Introduction
Partners working on HIV care and treatment across Low- and Middle-Income Countries (LMICs) in Africa identified the development of an Advanced HIV Disease (AHD) toolkit as a critical enabler to support the rollout of the World Health Organization (WHO) recommended package of care for people with AHD. The Global AHD toolkit is the culmination of this recognition and involves a strong collaboration of partners under the AHD Implementation Steering Committee (ISC) of the Unitaid/CHAI AHD Initiative.
Guiding principles for the development of the toolkit:
- Focus on current WHO recommendations for AHD care.
- Considers Ministries of Health (MoH), the community, frontline healthcare workers and Partners, the primary target audience in a bid to support planning, training and treatment literacy for AHD rollout and implementation.
- Development of training content is currently focused on commodities provided through the Unitaid AHD initiative. These relate primarily to the diagnosis, prevention and management of HIV-related tuberculous and cryptococcal disease.
- Recognition of the need for MOHs to review and adapt tools from the toolkit considering local guidelines, priorities, and context.
- The division of training materials for ease of implementation into AHD ‘hub’, ‘spoke’ and programmatic slide decks.
The Global AHD Toolkit
The Global AHD toolkit is divided into 6 sections and features tools developed by Partners. Sections and tools are listed below:
1. Introduction
Introduction to the Global AHD toolkit (Slide, CHAI/DREAMM, 2019)
2. Basics of AHD
Basics of AHD (Slide, CHAI/DREAMM, 2019)
Components of the package of care for PLHIV with AHD (Guidelines, WHO, 2017)
Algorithm for providing a package of care for PLHIV with AHD (Guidelines, WHO, 2017)
Minimum diagnostic package of care for AHD (Video, SAMU MSF, 2019)
3. Patient literacy & community materials
NEW! – TB symptoms (Poster/WhatsApp/Facebook/Instagram fliers, AFROCAB/CHAI/Unitaid, 2022)
NEW! – TB LAM test Poster/WhatsApp/Facebook/Instagram fliers, AFROCAB/CHAI/Unitaid, 2022)
NEW! – Prevent meningitis! (Poster/WhatsApp/Facebook/Instagram fliers, AFROCAB/CHAI/Unitaid, 2022)
Not feeling well (Poster/WhatsApp/Facebook/Instagram fliers, AFROCAB/CHAI/Unitaid, 2022)
Drug holiday or pill break? (Poster/WhatsApp/Facebook/Instagram fliers, AFROCAB/CHAI/Unitaid, 2022)
AHD treatment literacy booklet for recipients of care (Booklet, HIV i-Base/CHAI, 2020)
AHD treatment literacy facility poster (Poster, HIV i-Base/CHAI, 2020)
AHD treatment literacy training manual for peer educators (Manual, HIV i-Base/CHAI, 2020)
Information card for patient presenting with AHD (Leaflet, CDC/MMSN, 2018)
Patient guide to latent TB infection and TPT (Leaflet, Division of Global HIV TB office, CDC 2018)
4. Programmatic AHD tools
NEW! – Advanced HIV Disease Commodity Calculator (Quantification tool, CHAI/Unitaid, 2021)
Differentiated service delivery for AHD (Slide, IAS, 2019)
Programmatic considerations for scale up of AHD interventions (Slide, CHAI/DREAMM, 2019)
Baseline assessment tool for facilities AHD (Checklist, EGPAF, 2019)
Spoke facility assessment tool for the provision of AHD care (Checklist, CHAI/DREAMM, 2019)
Hub facility assessment tool for the provision of AHD care (Checklist, CHAI/DREAMM, 2019)
Differentiated care for adults with AHD (Guideline, ICAP CQUIN, 2019)
TB/HIV indicator reference guide (Guide, Division of Global HIV TB office CDC, 2018)
TB Preventive Treatment sample M&E register (Register, Division of Global HIV TB office CDC, 2018)
TPT Implementation Checklist (Checklist, Division of Global HIV TB office CDC, 2018)
TPT FAQ for Program Staff (Guide, Division of Global HIV TB office CDC, 2018)
Costing tool for TPT scale up (Guide, Division of Global HIV TB office CDC, 2018)
5. Training materials
NEW! – Management of cryptococcal meningitis in Advanced HIV Disease (Slide, CHAI/DREAMM/SHARE-CM, 2023)
NEW! – Workshop on safe administration of single high-dose L-AmB regimen for cryptococcal meningitis (Slide, CHAI/DREAMM/SHARE-CM, 2023)
NEW! – Workshop on safe administration of one-week amphotericin B deoxycholate + 5FC regimen for cryptococcal meningitis (Slide, CHAI/DREAMM/SHARE-CM, 2023)
Updated! – Training for Hub facilities managing Advanced HIV Disease (Slide, CHAI/DREAMM/SHARE-CM, 2023)
Updated! – Workshop on safe administration of flucytosine & fluconaozle oral regimen for cryptococcal meningitis in Advanced HIV Disease (Slide, CHAI/DREAMM/SHARE-CM, 2023)
How to conduct IMMY CrAg LFA Test (Video, IDI Uganda/CHAI/Unitaid, 2021)
How to conduct Determine TB LAM Test (Video, IDI Uganda/CHAI/Unitaid, 2021)
Workshop on lumbar puncture procedure (Slide, CHAI/DREAMM, 2020)
Workshop on safe administration of liposomal amphotericin B (Slide, CHAI/DREAMM, 2020)
AHD training slides for Spoke facilities (Slide, DREAMM/CHAI, 2019)
Workshop on how to perform CrAg LFA tests (Slide, DREAMM, 2018)
Workshop on the safe administration of amphotericin B deoxycholate (Slide, DREAMM, 2018)
AHD care post hospital discharge (Slide, CHAI/DREAMM, 2019)
6. Job aids
NEW! – AHD Toolkit App (Android, CHAI/Infectious Disease Institute, 2023)
NEW! – AHD Toolkit App (IOS, CHAI/Infectious Disease Institute, 2023)
NEW! – Safe administration of single high-dose liposomal amphotericin B regimen for cryptococcal meningitis (Poster, CHAI/DREAMM/SHARE-CM, 2023)
NEW! – Safe administration of one-week amphotericin B deoxycholate + flucytosine for cryptococcal meningitis in Advanced HIV Disease (Poster, CHAI/DREAMM/SHARE-CM, 2023)
Updated! – Safe administration of flucytosine & fluconaozle oral regimen for cryptococcal meningitis in Advanced HIV Disease (Poster, CHAI/DREAMM/SHARE-CM, 2023)
Updated! – Summary of HIV-associated cryptococcal meningitis (Poster, CHAI/DREAMM/SHARE-CM, 2023)
CSF Analysis Parameters by CNS Infection (Poster, DREAMM, 2021)
CSF Analysis Parameters by CNS Infection [FRENCH] (Poster, DREAMM, 2021)
How to perform the CrAg LFA test using IMMY kits (Poster, DREAMM, 2018)
How to perform the CrAg LFA test using Biosynex CryptoPS RDT (Poster, DREAMM, 2018)
NEW! – Summary of HIV-associated Cryptococcal meningitis [FRENCH] (Poster, DREAMM, 2021)
Safe administration of liposomal amphotericin B (Poster, CHAI/DREAMM, 2019)
Safe administration of amphotericin B deoxycholate (Poster, DREAMM, 2018)
NEW! – Safe administration of amphotericin B deoxycholate [FRENCH] (Poster, DREAMM, 2021)
Safe administration of flucytosine and fluconazole (Poster, DREAMM, 2018)
Antifungal drug interactions app (App, Fungal Infections Trust, 2019)
Adult clinical algorithm for use of 3HP (Slide, IMPAACT4TB, 2019)
TPT and Resistance (Brief, IMPAACT4TB, 2019)
Fixed dose combination of INH/CTX/B6 (Poster, CHAI, 2019)
Acknowledgements
This toolkit was developed through a collaborative process involving a coalition of partners (The World Health Organization, Clinton Health Access Initiative, Centers for Disease Control & Prevention, St George’s University of London, United States Agency for International Development, Médecins Sans Frontières, SHARE-CM group, Elizabeth Glaser Pediatric AIDS Foundation, International AIDS Society, National Institute for Communicable Diseases South Africa, National Institute for Medical Research Tanzania, Joint United Nations Program on HIV/AIDS, Infectious Disease Institute Uganda, U.S. President’s Emergency Plan for AIDS Relief, The Global Fund, Bill & Melinda Gates Foundation, Global Health Impact Group, Coalition Plus, Medical Mycology Society of Nigeria and Lighthouse Malawi) and made possible through the Unitaid Advanced HIV Disease Initiative.
Contributors
Alexander Jordan, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Amir Shroufi, CDC Foundation
Angela Loyse, Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM)/St. Georges University Hospital London (SGUL)
Anna Grimsrud, International AIDS Society
Barry Longwe, Elizabeth Glaser Pediatric AIDS Foundation
Ben Cheng, The London School of Hygiene & Tropical Medicine
Brian Ngwatu, Clinton Health Access Initiative
Carmen Pérez Casas, Unitaid
Carolyn Amole, Clinton Health Access Initiative
Chase Perfect, Coalition Plus
Danielle Ferris, Unitaid
David Meya, Makerere University/Infectious Diseases Institute, Uganda/University of Minnesota
David Lawrence, London School of Hygiene and Tropical Medicine/SHARE-CM/IMPRINT
Elfriede Agyemang, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Eric Goemaere, Médecins Sans Frontières International
Florence Anam, Médecins Sans Frontières International
Gabriella Ferlazzo, Médecins Sans Frontières International
Gilles van Cutsem, Médecins Sans Frontières International
Gregory Greene, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Heather Paulin, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Helen Bygrave, International AIDS Society
Herb Harwell, Clinton Health Access Initiative
Ikechukwu Amamilo, Clinton Health Access Initiative
Ikwo Oboho, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Jason Williams, USAID
Jennifer Cohn, Elizabeth Glaser Pediatric AIDS Foundation
Jessica Burry, Médecins Sans Frontières International
Joram Sunguti, Elizabeth Glaser Pediatric AIDS Foundation
Katherine Blumer, Unitaid
Lara Vojnov, World Health Organization
Lee Abdelfadil, The Global Fund
Lynne Wilkinson, International AIDS Society
Miriam Rabkin, ICAP at Columbia, Columbia University Mailman School of Public Health
Mohammed Lamorde, Infectious Diseases Institute, Uganda,
More Mungati, Elizabeth Glaser Pediatric AIDS Foundation
Nathan Ford, World Health Organization
Nelesh Govender, National Institute for Communicable Diseases, South Africa
Patricia Hall, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Peter Ehrenkranz, Bill & Melinda Gates Foundation
Richard Borain, Clinton Health Access Initiative
Rita Oladele, Medical Mycology Society of Nigeria
Roland Van de Ven, Elizabeth Glaser Pediatric AIDS Foundation
Sam Phiri, Lighthouse Malawi
Sarita Shah, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Satvinder Singh, World Health Organization
Sayoki Mfinanga, National Institute for Medical Research, Tanzania
Serhin Birhanu, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Sokoine Kivuyo, National Institute for Medical Research, Tanzania
Teri Roberts, International AIDS Society
Tom Boyle, The Wits Reproductive Health and HIV Institute
Tom Chiller, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Tom Harrison, St Georges University London/SHARE-CM/IMPRINT
Wale Ajose, Unitaid
The development of the Global AHD toolkit was led by Angela Loyse (DREAMM), Ikechukwu Amamilo (CHAI) and Brian Ngwatu (CHAI)
Annex – Links to partner toolkits
PEPFAR solutions/CDC TPT toolkit
Have a suggestion or tool to recommend? Please contact, Ikechukwu Amamilo
