Management of Patients Previously on ART

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Individuals who interrupt ART for any reason are at increased risk of resistance and treatment failure. Management in ART re-initiation is based on several factors, and a complete history to establish why the treatment was stopped is critical. For HIV-infected children, caregivers must be questioned.

• If treatment failure or toxicity is not suspected as the reason for stopping ART, and previous good adherence is reported, reinitiate original ART in consultation with next level.
• If previous adherence is poor and there is treatment failure, these individuals (and caregivers of children) MUST be enrolled in intensive
  adherence counselling sessions until there is agreement among the patient, provider, and adherence counsellor that the patient is ready to
  commence Second-Line ART. Use of treatment supporters for such patients is strongly recommended.
• If severe toxicity is the reason for stopping ART, refer to the next level and initiate ART using the appropriate drug substitution and counsel
  regarding adherence.
• Viral load testing should be done 6 months after re-initiation of the original regimen to document HIV viral suppression.
• Do not collect viral load tests for patients who present to care while not taking ART