Consolidated Guidelines

3.1 Integrating Framework

These Policy Guidelines are aimed at accelerating the provision of priority access to prevention, diagnosis, treatment, care and support to healthcare workers with respect to HIV and TB. As is the case with most complex public health interventions, the various elements are mutually synergistic, and failure to implement one of the recommendations can have deleterious effects on proper implementation of others. Thus it is essential that the various statements be seen as a "package", not simply as a series of recommendations that can be individually considered.

2.14.1 Develop and implement mechanisms for monitoring the availability of these TREAT policy guidelines at the national level, as well as the dissemination of these policies and their application in the healthcare setting.

Existing guidelines regarding monitoring and evaluation, such as the following, do not specifically address HIV programmes for healthcare workers, nor even the workplace setting generally however WHO does provide some guidance on monitoring and evaluation generally (e.g. WHO's Monitoring and Evaluation Toolkit HIV/AIDS, Tuberculosis and Malaria 2004; FHI/Impact/UNAID. Evaluating Programmes for HIV/AIDS Prevention and Care in Developing Countries, A Handbook for Programme Managers and Decision Makers. 2006.)

2.13.1 Establish schemes for reasonable accommodation and compensation, including, as appropriate, paid leave, early retirement benefits and death benefits in the event of occupationally-acquired disease.

The 17 survey confirmed what had often been noted in qualitative studies consisting of interviews and focus group with worker representatives and unions, namely that compensation systems for workers with HIV and TB have been problematic. Although laws are generally in existence that apply to all workers including health workers, they have been difficult to interpret and implement. Most policies have lacked specific reference and guidance to compensation of health workers with HIV sero-conversion/AIDS and/or TB infection from health care settings.

2.11.2 Key References and Supporting WHO Guidelines

Bezanson, K., Pouteau, K., Mnthambala, A., Stephany, P., Chiwewe, D., Kumumbala, R., et al. (2006). Do health care workers with HIV/AIDS have delayed initiation of antiretroviral therapy and higher mortality when compared with other patients in Malawi? XVI International AIDS Conference, Toronto, Canada.

Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, et al. (2006). Uptake of workplace HIV counselling and testing: A cluster-randomised trial in Zimbabwe. PLoS Medicine, 3(7), e238.

2.10.1 Provide universal availability of free and timely PEP to all health care providers, for both occupational and non-occupational exposures, with appropriate training of counsellors and information on the benefits and risks provided to all staff.

The rationale for post-exposure prophylaxis is set out in detail in the WHO guideline on PEP based on the pathogenesis of HIV infection, the biological plausibility that using antiretroviral drugs can prevent transmission and the risk and benefits of post-exposure prophylaxis to exposed healthcare workers.