Form Id: FRM-ART-PREPARA
ENGLISH FRANÇAIS PORTUGUÊS ITALIANOPsychosocial/Knowledge Criteria (applies to patients and caregivers) | |
| 1. Understands the nature of HIV infection and benefits of ART: | |
| 2. Has screened negative for alcohol or other drug use disorder, or is established on treatment: | |
| 3. Has screened negative for depression or other psychiatric illness, or is established on treatment: | |
| 4. Is willing to disclose/has disclosed HIV status, ideally to a family member or close friend?: | |
| 5. Has received demonstration of how to take/administer ART and other prescribed medication?: | |
| 6. Has received information on predictable side effects of ART and understands what steps to take in case of these side effects?: | |
| 7. For patients dependent on a caregiver: caregiver is committed to long-term support of the patient, daily administration of ART, and meets the criteria above?: | |
| 8. Other likely barriers to adherence have been identified and there is a plan in place to address them (e.g. frequent travel for work, plan to deal with unexpected travel, distance from clinic, etc)?: | |
| 9. Patient/caregiver has provided accurate locator information and contact details?: | |
| 10. Patient/caregiver feels ready to start ART today?: | |
Support Systems Criteria (applies to patients and caregivers) | |
| 1. Has identified convenient time/s of day for taking ART, and/or associated dose/s with daily event/s: | |
| 2. Treatment supporter has been identified and engaged in HIV education, or will attend next counselling session?: | |
| 3. Is aware of support group meeting time/s?: | |
| 4. If facility has SMS reminder system: Has enrolled into SMS reminder system?: | |
| 5. Other support systems are in place or planned (e.g. setting phone alarm, pill box)?: | |
Medical Criteria (applies to patients) | |
| 1. Newly diagnosed with TB:defer ART until patient tolerates anti-TB medication; initiate ART as soon as possible preferably within 2 weeks; for TB meningitis delay ART for 4 to 8 weeks); monitor closely for IRIS: | |
| 2. Newly diagnosed cryptococcal meningitis (CM), or symptoms consistent with CM (progressive headache, fever, malaise, neck pain, confusion): defer ART until completed 5 weeks of CM treatment, or until ruling out CM as the cause of symptoms; monitor closely for IRIS: | |
*If the response to any of the psychosocial criteria or support systems criteria is "No”: develop a strategy to address the issue as quickly as possible and consider assigning a case manager. ART may be initiated with adequate adherence support while the criteria is being addressed, on a case-by-case basis | |
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