Many governments have produced national treatment guidelines that are intended to improve rational drug use and encourage good practice in HIV/AIDS-related treatment work. In addition, many NGOs/CBOs have developed their own treatment guidelines.
Treatment guidelines provide information about different health problems and the necessary advice for treating them. They will tell health workers about diagnosis and management of health problems as well as what alternative treatments can be used. They do not usually give complete information about each drug, just what is necessary to use it - such as the dose and length of treatment.
A prescribing manual (sometimes called a formulary) contains detailed information about each drug that is available for different health problems. This includes the dose, side-effects, necessary precautions and other special requirements for using the drug. It is usually arranged in the same way as an essential medicines list, with the drugs listed alphabetically under the types of disease that they can treat.
These key resources - treatment guidelines and prescribing manuals, alongside essential medicines lists - can be used together to answer key questions about providing effective HIV/AIDS-related treatment.
The quality of treatment for people living with HIV/AIDS is improved if national treatment guidelines are developed with the participation of NGOs/CBOs that provide treatment on a daily basis. Their active involvement will ensure that the treatment needs of people living with HIV/AIDS are more accurately understood and are reflected in the advice given.
Realistic treatment guidelines will also provide better input for the national essential medicines list and prescribing manuals. This, in turn, will encourage improved availability and accessibility of drugs for HIV/AIDS-related treatment. WHO's Guidelines for scaling up antiretroviral therapy in resource-limited settings provide guidance on technical and policy aspects of ARV therapy (see 'Further sources of information' on page 93).
Participatory group activity
To raise awareness about treatment guidelines and other important sources of information for rational drug use.
Before starting this activity, the facilitator needs to collect some examples of prescribing manuals and treatment guidelines. If possible, they should include some local, national and/or international examples.
1. Explain the aim of the activity.
2. Ask participants what information they need in order to provide effective HIV/AIDS-related treatment.
3. Ask participants to share their practical experiences in finding out this type of information.
4. Explain to participants what is meant by prescribing manuals (or formularies) and treatment guidelines (see previous page). Show them some local, national and international examples.
5. Ask participants what national prescribing manuals and treatment guidelines are available to them and whether they are appropriate for their situation. Encourage the participants to ask each other questions and to make comments.
6. Discuss how NGOs/CBOs could help to improve national prescribing manuals and treatment guidelines for HIV/AIDS-related work.
7. Facilitate a group discussion about what has been learned from the activity, based upon questions such as:
• Why are national materials (such as treatment guidelines) important for NGOs/CBOs, alongside their own practical experiences?
• How can NGOs/CBOs influence what is included in national prescribing manuals and treatment guidelines.
• Help participants to think positively about how to improve national prescribing manuals and treatment guidelines, rather than just criticizing the current weaknesses.
At a skills-building workshop, NGO/CBO participants brainstormed about what information they needed in order to provide effective HIV/AIDS-related treatment. They then shared their experiences of finding out the information.
Participants were shown examples of local, national and international prescribing manuals and treatment guidelines. They then discussed which of these resources were available to them and whether they were appropriate for their situation. Some of their comments included the following:
• The Zambian EML gives us an idea of what drugs can be used for each type of illness, but it doesn't give us any idea of dosage.
• National treatment guidelines would be very helpful but they are not yet available in Zambia.
Finally, the participants discussed how NGOs/CBOs could help to improve national prescribing manuals and guidelines. Their ideas included the following:
• The Zambian National Formulary is a dictionary of drug treatment. This includes information on dosages and side-effects. It should be more easily available and accessible.
• The Zambian Government is working on developing local treatment guidelines. NGOs/ CBOs involved in providing care and treatment should be involved in the process of developing the treatment guidelines.
Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that national and international guidelines are important resources, but are only truly useful when combined with local experiences.
Reference: Adapted from the workshop on access to HIV-related treatment, Catholic Dioceses of Ndola and the International HIV/AIDS Alliance, Zambia, April, 2001.