In July 2019, the World Health Organization released the policy brief on HIV treatment building up on the July 2018 technical update. This version of the Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection provides simplified guidance on the country’s transition plan, the continued approach that positively affects the continuum of HIV care, while adding to innovative methods that will reduce transmission rates and increase life span for those on treatment. This is all to further accelerate efforts to meet the ambitious 2020 Fast-Track 90–90–90 treatment target: ensuring that 90% of the people living with HIV know their HIV status; 90% of the people living with HIV who know their HIV status are accessing treatment; and 90% of people living with HIV who are receiving treatment have suppressed viral load, thereby achieving major reductions in the number of people dying from HIV-related causes and the reducing the number of newly HIV infected people. Besides the recommendation to provide lifelong antiretroviral therapy to all HIV infected populations regardless of CD4 cell count and WHO clinical staging, these guidelines present several recommendations, including Universal routine HIV Testing, counselling and treatment in all public and private health facilities in Zambia. This approach gives a window to provide prioritized HIV testing and immediate treatment and care to all of those at substantial risk of HIV acquisition but do not leave out those who never had an HIV test done recently. Furthermore, individuals who are tested HIV positive will have their sample tested for recency HIV in order to determine whether they are recently infected or long-term HIV. This will accelerate our strides towards HIV epidemic control. Additionally, these guidelines provide the use of better and safer antiretroviral agents such as Darunavir-ritonavir (DRV-r) as part of second line HIV treatment whilst emphasizing the use of newer agents like Dolutegravir (DTG), Tenofovir alafenamide (TAF), and Efavirenz-400mg (EFV), and how to transition patients who are on the older regimens. Our 2020 guidelines have also adopted the use of a fixed dose combination of Tenofovir alafenamide, Emtricitabine and Dolutegravir (TafED) to treat HIV positive children aged 6 years and above, and weighing 25kg or more. In order to manage our patients better, these guidelines also recommend resistance testing after Enhanced Adherence Counselling (EAC) in those who are unsuppressed. Importantly, there has been introduction of Darunavir-ritonavir (DRV-r) dosed as 800mg/100mg, as a part of the Second-Line regimen for adults. These guidelines also highlight the management of patients failing Second-Line ART with third-line ART, who should be managed at higher-level health facilities called Advanced Treatment Centres (ATCs). All of the recommendations have been adopted because of their anticipated public health effect. Several significant recommendations from the previous guidelines remain a priority, namely providing lifelong ART regardless of CD4 cell count and WHO clinical staging, to all populations, and moving toward viral load testing as the preferred means of monitoring people on ART. Newer developments aim to complement and improve the service delivery of HIV services to our population. Importantly, in the guidance WHO emphasizes the need for differentiated approaches to care for people who are stable on ART, such as reducing the frequency of clinic visits and community ART distribution. Such efficiencies are essential if countries with a high burden of HIV infection are to manage their growing numbers of people receiving ART and reduce the burden on people receiving treatment and on health facilities. There will be continued concerted efforts required toward implementing these guidelines at district and health facility levels; the 2020 Consolidated Guidelines represent an important step toward achieving the goal of universal access to ARV drugs, treating and preventing HIV, and ultimately ending the HIV epidemic by 2030.

A minimum package is an important step inadvocating for quality, comprehensive and integrated health services for sex workers. Since 2000 the COH program with funding fromUSAID/PEPFAR has targeted FSWs and their clients with HIV prevention services around HIV testing and counselling, STI treatment services andbehavior change communication. Over the years more services have been availed to FSWs including family planning, screening for tuberculosis andmalaria and formed strong linkages with other implementing partner's under the hospice of the District AIDS task forces. After several years andexperiences working with sex workers COH has come up with this package that is not only for FSWs in the 10 COH district sites but is applicable andappropriate for implementation by any other organization involved in the provision of HIV prevention services to FSW and other key and vulnerablegroups and in community empowerment.

These guidelines present several new recommendations, including the recommendation to provide lifelong ART to all children, adolescents, and adults, including all pregnant and breastfeeding women living with HIV, regardless of CD4 cell count. The guidelines emphasize on the vulnerable transition of adolescence from childhood to adulthood. These guidelines also highlight the management of patients failing second-line ART with third-line ART, who should be managed at higher-level health facilities called Advanced Treatment Centres (ATCs).

These guidelines to UNAIDS’ preferred terminology have been developed for use by staff members, colleagues in the programme’s 10 Cosponsoring organizations, and their partners working in the global response to HIV. Language shapes beliefs and may influence behaviours. Considered use of appropriate language has the power to strengthen the global response to the epidemic. UNAIDS is pleased to make these guidelines to preferred terminology freely available. It is a living, evolving document that is reviewed on a regular basis. Comments and suggestions for additions, deletions, or modifications should be sent to terminology@unaids.org. The boxed list (summary of preferred terminology) overleaf highlights the most important points that we recommend users follow. These guidelines may be freely copied and reproduced, provided that it is not done so for commercial gain and the source is mentioned.