I. Introduction

A key objective of the Emergency Plan is to reduce HIV-related morbidity and mortality rates and slow the progression of HIV disease in affected communities. A specific Emergency Plan goal is to support the provision of care for 10 million people infected and affected by HIV/AIDS. To address these priorities, it is necessary to identify and implement interventions targeted at the primary causes of HIV-related illness and death.

The use of antiretroviral treatment (ART) is one approach to slowing the progression of disease. However, is also important to provide adults and children with interventions that prevent the onset of conditions such as Pneumocystis carinii pneumonia (PCP), tuberculosis (TB), malaria, malnutrition, and others, regardless of stage of HIV disease or eligibility for antiretroviral treatment. Each of these conditions can be complicated, severe, and even fatal to persons with HIV disease. Provision of preventive care interventions may also augment counseling and testing and HIV prevention programs by attracting more clients who will perhaps be more receptive to behavioral change messages. Counseling HIV-infected persons to refrain from high-risk behaviors offers an opportunity to prevent exposure to additional sexually-transmitted infections and to reduce transmission of HIV to others. Similarly, counseling and testing of family members and other contacts of HIV-infected persons offer an opportunity to identify additional HIV-infected persons and to refer them to appropriate care and prevention.

Emergency Plan countries should consider implementation of a standard "preventive care package" as part of their palliative care programs. Funding for the Preventive Care Package should be requested in Country Operational Plans, in appropriate program areas such as: Laboratory; Orphans and Vulnerable Children (OVCs); Palliative Care; TB/HIV; Treatment; and Strategic Information. United States Government (USG) teams in countries that are also part of the President�s Malaria Initiative (PMI) and/or are recipients of grants for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), should work closely to integrate Emergency Plan work with activities funded by these two programs.

There is ongoing discussion regarding which interventions should be included in a preventive care package. Recognizing that a package cannot be standardized for all situations and countries, components of a care package are likely to vary within regions, and even within countries, depending on the setting and the capacity of the partners who are implementing such programs. However, it is valuable to offer a "menu" of interventions that should be considered. Emergency Plan programs should link the preventive components within this document to other key health care, such as routine medical care and voluntary family planning, which play a key role in reducing morbidity and mortality. Those interventions for people living with HIV/AIDS (PLWHA) and their families that cannot be funded directly should be considered for "wrap-around" funding from other sources including the PMI, the GFATM, and family planning programs. "Wrap-around" services may benefit non-HIV-infected, as well as HIV-infected, persons in the household or elsewhere in the community. An example of such an activity is the construction of latrines, which have been shown to prevent diarrheal disease in resource- constrained settings. This intervention is mentioned under "Safe water and personal hygiene," but is not included in the recommendations, since latrine construction is not currently supported by PEPFAR. Prioritization and selection of the components of a preventive care package must be performed locally, and should be consistent with national guidelines and those sponsored by the World Health Organization (WHO) operative within the country.

The following sections provide the scientific basis for the interventions that could be included in a "preventive care package." Although most interventions included here are pertinent to both adults and children, HIV-infected/exposed children require additional consideration. Therefore, a separate document focusing on a preventive care package for such children has been developed. It should also be emphasized that the preventive care package described here constitutes only a fraction of palliative care to be considered by USG programs. Treatment of symptomatic conditions, alleviation of pain, and psychological, spiritual and social support are important components of palliative care but are beyond the scope of this document (see "HIV/AIDS Palliative Care Guidance #1: An Overview of Comprehensive HIV/AIDS Care Services in the President's Emergency Plan for AIDS Relief" (section 1.5)).

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