIV testing and counseling, as well as screening for other blood-borne infections.
For adolescents, the guidelines recommend providing age-appropriate HIV testing and counseling, as well as ensuring that they have access to appropriate HIV treatment and care.
Healthcare providers should also take into consideration the unique challenges that adolescents face, such as disclosure and adherence, and provide appropriate support.
Final Thoughts
In conclusion, the NASCOP ART guidelines for HIV treatment in Kenya are an essential resource for healthcare providers and policymakers.
These guidelines provide evidence-based recommendations for the use of antiretroviral therapy in the treatment and prevention of HIV infection in Kenya.
By following these guidelines, healthcare providers can ensure that their patients receive the best possible care and treatment.
It is important to note that these guidelines are updated regularly to reflect new research and emerging evidence. Therefore, healthcare providers should stay up-to-date with the latest guidelines to ensure that they are providing the most effective and appropriate treatment to their patients.
Additionally, it is important to recognize that the success of HIV treatment in Kenya is not solely dependent on the availability of ART drugs and adherence to treatment guidelines.
Other factors, such as stigma, discrimination, and access to healthcare, also play a significant role in the overall success of HIV treatment and prevention efforts in the country.
Frequently Asked Questions
What are the latest NASCOP guidelines for HIV treatment in Kenya?
The latest NASCOP guidelines for HIV treatment in Kenya were released in 2022. These guidelines provide updated recommendations for the prevention, diagnosis, and treatment of HIV in Kenya. They cover a range of topics including HIV testing, antiretroviral therapy (ART), and management of co-morbidities.
What are the ART regimens recommended by NASCOP for HIV treatment in Kenya?
NASCOP recommends several ART regimens for HIV treatment in Kenya. The choice of regimen depends on various factors such as the patient’s age, clinical status, and co-morbidities. The recommended regimens include first-line and second-line ART regimens.
What are the first-line ARVs recommended by NASCOP in Kenya?
NASCOP recommends several first-line antiretroviral (ARV) regimens for HIV treatment in Kenya. The recommended regimens include Tenofovir-Lamivudine-Dolutegravir (TLD), Tenofovir-Emtricitabine-Dolutegravir (TED), and Zidovudine-Lamivudine-Dolutegravir (ZLD).
What is the current guideline for initiating antiretroviral therapy in Kenya?
The current guideline for initiating antiretroviral therapy in Kenya recommends that all people living with HIV should start ART as soon as possible after diagnosis, regardless of their CD4 count. This is known as “test and treat” and is based on evidence that early ART initiation leads to better health outcomes for people living with HIV.
Where can I find the NASCOP HIV treatment guidelines for Kenya?
The NASCOP HIV treatment guidelines for Kenya can be found on the NASCOP website (https://www.nascop.or.ke/). The guidelines are regularly updated to reflect the latest evidence and recommendations for HIV prevention, diagnosis, and treatment in Kenya.
What are the key updates in the 2022 NASCOP ART guidelines for HIV treatment in Kenya?
The 2022 NASCOP ART guidelines for HIV treatment in Kenya include several key updates. These updates include new recommendations for the use of dolutegravir-based regimens, simplified ART initiation and monitoring, and the integration of HIV services with other health services.
The guidelines also emphasize the importance of patient-centered care and the involvement of people living with HIV in decision-making about their own care.