Welcoming patients back to care after treatment interruption

Clinical description

• Treatment interruptions are common, and many patients need active support to return to ART.
• Most treatment interrupters feel more comfortable returning to ART via the HTS program and

many do not disclose previous ART use out of fear of reprisals.

• Judgemental and derogatory comments from health workers are a significant barrier for

treatment interrupters to return to care. Do not judge/criticize/shame.

• Emphatically welcome treatment interrupters to return to ART, either self-motivated or after

active follow-up.

• Openly advertise at OPD and HTS that interrupters are welcome to restart ART at this facility.

Confirmatory HIV testing before ART re-initiation

• With documentation of HIV+ status: no need for confirmatory HIV testing before ART re-initiation.
• Without documentation of HIV + status: routinely do confirmatory HIV test before ART re-

initiation. Follow the standard serial HIV testing algorithm.

• If confirmatory inconclusive: collect a DBS sample and send to National HIV Reference Laboratory

(NHRL).

ART re-initiation

• Offer individual counselling to establish the reasons behind the disengagement. (See section 18.7.1

on page 85 for steps for individual counselling)

• Screen for advanced HIV disease (AHD). See section 8.1, page 22 and section 10.3, page
• Treat any severe OIs first
• Screen for depression and substance use using PHQ-2 and DSM 5 screening tools. See section 12.4,

page

• Follow the routine ART initiation protocol. See section 16.4 , page
• Collect VL sample at 6 months after ART restart/re-initiation
• Ensure a committed and well-informed treatment supporter (guardian or expert client) is assigned.
• Encourage the patient to visit with his/her treatment supporter at the next appointment.
• Give 1-3-month appointments until the patient is stable and adherence is good.