THE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES The South African Antiretroviral Treatment Guidelines Goals of the programme
Achieve best health outcomes in the most cost-efficient
Decentralise service delivery to PHC facilities
Integrate services for HIV, TB, MCH, SRH and
Prevent new infections among children, adolescents,
Objectives
To contribute to strengthening of the public and private
health sectors’ capacity to deliver high quality
To ensure timely initiation of ARVs for treatment and
prevention according to the Presidential mandates
To minimize unnecessary drug toxicities
Specific Objectives
Patients with CD4 counts < 200cells/mm3 or
with severe HIV disease irrespective of CD4
Patients co-infected with TB/HIV Pregnant women with CD4 < 350cells/mm3 for
lifelong ART and CD4 >350cells/mm3 for
To test all HIV exposed children under one year and
treat all those found to be infected with HIV
To standardise first and second line therapy for
children, adolescents, and adults in the public and
To expand the use of fixed-dose and co-packaged
To enable nurses to initiate ARVs for treatment and
To enable PHC facilities to initiate, manage, monitor
1. Standardised national eligibility criteria for starting ART regimens for Adults and Adolescents Eligible to start ART
CD4 count <200cells/mm3 irrespective of clinical stage
o In patients with TB/HIV o Pregnant women
WHO stage IV irrespective of CD4 count
Require fast track (i.e. ART initiation within 2 weeks of being eligible
Pregnant women eligible for lifelong ART
Patients with very low CD4 (<100)
Stage 4, CD4 count not yet available
Not yet eligible for ART
Transfer to a wellness programme for regular follow up
Advice on how to avoid HIV transmission to sexual
Initiate INH prophylaxis if asymptomatic for TB Contraceptives and annual Pap smear
2. Standardised national ART regimens for adults and adolescents 3. Standardized National Monitoring for Adults and Adolescents with HIV At initial Diagnosis of HIV At Routine Follow-Up Visits If Eligible for ART Standardised national eligibility criteria for starting ART regimens for infants and children Eligible to Start ART
All children less than 1 year of age
Children 1 – 5 years with clinical stage 3 or 4 or CD4 ≤ 25 % or
Children > 5 years to 15 years with clinical stage 3 or 4 or CD4 <
Require Fast-Track (i.e. start ART within 2 weeks of being eligible)
Children less than 1 year of age Stage 4 MDR or XDR-TB
4. Standardised national ART regimens for infants and children 5. Standardized national monitoring for infants and children with HIV At initial Diagnosis of HIV
Document weight and height To monitor growth and development +
At Routine Follow-Up If eligible for ART 6. Standardised national ART and ARV regimens for women who are HIV positive and pregnant and their Maternal Regimens Infant Regimens any breastfeeding any breastfeeding Acronym glossary
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THE SOUTH AFRICAN 
The South African Antiretroviral Treatment 
Specific Objectives 
Standardised national eligibility criteria for starting ART