The Guyana Government is committed to providing ARV treatment as part of a comprehensive management program for PLWHA. In 2002, the Guyana Government declared a universal treatment program for PLWHA. This was a bold move, but one fraught with financial difficulties. Yet financial constraints were not the only hurdles to overcome. Guyana was also faced with a severe lack of human resources and the technical expertise to fully roll out such an enormous undertaking. With generous assistance from the United States and Canadian governments and from the Joint United Nations Programme on HIV/AIDS (UNAIDS),(United Nations International Children’s Emergency Fund (UNICEF) and the Pan American Health Organization (PAHO)/World Health Organization (WHO), the treatment program has grown by leaps and bounds. Guyana is proud of this evolving program, and we are gradually moving towards a model treatment program for PLWHA. But treatment with ARV drugs is not the only concern medical practitioners have in the overall management of PLWHA. Another important aspect of the program is the differential treatment for children, adolescents, and adults. Unfortunately, many children are born infected through transmission of the virus from mother-to-child. The differences in dose and formulation (pills vs liquids) are important aspects of the treatment of children compared to the treatment of adolescents and adults.

There are other concerns, too. Another major concern is the co-infection of PLWHA with tuberculosis (TB). In these cases, persons must be managed for both HIV and TB. The TB drugs have serious interactions with some of the ARV drugs. Thus, different treatment regimens are necessary for PLWHA who are co-infected with TB. The possibility of resistance to or diminished efficacy of ARV drugs in some PLWHA represents an additional concern for practitioners. It is important, therefore, that countries like Guyana establish treatment protocols for first-line and second-line drug regimens that minimise resistance and maximise efficacy. Guyana is in a fortunate position in that, in spite of cost constraint, Guyana is not limited in selecting drugs for care and treatment program PLWHA often present at clinic with one or more opportunistic infections and with concomitant sexually transmitted infections (STIs). Practitioners must be aware of these infections and must have clear treatment protocols with which to treat patients.

The Ministry of Health, in collaboration with the Government of the United States of America and the Canadian Government, has developed treatment protocols in response to the above circumstances. This document represents the first revision of these protocols to reflect evolving trends in the management of HIV-infected and HIV-exposed adults and children.