WHO SMART Guidelines - HIV
0.3.0 - ci-build
WHO SMART Guidelines - HIV - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Active as of 2024-12-06 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="CareAndTreatmentClinicalVisit-PlanDefinition"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">CareAndTreatmentClinicalVisit-PlanDefinition</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-CareAndTreatmentClinicalVisit-PlanDefinition.html">PlanDefinition - Care and treatment clinical visit</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.3.0</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">PlanDefinition - Care and treatment clinical visit</td>
</tr>
<tr>
<th scope="row"><b>Experimental: </b></th>
<td style="padding-left: 4px;">true</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://hl7.org/fhir/R4/codesystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
</p>
<p style="margin-bottom: 5px;">
<b>code: </b> <span>workflow-definition</span>
</p>
<p style="margin-bottom: 5px;">
<b>display: </b> <span>Workflow Definition</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2024-12-06 22:28:12+0000</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">WHO</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>To initiate ART and to provide HIV care, treatment and integrated health services</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Care and treatment clinical visit business process:</b> To initiate ART and to provide HIV care, treatment and integrated health services
<br/>
<b>Then:</b>
<table class="grid-dict">
<tr>
<td>
<b> Determine reason for visit:</b>
Search for client details in the system and determine reason for visit
<br/>
</td>
</tr>
<tr>
<td>
<b> Take vital signs:</b>
Also record weight, height, etc. For children, weight will be needed to determine dosage and to check for malnutrition.
<br/>
</td>
</tr>
<tr>
<td>
<b> Check for signs of serious illness:</b>
Any person who has signs of seriously illness should be referred to the appropriate higher-lever facility for management
<br/>
</td>
</tr>
<tr>
<td>
<b> Screen for TB :</b>
Adults and adolescents living with HIV should be screened for TB according to a clinical algorithm
<br/>
</td>
</tr>
<tr>
<td>
<b> Seriously ill?:</b>
Any person who has signs of serious illness should be referred to the appropriate higher-lever facility for management or receive emergency care, depending on availability and policies.
<br/>
</td>
</tr>
<tr>
<td>
<b> Capture or update client history:</b>
Discuss history with client and review available records. History-taking should include partner’s HIV status and whether the partner is virally suppressed on ART
<br/>
</td>
</tr>
<tr>
<td>
<b> First time initiating treatment?:</b>
This step checks whether the client is naïve to ART
<br/>
</td>
</tr>
<tr>
<td>
<b> Counsel returning clients:</b>
Adherence, such as whether client is picking up meds and/or has any barriers to adherence to their treatment(s), if so, set plan for adherence support
<br/>
</td>
</tr>
<tr>
<td>
<b> Retest for HIV using testing algorithm:</b>
WHO recommends that all programmes retest people diagnosed with HIV prior to initiating lifelong ART
<br/>
</td>
</tr>
<tr>
<td>
<b> Determine recommended screenings and tests:</b>
HIV.D12.DT Determine recommended screenings and tests
<br/>
</td>
</tr>
<tr>
<td>
<b> Examine client:</b>
Examine the client clinically, with a physical exam
<br/>
</td>
</tr>
<tr>
<td>
<b> Prevent, screen and manage comorbidities and coinfections:</b>
With ART, HIV is a chronic disease requiring lifetime care. WHO guidelines cover information on common and important concomitant conditions among people living with HIV, including: co-trimoxazole prophylaxis; the diagnosis, prevention and treatment of TB, viral hepatitis, malaria, sexually transmitted infections, cervical cancer prevention, nutrition, vaccinations, mental health and substance use
<br/>
</td>
</tr>
<tr>
<td>
<b> Determine clinical stage of HIV:</b>
HIV.D15.DT Determine WHO clinical stage of HIV
<br/>
</td>
</tr>
<tr>
<td>
<b> Perform other screenings:</b>
Conduct screenings based on recommendations and priorities and depending on the diagnostics that are available.
<br/>
</td>
</tr>
<tr>
<td>
<b> Check for signs of treatment failure:</b>
Review new diagnostic results
<br/>
</td>
</tr>
<tr>
<td>
<b> Diagnostics:</b>
Viral load should be tested routinely for early warning of virological failure and monitored if clinical or virological failure are suspected
<br/>
</td>
</tr>
<tr>
<td>
<b> Determine regimen and treatment options:</b>
For continuing care, check the dosage and need for readjustment or whether treatment failure is suspected.
<br/>
</td>
</tr>
<tr>
<td>
<b> Make informed decision on treatment:</b>
Even if client is eligible to start ART, the choice to accept or decline ART ultimately lies with the person or his or her caregiver, and if the decision is to defer initiation, ART can be offered again at subsequent visits
<br/>
</td>
</tr>
<tr>
<td>
<b> Prescribe:</b>
The scripting period should cover the period until the next clinical consultation (not until the following ART refill visit).
<br/>
</td>
</tr>
<tr>
<td>
<b> Counsel:</b>
Counsel clients on adherence.
<br/>
</td>
</tr>
<tr>
<td>
<b> Laboratory diagnostics needed:</b>
Additional testing or specimen collection may be needed and may happen after the visit
<br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<url
value="http://smart.who.int/hiv/PlanDefinition/CareAndTreatmentClinicalVisit-PlanDefinition"/>
<version value="0.3.0"/>
<name value="PlanDefinition_Care and treatment clinical visit"/>
<title value="PlanDefinition - Care and treatment clinical visit"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="workflow-definition"/>
<display value="Workflow Definition"/>
</coding>
</type>
<status value="active"/>
<experimental value="true"/>
<date value="2024-12-06T22:28:12+00:00"/>
<publisher value="WHO"/>
<contact>
<name value="WHO"/>
<telecom>
<system value="url"/>
<value value="http://who.int"/>
</telecom>
</contact>
<description
value="To initiate ART and to provide HIV care, treatment and integrated health services"/>
<action>
<title value="Care and treatment clinical visit business process"/>
<description
value=" To initiate ART and to provide HIV care, treatment and integrated health services"/>
<participant>
<type value="patient"/>
<role>
<coding>
<code value="client"/>
</coding>
</role>
</participant>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
<action id="HIV.D.1">
<title value="Determine reason for visit"/>
<description
value="Search for client details in the system and determine reason for visit"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.2">
<title value="Take vital signs"/>
<description
value="Also record weight, height, etc. For children, weight will be needed to determine dosage and to check for malnutrition."/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.3">
<title value="Check for signs of serious illness"/>
<description
value="Any person who has signs of seriously illness should be referred to the appropriate higher-lever facility for management "/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.4">
<title value="Screen for TB "/>
<description
value="Adults and adolescents living with HIV should be screened for TB according to a clinical algorithm"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.5">
<title value="Seriously ill?"/>
<description
value="Any person who has signs of serious illness should be referred to the appropriate higher-lever facility for management or receive emergency care, depending on availability and policies."/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.8">
<title value="Capture or update client history"/>
<description
value="Discuss history with client and review available records. History-taking should include partner’s HIV status and whether the partner is virally suppressed on ART "/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.9">
<title value="First time initiating treatment?"/>
<description
value="This step checks whether the client is naïve to ART"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.10">
<title value="Counsel returning clients"/>
<description
value="Adherence, such as whether client is picking up meds and/or has any barriers to adherence to their treatment(s), if so, set plan for adherence support"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.11">
<title value="Retest for HIV using testing algorithm"/>
<description
value="WHO recommends that all programmes retest people diagnosed with HIV prior to initiating lifelong ART"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.12">
<title value="Determine recommended screenings and tests"/>
<description
value="HIV.D12.DT Determine recommended screenings and tests"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.13">
<title value="Examine client"/>
<description
value="Examine the client clinically, with a physical exam"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.14">
<title
value="Prevent, screen and manage comorbidities and coinfections"/>
<description
value="With ART, HIV is a chronic disease requiring lifetime care. WHO guidelines cover information on common and important concomitant conditions among people living with HIV, including: co-trimoxazole prophylaxis; the diagnosis, prevention and treatment of TB, viral hepatitis, malaria, sexually transmitted infections, cervical cancer prevention, nutrition, vaccinations, mental health and substance use"/>
<participant>
<type value="patient"/>
<role>
<coding>
<code value="client"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.15">
<title value="Determine clinical stage of HIV"/>
<description value="HIV.D15.DT Determine WHO clinical stage of HIV"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.16">
<title value="Perform other screenings"/>
<description
value="Conduct screenings based on recommendations and priorities and depending on the diagnostics that are available. "/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.17">
<title value="Check for signs of treatment failure"/>
<description value="Review new diagnostic results"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.20">
<title value="Diagnostics"/>
<description
value="Viral load should be tested routinely for early warning of virological failure and monitored if clinical or virological failure are suspected"/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.21">
<title value="Determine regimen and treatment options"/>
<description
value="For continuing care, check the dosage and need for readjustment or whether treatment failure is suspected."/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.22">
<title value="Make informed decision on treatment"/>
<description
value="Even if client is eligible to start ART, the choice to accept or decline ART ultimately lies with the person or his or her caregiver, and if the decision is to defer initiation, ART can be offered again at subsequent visits "/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.23">
<title value="Prescribe"/>
<description
value="The scripting period should cover the period until the next clinical consultation (not until the following ART refill visit). "/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.24">
<title value="Counsel"/>
<description value="Counsel clients on adherence."/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
<action id="HIV.D.30">
<title value="Laboratory diagnostics needed"/>
<description
value="Additional testing or specimen collection may be needed and may happen after the visit "/>
<participant>
<type value="practitioner"/>
<role>
<coding>
<code value="TrainedLayProvider"/>
</coding>
</role>
</participant>
</action>
</action>
</PlanDefinition>