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The Operations manual provides guidance on planning and delivering HIV prevention, care, and treatment services at health centres in countries with high HIV prevalence. It provides an operational framework to ensure that HIV services can be provided in an integrated, efficient and quality-assured manner.
The manual is based on the public health approach to scaling-up HIV services in resource-constrained settings, which includes simple, standardized regimens and formularies; standardized supervision and patient monitoring approaches; as well as integrated delivery of care at primary health centres within a district network. Decentralization of services to health centre and community level is facilitated with the public health approach.
This manual supports efforts to deliver and scale up HIV prevention interventions including provider-initiated testing and counselling, prevention of mother-to-child transmission, prevention of HIV and TB transmission and prevention of disease progression in HIV infected individuals.
The Operations manual deals with environmental health, logistic, managerial and infrastructure requirements for delivery of the essential HIV and primary care services as laid out in clinical guidelines such as country-adapted WHO IMAI, IMCI and IMPAC guidelines or other national clinical guidelines for provision of acute and chronic HIV care.
This manual is written as a learning aid and job aid for the health centre team, and in particular the health centre manager (often an in-charge nurse). Specific chapters may be particularly useful for those with tasks such as managing the supplies, providing laboratory services, or managing patient records, registers and reports.
During country adaptation, some content may be presented as wall charts or used to develop standard operating procedures for various services or specific types of patients.
District management teams, which supervise and support health centre services, should also find this manual helpful, as should national Ministries of Health and other partners responsible for planning and supporting the decentralization of HIV services.
Contents
- 1. INTRODUCTION AND GUIDING PRINCIPLES
- 2. PLANNING INTEGRATED HIV SERVICES AT THE HEALTH CENTRE
- 3. SERVICE INTEGRATION, LINKAGES AND TRIAGE
- 3.1 ORGANIZING HIV SERVICES: INTEGRATION, LINKAGES AND TRIAGE
- 3.2 INTEGRATING SERVICES AT THE HEALTH CENTRE
- 3.2a APPLYING BEST PRACTISES IN INTEGRATION
- 3.2b INTEGRATE PITC INTO ALL CLINICAL SERVICES
- 3.2c INTEGRATE CHRONIC HIV CARE OF MEN,NON-PREGNANT WOMEN AND CHILDREN
- 3.2d INTEGRATE HIV SERVICES INTO ANTENATAL, LABOUR AND DELIVERY, POSTPARTUM AND NEWBORN CARE (PMTCT)
- 3.2e INTEGRATE CARE OF HIV-EXPOSED INFANTS WITH THEIR MOTHERS
- 3.2f INTEGRATE TB AND HIV CARE AND TREATMENT (TB-HIV CO-MANAGEMENT)
- 3.2g INTEGRATE FAMILY PLANNING AND SEXUAL AND REPRODUCTIVE HEALTH INTO HIV SERVICES AND MATERNAL CARE
- 3.2h INTEGRATE STI MANAGEMENT INTO ACUTE AND CHRONIC HIV CARE
- 3.2i INTEGRATE HIV INTERVENTIONS INTO SERVICES FOR ADOLESCENTS
- 3.3 LINKAGES WITH OTHER SERVICES
- 3.3a APPLYING BEST PRACTISES IN LINKAGES
- 3.4 TRIAGE
- 3.4a APPLY BEST PRACTISES IN TRIAGE
- 3.5 PATIENT FLOW: PLAN HOW PEOPLE MOVE THROUGH YOUR HEALTH CENTRE TO RECEIVE VARIOUS HIV SERVICES
- 3.6 QUALITY MANAGEMENT OF INTEGRATION, LINKAGES AND TRIAGE
- 4. COMMUNITY
- 5. INFRASTRUCTURE
- 5.1 INFRASTRUCTURE CONSIDERATIONS FOR HEALTH CENTRES
- 5.2 SPACE NEEDED FOR HIV SERVICES (INTEGRATED WITHIN PRIMARY CARE)
- 5.3 PRIVACY AND CONFIDENTIALITY
- 5.4 TB INFECTION CONTROL
- 5.5 HIV INFECTION CONTROL
- 5.6 WATER SUPPLY AND WASTEWATER
- 5.7 HAND WASHING AND OTHER HYGIENE PRACTISES
- 5.8 LATRINES/TOILETS
- 5.9 CLEANING
- 5.10 HEALTH CENTRE WASTE MANAGEMENT
- 5.11 POWER
- 5.12 COMMUNICATION INFRASTRUCTURE
- 5.13 FIRE SAFETY
- INFRASTRUCTURE BY HEALTH CENTRE AREA
- 6. MONITORING SERVICES, PATIENTS AND PROGRAMMES
- INTRODUCTION
- 6.1 HOW TO MONITOR HIV PATIENTS AND PROGRAMMES
- 6.2 HOW TO IMPLEMENT AN INTEGRATED PATIENT MONITORING SYSTEM
- 6.3 HOW TO INTEGRATE PATIENT MONITORING WITH SERVICE DELIVERY
- 6.4 HOW TO RECORD INFORMATION IN MATERNAL HEALTH SERVICES
- 6.5 HOW TO RECORD INFORMATION FOR HIV-EXPOSED INFANTS
- 6.6 HOW TO RECORD INFORMATION IN TB SERVICES
- 6.7 HOW TO RECORD INFORMATION FOR TESTING AND COUNSELLING SERVICES
- 6.8 HOW TO RECORD INFORMATION FOR CARE AND TREATMENT SERVICES
- 6.9 HOW TO USE REGISTERS TO MONITOR SERVICES AND PATIENTS
- 6.10 HOW TO SUMMARIZE ROUTINE INFORMATION IN ORDER TO REPORT
- 6.11 HOW TO USE THE PATIENT MONITORING SYSTEMS TO PROMOTE QUALITY AND MONITOR PROGRAMMES
- 6.12 HOW TO CHECK THE QUALITY OF THE INFORMATION COLLECTED
- 7. SUPPLY MANAGEMENT
- 8. LABORATORY SERVICES
- INTRODUCTION
- 8.1 ESSENTIAL LAB SERVICES
- 8.2 LAB SAFETY
- 8.3 LAB TESTING
- 8.4 SPECIMEN LABELLING AND LOGGING
- 8.5 GENERIC QUALITY INSTRUCTIONS FOR ALL TESTS
- 8.6 INSTRUCTIONS FOR THE COLLECTION OF BLOOD SAMPLES
- 8.7 RAPID TESTS ON BLOOD – COMMON INSTRUCTIONS
- 8.8 RAPID HIV ANTIBODY TESTS
- 8.9 RAPID SYPHILIS TESTS
- 8.10 RAPID MALARIA TESTS
- 8.11 INFANT HIV DIAGNOSIS
- 8.12 ESTIMATING HAEMOGLOBIN
- 8.13 URINE DIPSTICK FOR SUGAR AND PROTEIN
- 8.14 PREGNANCY TESTS
- 8.15 MALARIA SMEAR AND MICROSCOPY
- 8.16 TB SMEAR AND MICROSCOPY
- 8.17 CD4: BLOOD COLLECTION AND SEND-OUT
- 8.18 FULL BLOOD COUNT AND DIFFERENTIAL: BLOOD COLLECTION AND SEND-OUT
- 8.19 SPECIMEN TRANSPORT
- 8.20 HOW TO SET UP A LAB
- 8.21 HUMAN RESOURCES
- 8.22 EQUIPMENT MAINTENANCE
- 8.23 TRAINING MATERIALS
- 9. HUMAN RESOURCES
- INTRODUCTION
- 9.1 HOW TO HELP ENSURE AN ADEQUATE NUMBER OF STAFF
- 9.2 HOW TO HELP MAKE TASK SHIFTING EFFECTIVE
- 9.3 HOW TO HELP MAKE SURE STAFF HAVE APPROPRIATE TRAINING
- 9.4 HOW TO SUPPORT CLINICAL MENTORING AND SUPPORTIVE SUPERVISION
- 9.5 HOW TO ENSURE A SAFE WORK ENVIRONMENT
- 9.6 HOW TO IMPROVE EMPLOYEE MOTIVATION AND RETENTION
- 10. LEADERSHIP AND MANAGEMENT
- 10.1 INTRODUCTION TO GOOD MANAGEMENT
- 10.2 MANAGERS AND LEADERS
- 10.3 CONDITIONS FOR GOOD MANAGEMENT
- 10.4 HOW TO LEARN AS A MANAGER
- 10.5 OVERVIEW: A MANAGER'S ROLE AND TASKS
- 10.6 HOW TO MANAGE RELATIONS WITH THE DISTRICT TEAM/ SUPERVISOR
- 10.7 HOW TO MANAGE PATIENT RELATIONS AND ACHIEVE PATIENT SATISFACTION
- 10.8 PATIENTS' RIGHTS
- 10.9 HOW TO MANAGE FINANCES
- 10.10 HOW TO MANAGE HARDWARE
- 10.11 HOW TO DESIGN MANAGEMENT SCHEDULES
- 11. QUALITY IMPROVEMENT (QI)
- Annex 2 Forms for Chapter 2: Planning integrated services at the health centre
- Annex 3 Forms for Chapter 3: Services integration, linkages and triage
- Annex 5 Forms for Chapter 5: Infrastructure
- Annex 6 Forms for Chapter 6: Monitoring services, patients, and programmes
- Annex 7 Forms for Chapter Six: Supply management
- Annex 8 Forms for Chapter 8: Laboratory services
- Annex 9 Forms for Chapter 9: Human Resources
- Annex 10 Forms for Chapter Ten: Leadership and facility mangement
- Annex 11 Forms for Chapter Eleven: Quality Improvement (Ql)
- REFERENCES BY CHAPTER
- Acronyms
- Accompanying materials
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
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