Guidelines : consolidated guidelines on HIV testing services - 5cs: consent, confidentiality,...

8/19/2019 Guidelines : consolidated guidelines on HIV testing services - 5cs: consent, confidentiality, counselling, correct resu…

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F@KV@BJCASOC G_JCOBJKOV @K

M J

T

S O V S J K G

V O U T

J F O V

N_BZ 591?

MJT SOVSJKGVOUTJFOV?Fs> F@KVOKS, F@KDJCOKSJABJSZ, F@_KVOBBJKG,

F@UUOFS UOV_BSV AKC F@KKOFSJ@K


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WM@ Bjerary Fatab`gujkg-jk-Yuebjfatj`k Cata

F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos 591?.

1.AJCV Vor`cjagk`sjs - lotm`cs. 5.MJT Jkdoftj`ks - cjagk`sjs. 6.Fùksobjkg - `rgakjzatj`k akcacljkjstratj`k. 3.Cjroftjvo Fùksobjkg - utjbjzatj`k. ?.Gujcobjko. J.W`rbc Moabtm @rgakjzatj`k.

JVEK :7= :5 3 1?9=:5 4 (KBL fbassjdjfatj`k> WF ?96.1)

© W`rbc Moabtm @rgakjzatj`k 591?

Abb rjgmts rosorvoc. Yuebjfatj`ks `d tmo W`rbc Moabtm @rgakjzatj`k aro avajbaebo `k tmo WM@woesjto (www.wm`.jkt) `r fak eo purfmasoc dr`l WM@ Yross, W`rbc Moabtm @rgakjzatj`k,59 Avokuo Appja, 1511 Gokova 57, Vwjtzorbakc (tob. > +31 55 7:1 65438 dax > +31 55 7:1 3=?78o-lajb> e``h`rcorsIwm`.jkt).

Uoquosts d`r porljssj`k t` ropr`cufo `r traksbato WM@ puebjfatj`ks ‖wmotmor d`r sabo `r d`rk`k-f`llorfjab cjstrjeutj`k‖ smùbc eo accrossoc t` WM@ Yross tmrùgm tmo WM@ woesjto(www.wm`.jkt/aeùt/bjfoksjkg/f`pyrjgmtPd`rl/ok/jkcox.mtlb).

Smo cosjgkatj`ks olpb`yoc akc tmo prosoktatj`k `d tmo latorjab jk tmjs puebjfatj`k c` k`t jlpbytmo oxprossj`k `d aky `pjkj`k wmatsòvor `k tmo part `d tmo W`rbc Moabtm @rgakjzatj`kf`kforkjkg tmo bogab status `d aky fùktry, torrjt`ry, fjty `r aroa `r `d jts autm`rjtjos, `rf`kforkjkg tmo cobjljtatj`k `d jts dr`ktjors `r eùkcarjos. C`ttoc bjkos `k laps roprosoktappr`xjlato e`rcor bjkos d`r wmjfm tmoro lay k`t yot eo dubb agroolokt.

Smo loktj`k `d spofjdjf f`lpakjos `r `d fortajk lakudafturors‚ pr`cufts còs k`t jlpby tmat tmoyaro okc`rsoc `r rof`llokcoc ey tmo W`rbc Moabtm @rgakjzatj`k jk prodorokfo t` `tmors `d asjljbar katuro tmat aro k`t loktj`koc. Orr`rs akc `ljssj`ks oxfoptoc, tmo kalos `d pr`prjotarypr`cufts aro cjstjkgujsmoc ey jkjtjab fapjtab bottors.

Abb roas`kaebo profautj`ks mavo eook tahok ey tmo W`rbc Moabtm @rgakjzatj`k t` vorjdy tmojkd`rlatj`k f`ktajkoc jk tmjs puebjfatj`k. M`wovor, tmo puebjsmoc latorjab js eojkg cjstrjeutocwjtmùt warrakty `d aky hjkc, ojtmor oxprossoc `r jlpbjoc. Smo rosp`ksjejbjty d`r tmo jktorprotatj`kakc uso `d tmo latorjab bjos wjtm tmo roacor. Jk k` ovokt smabb tmo W`rbc Moabtm @rgakjzatj`k eobjaebo d`r calagos arjsjkg dr`l jts uso.

Bayùt B‚JT F`l Vérb, Tjbbars-sùs-Zoks, Vwjtzorbakc.

Yrjktoc jk Fakaca.


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F@KSOKSV

AFHK@WBOCGOLOKSV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vj

AEEUOTJASJ@KV AKC AFU@KZLV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

GB@VVAUZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xjj

O]OF_SJTO V_LLAUZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvj

1 JKSU@C_FSJ@K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1.1 Yr`gross akc fmabbokgos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.5 Uatj`kabo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.6 Vf`po `d gujcobjkos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.3 _sjkg tmoso gujcobjkos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.? Gàb akc ènoftjvos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =

1.4 Sargot aucjokfo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :1.7 Gujcobjkg prjkfjpbos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :

5 LOSM@C@B@GZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

5.1 @vorvjow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

5.5 Ostaebjsmjkg tmo Gujcobjko Covob`plokt Grùp . . . . . . . . . . . . . . . . . . . . . . . . 15

5.6 Cofikjkg tmo sf`po `d tmo gujcobjkos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

5.3 Uovjow `d tmo ovjcokfo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

5.? Covob`plokt `d tmo rof`llokcatj`k `k MJT tostjkg, usjkg UCSs,ey trajkoc bay pr`vjcors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

5.4 Covob`pjkg tmo rof`llokcatj`k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

5.7 Uovjow `d sorvjfo cobjvory, jlpboloktatj`k appràfmos akc faso oxalpbos . . . . . 13

5.= Accjtj`kab eafhgrùkc w`rh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1?

6 YUO-SOVS AKC Y@VS-SOVS VOUTJFOV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

6.1 Jktr`cuftj`k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1=

6.5 Vorvjfos prj`r t` MJT tostjkg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1=

6.6 Vorvjfos d`r tm`so wm` tost MJT-kogatjvo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

6.3 Vorvjfos d`r tm`so wm`so MJT status js jkf`kfbusjvo `r tost rosubtsaro k`t yot f`kfirloc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54


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6.? Vorvjfos d`r tm`so wm`so tost rosubts aro MJT-p`sjtjvo . . . . . . . . . . . . . . . . . . . . 54

6.4 Bjkhago t` faro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

3 VOUTJFO COBJTOUZ AYYU@AFMOV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

3.1 Yrjkfjpbos akc appràfmos t` sorvjfo cobjvory . . . . . . . . . . . . . . . . . . . . . . . . . . 6=

3.5 G``c praftjfos d`r oddoftjvo MSV pr`gralljkg . . . . . . . . . . . . . . . . . . . . . . . . . 39

3.6 MJT tostjkg sorvjfo appràfmos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

? YUJ@UJSZ Y@Y_BASJ@KV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ?:

?.1 Jkdakts akc fmjbcrok . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

?.5 Ac`bosfokts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

?.6 Yrogkakt w`lok . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4??.3 Fùpbos akc partkors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

?.? Lok. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4=

?.4 Hoy p`pubatj`ks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4:

?.7 @tmor vubkoraebo p`pubatj`ks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

4 VSUASOGJF YBAKKJKG D@U MJT SOVSJKG VOUTJFOV . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

4.1 Jktr`cuftj`k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

4.5 Vtratogjf cofjsj`k-lahjkg d`r soboftjkg appràfmos t` MJT tostjkg . . . . . . . . . . . =9

4.6 Covob`pjkg a stratogjf, odfifjokt akc f`st-oddoftjvo MJT tostjkg sorvjfos pbak . . . . =:

7 CJAGK@VSJFV D@U MJT CJAGK@VJV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :1

7.1 @vorvjow `d MJT cjagk`sjs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :5

7.5 MJT tostjkg stratogjos d`r cjagk`sjs (adtor 53 l`ktms d̀ ago) . . . . . . . . . . . . . . 191

7.6 MJT tostjkg abg`rjtmls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19?

7.3 Uotostjkg t` vorjdy MJT status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

= Q_ABJSZ AVV_UAKFO @D MJT SOVSJKG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11?

=.1 Assurjkg tmo quabjty `d MJT tostjkg rosubts . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

=.5 Uogubatj`ks d`r jk vjtr` cjagk`stjfs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

=.6 Quabjty lakagolokt systols, jrrospoftjvo `d tmo tostjkg sottjkg . . . . . . . . . . . 151

=.3 Quabjty jlpr`volokt d`r MJT tostjkg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161


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: MJT SOVSJKG JK SMO F@KSO]S @D V_UTOJBBAKFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

:.1 @vorvjow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

:.5 Y`pubatj`ks soboftoc d`r ej`b`gjfab survojbbakfo . . . . . . . . . . . . . . . . . . . . . . . 16?

:.6 Uoturkjkg MJT tost rosubts t` partjfjpakts jk ej`b`gjfab survojbbakfo . . . . . . . . . . 167

:.3 Appràfmos d`r MJT tostjkg jk tmo f`ktoxt `d survojbbakfo . . . . . . . . . . . . . . . . 167

:.? _sjkg YLSFS pr`grallo cata t` ropbafo AKF soktjkob survojbbakfo cata . . . . . 16:

:.4 MJT faso rop`rtjkg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

19 L@KJS@UJKG AKC OTAB_ASJ@K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

19.1 Eafhgrùkc akc hoy jssuos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

19.5 Voboftj`k akc uso `d jkcjfat`rs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13?

UODOUOKFOV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13:

AKKO]OV

Abb akkoxos fak eo dùkc `k tmo Jktorkot at mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/

Akkox 1. Vmùbc trajkoc bay pr`vjcors pord`rl MJT tostjkg akc fùksobbjkg sorvjfos usjkg MJTrapjc cjagk`stjf tosts0> A systolatjf rovjow

Akkox 5. Ak akabysjs `d 3= katj`kab MJT tostjkg akc fùksobbjkg p`bjfjos

Akkox 6. Faso oxalpbos> Gbèab oxalpbos `d MJT tostjkg sorvjfos

Akkox 3. Uop`rt `k tmo attjtucos, vabuos akc prodorokfos `k MJT sobd-tostjkg al`kg hoyp`pubatj`ks

Akkox ?. Bjtoraturo rovjow `k tmo f`st `d cjddorokt MJT tostjkg sorvjfos appràfmos

Akkox 4. Latmolatjfab l`cob `k tmo f`st `d tostjkg progkakt w`lok jk mjgm akc vory b`wprovabokfo sottjkgs

Akkox 7. Cjagk`stjfs d`r MJT cjagk`sjs

Akkox =. Oksurjkg tmo quabjty `d MJT tostjkg sorvjfos

Akkox :. Quabjty MJT tostjkg jk pr`grallos d`r provoktj`k `d l`tmor-t`-fmjbc traksljssj`k

Akkox 19. A bjtoraturo rovjow `d f`llukjty-easoc MJT tostjkg sorvjfos al`kg tmo gokorabp`pubatj`k

Akkox 11. A bjtoraturo rovjow `d f`llukjty-easoc MJT tostjkg sorvjfos al`kg hoyp`pubatj`ks

Akkox 15. F`lpromoksjvo bjst `d MJT tostjkg sorvjfos appràfmos akc f`ksjcoratj`ks ey

opjcoljf sottjkg

Akkox 16. Jkcjfat`r rodorokfo smoots d`r l`kjt`rjkg akc ovabuatjkg MJT tostjkg sorvjfos

Akkox 13. F`lpromoksjvo bjtoraturo rovjow `k ljscjagk`sjs `d MJT status

Akkox 1?. Vullary `d tmo Gujcobjko Covob`plokt Grùp cofbaratj`ks `d jktorost

http://www.who.int/hiv/pub/guidelines/http://www.who.int/hiv/pub/guidelines/


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AFHK@WBOCGOLOKSV

Gujcobjko Covob`plokt GrùpNaljba Sajsoor Ab-Aerj (Copartlokt `d Daljby akc F`llukjty Moabtm, Ljkjstry `d Moabtm,@lak), Hatmbook Fmartors (_H Fjvjb V`fjoty Acvjs`ry Eàrc, _kjtoc Hjkgc`l), LartjkFm`` (Gbèab Kotw`rh `d Yo`pbo Bjvjkg wjtm MJT/AJCV, Labaysja), Objzaeotm F`reott (B`kc`k Vfm``b `d Mygjoko & Sr`pjfab Locjfjko, Labawj), Kooran Cmjkgra (Ljkjstry `dMoabtm akc Daljby Wobdaro, Jkcja), Ljrjal Drakfmjkj (Ljkjstry `d Moabtm, Erazjb), LomcjHarhùrj (Foktro M`spjtabjor _kjvorsjtajro, Jek, L`r`ff`), Vogukc` Bo`k (_kjvorsjcacKafj`kab Lay`r co Vak Larf`s, Yoru), N`sopm Sah Daj Bau (Fmjkoso _kjvorsjty `d M`kg

H`kg, M`kg H`kg VAU, Fmjka), Gortruco Kfueo (Ljkjstry `d Moabtm, ^jleaewo), BjsaKobs`k (Gbèab Dukc t` Djgmt Sueorfub`sjs, MJT/AJCV akc Labarja, Vwjtzorbakc), AkkoKg‚akg‚a (Katj`kab AJCV F`ktr`b Yr`grallo, Hokya), Farba @eorloyor (Alorjfak_kjvorsjty `d Eojrut, Boeak`k), Ljckjgmt Y``khasotwattaka (Asja Yafjdjf Fàbjtj`k `kLabo Voxuab Moabtm, Smajbakc), Nokkjdor Vtuart-Cjx`k (_kjvorsjty `d tmo Wost Jkcjos,Nalajfa), Ljrjal Saogtloyor (Bjvorp``b Vfm``b `d Sr`pjfab Locjfjko, _kjtoc Hjkgc`l),N`mkky S`mlo (Arae Dùkcatj`k d`r Drooc`ls akc Oquabjty, Boeak`k), Fùlea S̀ uro-Hako (Bae`rat`jro co Eaftorj`b`gjo, FM_ Bo Caktof, Vokogab) akc Tjkfokt W`kg (_kjtocVtatos Agokfy d`r Jktorkatj`kab Covob`plokt (_VAJC), _VA).

F`ktrjeut`rs t` tmo GUACO systolatjf rovjowFajtbjk Hokkocy akc Tjrgjkja D`kkor (N`mks M`phjks Eb``leorg Vfm``b `d YuebjfMoabtm, _VA)8 Kakcj Vjogdrjoc (jkcopokcokt fbjkjfab opjcolj`b`gjst, Vùtm Adrjfa) wastmo lotm`c`b`gjst.

F`ktrjeut`rs t` supp`rtjkg ovjcokfoUuakko Earkaeas¹ akc L`kjsma Vmarla¹ (_kjvorsjty `d Wasmjkgt`k, _VA), BykaoCareos, Gajb Hokkocy, Uyak Hoatjkg akc Mjbary Vpjkcbor (_kjvorsjty `d Fabjd`rkjaat Vak Drakfjsf`, _VA), Farlok Djguorà (Jkstjtut` co Vabuc Farb`s JJJ, Lacrjc, Vpajk),

Cavjc Dbykk (Grjddjtm _kjvorsjty, Austrabja), Tjrgjkja D`kkor, Fajtbjk Hokkocy akcVmar`k Ssuj (N`mks M`phjks Eb``leorg Vfm``b `d Yuebjf Moabtm, _VA), Cakjob M`gak(W`rbc Moabtm @rgakjzatj`k (WM@), Moabtm Vtatjstjfs akc Jkd`rlatj`k Vystols), Ka`h`Jsmjhawa¹ (WM@ Uogj`kab @ddjfo d`r tmo Wostork Yafjdjf), Uoeoffa Latmows akc Grotfmok Yarr`tt¹ (f`ksubtakt, WM@ Copartlokt `d MJT), Farba @eorloyor (Alorjfak_kjvorsjty `d Eojrut, Boeak`k) akc Tjkfokt W`kg (_VAJC, _VA).

Vpofjab tmakhs t` abb tmo f`ktrjeut`rs `d tmo faso oxalpbos.

¹ Yoor rovjowor+ Vtoorjkg f`lljttoo loleor akc poor rovjowor


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Oxtorkab poor rovjoworsAvobjk Agm`kokg (Tjr`b`gy Bae`rat`ry FUOLOU-JLYL, Falor``k), Mobok Aybos (ÂLEAUS, B`kc`k Vfm``b `d Mygjoko & Sr`pjfab Locjfjko, âleja), Yaloba Eafmakas (Foktors d`r Cjsoaso F`ktr`b akc Yrovoktj`k (FCF), _VA), Dorokf Eagyjkszhy (AJCVAftj`k Our`po, Our`poak AJCV Sroatlokt Grùp, Eobgjul), Jroko Eokofm (FCF, _VA),

Kacja Eacrak (V`jks Jkdjrljors ot Cêvob`ppolokt F`llukautajro, Boeak`k), UuakkoEarkaeas (_kjvorsjty `d Wasmjkgt`k, _VA), Vf`tt Ejbby (V`fjoty d`r Daljby Moabtm,Vùtm Adrjfa), Vtopmakjo Eomob (FCF, _VA), Yauba Erajtstojk (_kjvorsjty `d S̀ r`kt`,Fakaca), Eorkarc Eraks`k (Vfjoktjdjf Addajrs, _VA), Fmarboko Er`wk (_VAJC, _VA), N`rcj Fasae`ka Earearé (Foktr` co ostucj`s opjcolj`b`gjf`s sèro bas JSV/TJM/VJCAco Fatabukya, Vpajk), L`maloc Fmahùk (_kjvorsjty M`spjtab Dattùla Eùrgujea,Sukjsja), Smat` Fmjcarjhjro (Katj`kab Copartlokt `d Moabtm, Vùtm Adrjfa), Abjs`k Vuc`Fmokg (_VAJC, _VA), Go`ddroy Fmjpukgu (FCF, Labawj), Augustjko Fm`h` (Labawj-Bjvorp``b-Wobbf`lo Fbjkjfab Uosoarfm Yr`grallo, Labawj), Nokkjdor F`mk (Lêcofjks

Vaks Dr`ktjíros Affoss Falpajgk, Vwjtzorbakc), Erac F`rkor (_VAJC, Kaljeja), BobbaF`slar` (D`kcazj`ko BJBA Ljbak` @KB_V, Jtaby), Farj Fùrtokay Qujrh (FCF, _VA),Obbj`t F`wak (Yrjkfjpab, Yartkors jk Cjagk`stjfs, BBF, _VA), Kjf`s Cocos (SmotjhjD`kj, Y`sjtjvo T`jfo, Groofo), Nubjo Cokjs`k (N`mk M`phjks Eb``leorg Vfm``b `d YuebjfMoabtm, _VA), Abjfo Cosfbaux (Jkstjtut co rofmorfmo pùr bo cêvob`ppolokt, Vokogab),Hrjsta C`kg (jSoafm, Uag`k Jkstjtuto `d Lassafmusotts Gokorab M`spjtab, Vùtm Adrjfa),Orjf C‚@roktjz` (V`btmjs, Drakfo), Eoatrjfo Cupwa (Ljkjstry `d Moabtm, ^jleaewo),Orjf Czjueak (FCF, _VA), Noddroy Oat`k (Jlporjab F`bbogo B`kc`k, _kjtoc Hjkgc`l),Far`b Ob-Mayoh (Eurkott Jkstjtuto, Austrabja), Hatrjok Draksok (Jkstjtuto `d Sr`pjfabLocjfjko, WM@ F`bbae`ratjkg Foktro, Eobgjul), N`mk Makkay (Moabtm Uosùrfos akcVorvjfos Acljkjstratj`k, _VA), Harjk Matz`bc (Y`pubatj`k Vorvjfos Jktorkatj`kab,^jleaewo), Nalos Mojey (_VAJC, _VA), Eorkacotto Moksok (B`kc`k Vfm``b `d Mygjoko& Sr`pjfab Locjfjko, _kjtoc Hjkgc`l), Ljrojbbo Habù (FCF, _VA), N`mk Hapbak (FCF, _VA), Cavjc Hatz (_kjvorsjty `d Wasmjkgt`k, _VA), Fara H`safh (LêcofjksVaks Dr`ktjíros, Kotmorbakcs), Objko H`rokr`lp (Avokjr Moabtm, Vwjtzorbakc), NoksBukcgrok (F`pokmagok MJT Yr`grallo, WM@ F`bbae`ratjvo Foktro `k MJT akc TjrabMopatjtjs, Coklarh), Yotor LafYmors`k (Bjvorp``b Vfm``b `d Sr`pjfab Locjfjko, _kjtocHjkgc`l), Mokcral``rtmy Lamoswarak (Labawj-Bjvorp``b-Wobbf`lo Fbjkjfab UosoarfmYr`grallo, Labawj), Aly Locboy (FCF, _VA), Buâs Lokcæ` (Our`poak AJCV Sroatlokt

Grùp, Y`rtugab), Vohosaj Ltapurj-^jky`wora (Katj`kab Ljfrèj`b`gy UodorokfoBae`rat`ry, ^jleaewo), Fmrjs Lurrjbb (FCF, _VA), Akgobjka Kaljeja (Y`sjtjvoby _H,_kjtoc Hjkgc`l), Vuo Kapjoraba Lavoczokgo (USJ Jktorkatj`kab, _VA), @`k Kg Soh (Katj`kab _kjvorsjty `d Vjkgap`ro, Sak S`fh Vokg M`spjtab, Vjkgap`ro), Kjtjha Yakt Yaj (LfGjbb _kjvorsjty, Fakaca), Emarat Yarohm (FCF, _VA), N`mk Yarry (Yuebjf MoabtmOkgbakc, _kjtoc Hjkgc`l), Yrapmak Ymakupmah (Smaj Uoc Fr`ss, Smajbakc), AkcrowYmjbbjps (_kjvorsjty F`bbogo `d B`kc`k, _kjtoc Hjkgc`l), C`rtmo Uaeok (F`pokmagokMJT Yr`grallo, MJT Our`po, Coklarh), Ljrjal Vaejk (Gbèab Dukc t` Djgmt AJCV,Sueorfub`sjs akc Labarja, Vwjtzorbakc), N`smua Vab`lak (Marvarc _kjvorsjty, _VA),

L`kjsma Vmarla (_kjvorsjty `d Wasmjkgt`k, _VA), Cakjob Vm`cobb (FCF, L`zalejquo),Cakjob Vjlÿos (Our`poak AJCV Sroatlokt Grùp, Y`rtugab), Yotra Vtakharc (Y`pubatj`k


10/192

vjjj F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

Vorvjfos Jktorkatj`kab, _VA), Nàkko Vtohbor (_kjvorsjty `d Wasmjkgt`k, _VA), BaraSav`sfmj (Our`poak Foktro d`r Cjsoaso Yrovoktj`k akc F`ktr`b, Vwocok), Bosbjo Vmakhs (Lêcofjks Vaks Dr`ktjíros, Kotmorbakcs), Bavjkja Vmjh`kg` (V`fjoty d`r Daljby Moabtm,Kaljeja), Nako Smj`lj (Bjvorp``b TFS, Hokya), N`sopm Sufhor (_KF Yr`noft Fmjka,Fmjka), Akk-Jsaeobbo T`k Bjkgok (Our`po AJCV Sroatlokt Grùp, MJT Our`po, Eobgjul),

Drakf`js Toktor (Wjts Jkstjtuto d`r Voxuab & Uopr`cuftjvo Moabtm, MJT akc UobatocCjsoasos, Vùtm Adrjfa), Vtovok Wjgkabb (Fbjkt`k Moabtm Affoss Jkjtjatjvo, Jkc`kosja),Googakago Woorsjkgmo (Katj`kab VSC/AJCV F`ktr`b Yr`grallo, Ljkjstry `d Moabtm,Vrj Bakha), N`mk Wjbbjals (FCF, _VA) akc Akka Ÿah`wjfz (AJCV Moabtmfaro Dùkcatj`kOur`po, Kotmorbakcs).

Uoprosoktatjvos `d _K agokfjos akc `tmor partkorsTbacakha Akcroova+ (N`jkt _kjtoc Katj`ks Yr`grallo `k MJT/AJCV (_KAJCV), Smajbakc),Bosbjo @kg (_kjtoc Katj`ks Covob`plokt Yr`grallo, Smajbakc), Lartjka Er`str`l,¹

Hojtm Vaejk,¹ akc Hjleorby Larsm

¹ (_KAJCV, Vwjtzorbakc), Larjko Gujbborl

¹ akc

Abak Yrajt¹ (Gbèab Dukc t` Djgmt AJCV, Sueorfub`sjs akc Labarja, Vwjtzorbakc), UèortLatjru akc Farlok Fasas Yoroz (_KJSAJC, Vwjtzorbakc).

WM@ stadd akc f`ksubtaktsAbjfo Arlstr`kg,¹ Smorosa Eae`vjf, Ljfmob Eousokeorg, Nosus Larja FabbonaGarfja,+ Log C`morty,+ Vmadfiq Ossanoo,+ Fmjha Mayasmj, + Cakjob B`w-Eoor,+ Awakcma Lamaljt, Nossjfa Larhey,+ Oyorusabol Kogussjo,+ Lartjka Yokazzat`,+ Ljfmobbo U`c`bpm, Nubjo Valuobs`k, Katmak Vmaddor,+ Akkotto Torstor¹ (Copartlokt

`d MJT), Avkj Aljk, Laknuba Bustjkarasjlmak,+

B`rj Kowlak,

+

Ôzgo Sukfabp (Copartlokt `d Uopr`cuftjvo Moabtm akc Uosoarfm), Akkaeob Eaccoboy,+ MabjoyususGotamuk,¹ Avjkasm Hakfmar,+ Abeort` Lattoobbj+ (Gbèab SE Yr`grallo), V`knaFaddo,+ Droccy Yoroz+ (WM@ Uogj`kab @ddjfo d`r tmo Alorjfas), Ymjbbjpa Oastorer``h,+ Varam Moss, Vtodak Wjht`r (Gbèab Mopatjtjs Yr`grallo), Nùlaka Morloz+ (WM@Uogj`kab @ddjfo d`r tmo Oastork Locjtorrakoak), Cakjob M`gak¹ (Moabtm Vtatjstjfs akcJkd`rlatj`k Vystols, L`rtabjty akc Eurcok `d Cjsoaso), Babj Hm`tokasmvjbj+ (WM@Uogj`kab @ddjfo d`r Our`po), Ka`h` Jsmjhawa,+ Vakcy Wabhor,+ C`kgea` Zu, Yokgdoj^ma` (WM@ Uogj`kab @ddjfo d`r tmo Wostork Yafjdjf), Eumbo Kfueo+ (WM@ Uogj`kab@ddjfo d`r Adrjfa), Erjak Yazvahavalea (WM@ Hokya), Uazja Yokcso,+ Kjf`bo Voguyv

(WM@ Uogj`kab @ddjfo d`r Vùtm-Oast Asja), Halar Uozwak¹ (WM@ Eakgbacosm),Luhta Vmarla¹ (WM@ Smajbakc), Aljtaem Vutmar¹ (WM@ Tjot Kal), Wjbby _rassa+ (Copartlokt `d Ossoktjab Locjfjkos akc Moabtm Yr`cufts).

Vpofjab tmakhs t` tmo d`bb`wjkg WM@ stadd loleors akc f`ksubtakts wm` f`ktrjeutoc t`tmo wrjtjkg, f``rcjkatj`k akc rosoarfm d`r tmo gujcobjkos> Fmoryb N`mks`k, Akjta Vakcs, Objzaeotm Larul akc Vm`ka Cabab. Smo d`bb`wjkg WM@ f`ksubtakts woro abs` jkv`bvocjk covob`pjkg tmoso gujcobjkos> Farlok Djguorà, Akt`kjk Nahè Haysor, UoeoffaLatmows akc Grotfmok Yarr`tt.



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Vpofjab tmakhs t` tmo _KAJCV/WM@ W`rhjkg Grùp `k Gbèab MJT/AJCV akc VSJVurvojbbakfo d`r tmo wrjtjkg akc f``rcjkatj`k `d Fmaptor :, ‒MJT tostjkg jk tmo f`ktoxt `dsurvojbbakfo“, jk partjfubar, Acalla Agmajzu (Yuebjf Moabtm Okgbakc, _kjtoc Hjkgc`l),Hojtm Vaejk, Hjleorby Larsm (_KAJCV, Vwjtzorbakc), Nosus Larja Fabbona Garfja (WM@ Copartlokt `d MJT) akc Akjta Vakcs (WM@ Copartlokt `d Ossoktjab Locjfjkos

akc Moabtm Yr`cufts).

WM@ acljkjstratjvo supp`rt was pr`vjcoc ey Kacja Mjbab LfC`kabc8 Uèort Eokù akc Baurokt Yùbajk pr`vjcoc tofmkjfab supp`rt8 Smjbagawtmj Cojvakaygal,@yuktukgabag Kalnjbsurok akc Caljak Wojhul pr`vjcoc f`llukjfatj`k supp`rt.Warc Ujkomart akc Varam N`mks`k (Nura Ocjt`rjab Vorvjfos) ocjtoc tmo c`fulokt. Cosjgkakc bayùt pr`vjcoc ey B‚JT F`l Vérb.

Vpofjab tmakhs t` tmo WM@ Gujcobjko Uovjow F`lljttoo akc tmo Vofrotarjat t` tmoGujcobjko Uovjow F`lljttoo Vusak K`rrjs akc Lyrjal Dobeor.

@vorabb f``rcjkatj`kUafmob Eaggaboy f``rcjkatoc tmo `vorabb gujcobjko covob`plokt pr`foss wjtm FmorybN`mks`k, Akjta Vakcs, Objzaeotm Larul akc Vm`ka Cabab ukcor tmo suporvjsj`k `dAkcrow Eabb akc G`ttdrjoc Mjrksfmabb (WM@ Copartlokt `d MJT).

DukcjkgSmo _kjdjoc Eucgot, Uosubts akc Affùktaejbjty Dralow`rh `d _KAJCV akc tmo _kjtocVtatos Yrosjcokt‚s Olorgokfy Ybak d`r AJCV Uobjod (YOYDAU) pr`vjcoc tmo dukcjkg t`supp`rt tmjs w`rh, jkfbucjkg tmo systolatjf rovjows `d ovjcokfo, ovjcokfo f`lpjbatj`k,covob`plokt, ocjtjkg akc prjktjkg `d tmo gujcobjkos.



12/192

x F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

AEEUOTJASJ@KV AKC AFU@KZLV

AJCV afqujroc jlluko codjfjokfy sykcr`lo

AKF aktokatab faro

AUS aktj-rotr`vjrab tmorapy

AUT aktj-rotr`vjrab crugs

FCF _kjtoc Vtatos Foktors d`r Cjsoaso F`ktr`b akc Yrovoktj`k

FBJA fmoljbuljkosfokfo jllukàssay

CEV crjoc eb``c sp`tCKA co`xyrje`kufbojf afjc

OFB oboftr`fmoljbuljkosfokfo jllukàssay

OJA okzylo jllukàssay

oLSFS objljkatj`k `d l`tmor-t`-fmjbc traksljssj`k

OQA oxtorkab quabjty assosslokt

GUACO Gracjkg `d Uof`llokcatj`ks, Assosslokt, Covob`plokt akc Ovabuatj`k

MET mopatjtjs E vjrusMFT mopatjtjs F vjrus

MJT mulak jlluk`codjfjokfy vjrus

MJTVS MJT sobd-tostjkg

MSV MJT tostjkg sorvjfos

JTC jk vjtr` cjagk`stjf locjfab covjfo

KAVEA kufbojf afjc soquokfo-easoc alpbjdjfatj`k

KAS kufbojf afjc tostjkgKG@ k`kg`vorkloktab `rgakjzatj`k

@VS `pj`jc suestjtutj`k tmorapy

YFU p`byloraso fmajk roaftj`k

YOY p`st-oxp`suro pr`pmybaxjs

YOYDAU _kjtoc Vtatos Yrosjcokt‚s Olorgokfy Ybak d`r AJCV Uobjod

YJF@ p`pubatj`k/jktorvoktj`k/f`lparjs`k/ùtf`lo

YJSF pr`vjcor-jkjtjatoc tostjkg akc fùksobbjkg

YLSFS provoktj`k `d l`tmor-t`-fmjbc traksljssj`k

YrOY pro-oxp`suro pr`pmybaxjs


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xj

QA quabjty assurakfo

QF quabjty f`ktr`b

QJ quabjty jlpr`volokt

UCS rapjc cjagk`stjf tost

UKA rje`kufbojf afjc

V@Y stakcarc `poratjkg pr`focuro

VSJ soxuabby traksljttoc jkdoftj`k

SE tueorfub`sjs

SKA t`tab kufbojf afjc

_AS ukbjkhoc ak`kyl`us tostjkg

_K _kjtoc Katj`ks

_KAJCV N`jkt _kjtoc Katj`ks Yr`grallo `k MJT/AJCV

_KJFOD _kjtoc Katj`ks Fmjbcrok's Dukc

_VAJC _kjtoc Vtatos Agokfy d`r Jktorkatj`kab Covob`plokt

TFS v`buktary f`uksobbjkg akc tostjkg

TLLF v`buktary locjfab labo fjrfulfjsj`k

WE Wostork eb`t

WM@ W`rbc Moabtm @rgakjzatj`k


14/192

xjj F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

GB@VVAUZ

Afuto jkdoftj`k> tmo porj`c jk wmjfm ak jkcjvjcuab eof`los MJT-jkdoftoc akc eod`ro MJTaktje`cjos fak eo cotoftoc ey a sor`b`gjfab assay (1) .

Akabyto> a suestakfo `r fmoljfab f`kstjtuokt tmat js akabysoc, gokorabby rodorrjkg t` af`lp`kokt `d eb``c `r ak`tmor e`cjby stujc. Jk tmo f`ktoxt `d MJT, akabytos jkfbuco MJT p53aktjgok akc MJT-1/5 aktje`cjos.

Assay> a f`lpboto pr`focuro d`r cotoftjkg tmo prosokfo `d `r tmo f`kfoktratj`k `d akakabyto, jkfbucjkg abb tmo f`lp`kokts `d a tost hjt usoc t` jcoktjdy MJT p53 aktjgok `r

MJT-1/5 aktje`cjos.

Ej`b`gjfab survojbbakfo> tmo f`bboftj`k akc uso `d ej`b`gjfab larhors t` jkd`rlsurvojbbakfo, jk tmjs f`ktoxt, MJT survojbbakfo systols. Smjs torl js ropbafjkg tmo torlsor`survojbbakfo eofauso ej`b`gjfab spofjloks `tmor tmak sorul aro jkfroasjkgby eojkgf`bboftoc rùtjkoby.

F`kfoktratoc opjcoljf> MJT mas sproac rapjcby jk a cofikoc suep`pubatj`k (sufm as lokwm` mavo sox wjtm lok, sox w`rhors, traksgokcor po`pbo, po`pbo wm` uso crugs `r po`pbojk prjs`k `r `tmor fb`soc sottjkgs) eut js k`t wobb ostaebjsmoc jk tmo gokorab p`pubatj`k.

Smjs typo `d opjcoljf suggosts tmat tmoro aro aftjvo kotw`rhs `d po`pbo wjtm mjgm rjsheomavjùrs wjtmjk tmo suep`pubatj`k. Smo duturo fùrso `d tmo opjcoljf js cotorljkoc eytmo katuro `d tmo bjkhs eotwook suep`pubatj`ks wjtm a mjgm MJT provabokfo akc tmo gokorabp`pubatj`k. Kulorjfab pr`xy> MJT provabokfo js f`ksjstoktby `vor ?% jk at boast `ko cofikocsuep`pubatj`k eut js eob`w 1% jk progkakt w`lok attokcjkg aktokatab fbjkjfs.

F`kfirloc> t` jssuo ak MJT status, jkjtjabby roaftjvo tost rosubts kooc t` eo f`kfirlocaff`rcjkg t` tmo katj`kab vabjcatoc tostjkg abg`rjtml.

Cofoktrabjzatj`k> tmo pr`foss `d cobogatjkg `r traksdorrjkg sjgkjfifakt autm`rjty akc

rosùrfos dr`l tmo foktrab ljkjstry `d moabtm t` `tmor jkstjtutj`ks `r t` fiobc `dfifos `d tmoljkjstry at `tmor bovobs `d tmo moabtm systol (pr`vjkfjab, rogj`kab, cjstrjft, suecjstrjft,prjlary moabtm-faro p`st akc f`llukjty).

Oarby jkdakt cjagk`sjs> tostjkg `d jkdakts t` cotorljko tmojr MJT status, gjvok tmat MJTfak eo afqujroc jk utor` (curjkg progkakfy), porjpartul (curjkg cobjvory), p`stpartul(tmrùgm eroastdoocjkg) `r vja paroktorab oxp`suro (5) .

Ofbjpso porj`c> tmo porj`c eotwook MJT jkdoftj`k akc cotoftj`k `d vjr`b`gjfab larhors,sufm as MJT UKA/CKA `r MJT p53 aktjgok (1) .

Oxtorkab quabjty assosslokt (OQA)> jktor-bae`rat`ry f`lparjs`k t` cotorljko jd tmo MJTtostjkg sorvjfo fak pr`vjco f`rroft tost rosubts akc cjagk`sjs.

Gokorabjzoc opjcoljf> MJT js firlby ostaebjsmoc jk tmo gokorab p`pubatj`k. Abtmùgmsuep`pubatj`ks at mjgm rjsh lay f`ktrjeuto cjspr`p`rtj`katoby t` tmo sproac `d MJT, soxuabkotw`rhjkg jk tmo gokorab p`pubatj`k js sudfifjokt t` sustajk tmo opjcoljf. Kulorjfab


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xjjj

pr`xy> MJT provabokfo js f`ksjstoktby `vor 1% jk progkakt w`lok attokcjkg aktokatabfbjkjfs.

MJT status> a f`bboftj`k `d rosubts dr`l `ko `r l`ro assays. Ak MJT status js sjljbar t` MJTcjagk`sjs. Jt rodors t` rop`rts `d MJT-p`sjtjvo, MJT-kogatjvo `r MJT-jkf`kfbusjvo, wmoroas

MJT cjagk`sjs gokorabby rodors t` MJT-p`sjtjvo cjagk`sos akc jk s`lo fasos MJT-kogatjvocjagk`sos.

MJT tost rosubt> tmo rosubt dr`l a sjkgbo tost `k a gjvok assay.

Jkcox tostjkg> a d`fusoc appràfm t` MJT tostjkg jk wmjfm tmo mùsom`bc akc daljbyloleors (jkfbucjkg fmjbcrok) `d po`pbo cjagk`soc wjtm MJT aro `ddoroc MJT tostjkgsorvjfos8 abs` rodorroc t` as jkcox faso MJT tostjkg (6) .

Jkcjfat`r f`kcjtj`k-gujcoc MJT tostjkg> a d`fusoc appràfm t` tost po`pbo l`ro bjhoby

t` eo jkdoftoc wjtm MJT wm` aro jcoktjfioc tmrùgm jkcjfat`r f`kcjtj`ks, sufm as VSJs,bylpm`la, forvjfab `r akab ko`pbasja, morpos z`stor akc mopatjtjs E/F. Smoso f`kcjtj`ks`ffur l`ro droquoktby jk MJT-jkdoftoc po`pbo tmak jk ukjkdoftoc po`pbo, ojtmor eofausotmoy smaro a f`ll`k l`co `d traksljssj`k wjtm MJT `r eofauso tmojr `ffurrokfo jsdafjbjtatoc ey tmo fmaraftorjstjf jlluko cofifjokfy ass`fjatoc wjtm MJT jkdoftj`k (3) .

Jktogratj`k> tmo f`-b`fatj`k akc smarjkg `d sorvjfos akc rosùrfos afr`ss cjddorokt cjsoasoaroas. Jk tmo f`ktoxt `d MJT, tmjs lay jkfbuco tmo pr`vjsj`k `d MJT tostjkg, provoktj`k,troatlokt akc faro sorvjfos ab`kgsjco `tmor moabtm sorvjfos, sufm as SE, VSJ `r vjrabmopatjtjs sorvjfos, aktokatab faro (AKF), f`ktrafoptjvo akc `tmor daljby pbakkjkg sorvjfos

akc sfrookjkg akc faro d`r `tmor f`kcjtj`ks, jkfbucjkg k`kf`llukjfaebo cjsoasos.

Jk vjtr` cjagk`stjf (JTC) locjfab covjfo> a locjfab covjfo, usoc ab`ko `r jk f`lejkatj`k,jktokcoc ey tmo lakudafturor d`r tmo oxaljkatj`k `d spofjloks corjvoc dr`l tmo mulake`cy s`boby `r prjkfjpabby t` pr`vjco jkd`rlatj`k d`r cjagk`stjf, l`kjt`rjkg `r f`lpatjejbjtypurp`sos. D`r oxalpbo, JTCs fak eo usoc d`r tmo d`bb`wjkg tost purp`sos> cjagk`sjs,sfrookjkg, l`kjt r̀jkg, procjsp`sjtj`k, pr`gk`sjs, procjftj`k, cotorljkatj`k `d pmysj`b`gjfabstatus. Oxalpbos `d JTCs jkfbuco roagokts, fabjerat`rs, f`ktr`b latorjabs akc spofjlokrofoptafbos (?) .

Hoy p`pubatj`ks> Cofikoc grùps wm`, cuo t` spofjfif mjgmor-rjsh eomavjùrs, aro atjkfroasoc rjsh d`r MJT jrrospoftjvo `d tmo opjcoljf typo `r b`fab f`ktoxt . Smoso gujcobjkosrodor t` tmo d`bb`wjkg grùps as hoy p`pubatj`ks> lok wm` mavo sox wjtm lok, po`pbo wm`jknoft crugs, po`pbo jk prjs`ks akc `tmor fb`soc sottjkgs, sox w`rhors akc traksgokcorpo`pbo.

Bay pr`vjcor> aky pors`k wm` pord`rls dukftj`ks robatoc t` moabtm-faro cobjvory akc maseook trajkoc t` cobjvor spofjfif sorvjfos eut mas k`t rofojvoc a d`rlab pr`dossj`kab `rparapr`dossj`kab fortjfifato `r tortjary ocufatj`k cogroo (4) .

Lubtj-akabyto tostjkg> sjljbar t` lubtjpbox tostjkg (soo ‒Lubtjpbox tostjkg“), tmo torlrodors t` tmo uso `d tmo salo pbatd`rl t` tost d`r cjddorokt akabytos wjtm cjddorokt sots `droagokts, typjfabby usjkg l`ro tmak `ko spofjlok (7) .

Lubtjpbox tostjkg> tostjkg a sjkgbo spofjlok wjtm `ko tost covjfo d`r l`ro tmak `koakabyto, d`r oxalpbo, a sjkgbo tost covjfo tmat cotofts MJT-1/5 aktje`cjos akc aktje`cjos t`Srop`kola pabbjcul (sypmjbjs) (7) .


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xjv F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

Kogatjvo procjftjvo vabuo> tmo prèaejbjty tmat a pors`k wjtm a kogatjvo tost rosubt jsk`t jkdoftoc wjtm MJT, tmat js, ‒truo kogatjvo“(=) .

K`k-roaftjvo tost rosubt> a tost rosubt tmat còs k`t sm`w a roaftj`k jkcjfatjkg tmoprosokfo `d akabyto.

Kufbojf afjc tostjkg (KAS)> abs` rodorroc t` as l`bofubar tofmk`b`gy, d`r oxalpbo,p`byloraso fmajk roaftj`k (YFU) `r kufbojf afjc soquokfo-easoc alpbjfifatj`k (KAVEA).Smjs typo `d tostjkg fak cotoft vory slabb quaktjtjos `d vjrab kufbojf afjc, tmat js, UKA, CKA`r SKA, quabjtatjvoby akc quaktjtatjvoby (:) .

Yro-tost jkd`rlatj`k> a cjab`guo akc tmo pr`vjsj`k `d affurato jkd`rlatj`k ey a trajkocbay pr`vjcor `r moabtm w`rhor eod`ro ak MJT tost js pord`rloc (19) .

Y`sjtjvo procjftjvo vabuo> tmo prèaejbjty tmat a pors`k wjtm a p`sjtjvo tost rosubt js

jkdoftoc wjtm MJT, tmat js, ‒truo p`sjtjvo“(=)

.Quabjty assurakfo (QA)> a part `d quabjty lakagolokt d`fusoc `k pr`vjcjkg f`kficokfotmat quabjty roqujrolokts wjbb eo dubfibboc (11) .1

Quabjty f`ktr`b (QF)> a latorjab `r lofmakjsl wmjfm, wmok usoc wjtm `r as part `d a tostsystol (assay), l`kjt`rs tmo akabytjfab pord`rlakfo `d tmat tost systol (assay). Jt layl`kjt`r tmo oktjro tost systol (assay) `r `kby `ko aspoft `d jt (11) .1

Quabjty jlpr`volokt (QJ)> a part `d quabjty lakagolokt d`fusoc `k jkfroasjkg tmoaejbjty t` dubfib quabjty roqujrolokts (11) .1

Quabjty lakagolokt systol> a systol t` cjroft akc f`ktr`b ak `rgakjzatj`k wjtmrogarc t` quabjty.

Uoaftjvo tost rosubt> a tost rosubt tmat sm`ws a roaftj`k t` jkcjfato tmo prosokfo `d akabyto.

Uopoat tostjkg> rodors t` a sjtuatj`k wmoro accjtj`kab tostjkg js pord`rloc d`r akjkcjvjcuab jllocjatoby d`bb`wjkg jkjtjab tost rosubts, wjtmjk tmo salo tostjkg vjsjt, usjkg tmosalo assays akc, wmoro p`ssjebo, tmo salo spofjlok (15) .

Uotostjkg> Smoro aro fortajk sjtuatj`ks jk wmjfm jkcjvjcuabs smùbc eo rotostoc adtor acofikoc porj`c `d tjlo> (1) MJT-kogatjvo po`pbo wjtm rofokt `r `k-g`jkg rjsh `d oxp`suro,(5) po`pbo wjtm ak MJT-jkf`kfbusjvo status akc (6) MJT-p`sjtjvo po`pbo eod`ro tmoy okr`b jkfaro `r jkjtjato troatlokt. Uoas`ks d`r rotostjkg eod`ro jkjtjatj`k `d faro `r troatloktjkfbuco rubjkg ùt bae`rat`ry `r traksfrjptj`k orr`r akc ojtmor rubjkg jk `r rubjkg ùtsor`f`kvorsj`k (15, 16) .

Uapjc cjagk`stjf tost (UCS)> jk vjtr` cjagk`stjf `d jlluk`fmr`lat`grapmjf `rjlluk`fibtratj`k d`rlat d`r, jk tmo faso `d MJT cjagk`sjs, tmo cotoftj`k `d MJT-1/5aktje`cjos akc/`r MJT p53 aktjgok (=, :) .

Vobd-tostjkg (MJTVS)> a pr`foss jk wmjfm ak jkcjvjcuab wm` wakts t` hk`w mjs `r mor MJTstatus f`bbofts a spofjlok, pord`rls a tost akc jktorprots tmo rosubt ey mjl- `r morsobd, `dtokjk prjvato. Uoaftjvo tost rosubts lust eo d`bb`woc ey accjtj`kab MJT tostjkg sorvjfos (13) .

1 Voo abs`, JV@ :999>599?. Quabjty lakagolokt systols ‖ Dukcaloktabs akc v`faeubary. Gokova> Jktorkatj`kab @rgakjzatj`k d`rVtakcarcjzatj`k8 599? (mttps>//www.js`.`rg/èp/uj/#js`>stc>js`>:999>oc-6>v1>ok, affossoc 69 Nuko 591?).

https://www.iso.org/obp/ui/#iso:std:iso:9000:ed-3:v1:enhttps://www.iso.org/obp/ui/#iso:std:iso:9000:ed-3:v1:en


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xv

Voksjtjvjty> cok`tos tmo prèaejbjty tmat ak MJT assay wjbb f`rroftby jcoktjdy abb spofjlokstmat f`ktajk MJT-1/5 aktje`cjos akc/`r MJT p53 aktjgok (15) .

Voktjkob survojbbakfo> a typo `d survojbbakfo tmat js f`kcuftoc tmrùgm soboftoc sjtosal`kg p`pubatj`ks `d partjfubar jktorost `r tmat lay pr`vjco appr`xjlatj`ks `d provabokfo

d`r a bargor p`pubatj`k, d`r oxalpbo, jk aktokatab fbjkjfs (=, 1?) .

Vor`f`kvorsj`k> wmok ak jkcjvjcuab first pr`cufos a quaktjty `d MJT aktje`cjos sudfifjoktt` eo cotoftaebo `k a gjvok MJT sor`b`gjfab assay (15) .

Vor`cjsf`rcakt fùpbo> a fùpbo jk wmjfm `ko partkor js MJT-p`sjtjvo akc `ko partkor jsMJT-kogatjvo (14) .

Vor`b`gjfab assay> ak assay tmat cotofts tmo prosokfo `d aktje`cjos jk mulak spofjloks,typjfabby sorul `r pbasla eut abs` fapjbbary/vokùs wm`bo eb``c akc `rab stujc. UCSs,

jllukàssays (jkfbucjkg OJAs, FBJAs, OFBs) akc fortajk suppboloktab MJT assays arooxalpbos `d sor`b`gjfab assays (:) .

Vpofjfifjty> cok`tos tmo prèaejbjty tmat tmo assay wjbb f`rroftby cotoft spofjloks tmat c`k`t f`ktajk MJT-1/5 aktje`cjos akc/`r MJT-1 p53 aktjgok.

Vuppboloktab assay> ak assay tmat pr`vjcos accjtj`kab jkd`rlatj`k d`r spofjloks tmat afirst-bjko assay mas dùkc t` eo roaftjvo eut lay k`t eo aebo t` cofikjtjvoby f`kfirl tmatroaftjvjty.

Sash smarjkg> tmo ratj`kab rocjstrjeutj`k `d tashs eotwook facros `d moabtm-faro pr`vjcorswjtm b`kgor trajkjkg akc `tmor facros wjtm sm`rtor trajkjkg, sufm as trajkoc bay pr`vjcors(4, 17) .

Sost d`r trjago> a f`llukjty-easoc MJT tostjkg appràfm jkv`bvjkg trajkoc akc supp`rtocbay pr`vjcors f`kcuftjkg a sjkgbo MJT UCS. Smo bay pr`vjcors tmok pr`lptby bjkh jkcjvjcuabswjtm roaftjvo tost rosubts t` a dafjbjty d`r durtmor MJT tostjkg akc t` ak assosslokt d`rtroatlokt. Jkcjvjcuabs wjtm k`k-roaftjvo tost rosubts aro jkd`rloc `d tmojr rosubts, rodorrocakc bjkhoc d`r appr`prjato MJT provoktj`k sorvjfos akc rof`llokcoc d`r rotostjkgaff`rcjkg t` rofokt `r `k-g`jkg MJT rjsh akc katj`kab gujcobjkos (1=) .

Sostjkg abg`rjtml> tmo f`lejkatj`k akc soquokfo `d spofjfif assays usoc wjtmjk MJTtostjkg stratogjos (15) .

Sostjkg stratogy> gokorjfabby cosfrjeos a tostjkg soquokfo d`r a spofjfif ènoftjvo, tahjkgjkt` f`ksjcoratj`k tmo prosuloc MJT provabokfo jk tmo p`pubatj`k eojkg tostoc (1:) .

Smrùgmput> tmo kuleor `d spofjloks por mùr por `porat`r tmat fak eo tostoc ey akassay8 tmo v`bulo `d fbjokts tmat f`lo tmrùgm a dafjbjty, bae`rat`ry `r `tmor f`llukjty-easoc sottjkgs.

Torjfioc> po`pbo cjagk`soc MJT-p`sjtjvo aro rotostoc akc tmojr MJT cjagk`sjs js vorjfioceod`ro tmoy jkjtjato faro `r troatlokt.

Wjkc`w porj`c> tmo porj`c eotwook MJT jkdoftj`k akc tmo cotoftj`k `d MJT-1/5aktje`cjos usjkg sor`b`gjfab assays, wmjfm sjgkabs tmo okc `d tmo sor`f`kvorsj`k porj`c.


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xvj F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

O]OF_SJTO V_LLAUZ

Yurp`so

Fùktrjos, pr`grallo lakagors, moabtm w`rhors akc `tmor stahom`bcors mavo jkcjfatoctmo jlp`rtakfo `d f`ks`bjcatjkg W`rbc Moabtm @rgakjzatj`k (WM@) gujcakfo d`r MJTtostjkg sorvjfos (MSV). Smus, tmjs gujcakfo erjkgs t`gotmor oxjstjkg gujcakfo robovakt t`tmo pr`vjsj`k `d MSV akc accrossos jssuos akc obolokts d`r oddoftjvo cobjvory `d MSV tmataro f`ll`k jk a varjoty `d sottjkgs, f`ktoxts akc cjvorso p`pubatj`ks. Jk accjtj`k, tmjsc`fulokt pr`vjcos a kow rof`llokcatj`k t` supp`rt MSV ey trajkoc bay pr`vjcors,

f`ksjcors tmo p`toktjab `d MJT sobd-tostjkg t` jkfroaso affoss t` akc f`vorago `d MJTtostjkg, akc ùtbjkos d`fusoc akc stratogjf appràfmos t` MSV tmat aro koococ t`supp`rt tmo kow _K :9‖:9‖:9 gbèab MJT targots ‖ tmo djrst targot eojkg cjagk`sjs `d:9% `d po`pbo wjtm MJT (59) . L`ro`vor, tmjs gujcakfo wjbb assjst katj`kab pr`grallolakagors akc sorvjfo pr`vjcors, jkfbucjkg tm`so dr`l f`llukjty-easoc pr`grallos, jkpbakkjkg d`r akc jlpboloktjkg MSV.

Smoso gujcobjkos ajl t`>

• pr`vjco f`lpromoksjvo ovjcokfo-easoc rof`llokcatj`ks d`r MSV8

• supp`rt tostjkg ey trajkoc bay pr`vjcors t` jkfroaso affoss t` MSV tmrùgm f`llukjty-easoc appràfmos8

• `ddor gujcakfo t` fùktrjos t` cobjvor a ljx `d MSV appràfmos appr`prjato t` tmojropjcoljf f`ktoxt, d`fusjkg `k MSV d`r grùps l`st addoftoc akc furroktby ukcjagk`socakc ukcorsorvoc8

• pr`vjco gujcakfo t` oksuro tmo affurafy `d tost rosubts akc supp`rt jlpr`volokt `d tmoquabjty `d MSV8

• fatabyso groator katj`kab akc gbèab f`lljtlokt t` tmo pr`vjsj`k `d oddoftjvo MSV as a

hoy obolokt `d f`lpromoksjvo MJT pr`grallos, wjtm eottor bjkhago t` provoktj`k,troatlokt akc faro, t` rocufo MJT jkfjcokfo, l`rejcjty akc l`rtabjty.

Smoso gujcobjkos cjsfuss jssuos robatjkg t` MSV akc mjgmbjgmt tmo kooc d`r tajb`roc MSVappràfmos t` tmo d`bb`wjkg p`pubatj`k grùps>

• jkdakts

• fmjbcrok

• ac`bosfokts (19‖1: yoars `bc)

• progkakt akc p`stpartul w`lok• fùpbos akc partkors

• lok

• hoy p`pubatj`ks.1

1 Jk tmjs c`fulokt hoy p`pubatj`ks aro cofikoc as tmo d`bb`wjkg grùps> lok wm` mavo sox wjtm lok, po`pbo jk prjs`k `r `tmor fb`socsottjkgs, po`pbo wm` jknoft crugs, sox w`rhors akc traksgokcor po`pbo. D`r durtmor gujcakfo `k hoy p`pubatj`ks, soo F`ks`bjcatocgujcobjkos `k MJT provoktj`k, cjagk`sjs, troatlokt akc faro d`r hoy p`pubatj`ks (mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/hoyp`pubatj`ks).

http://www.who.int/hiv/pub/guidelines/keypopulationshttp://www.who.int/hiv/pub/guidelines/keypopulations


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xvjj

Curjkg gbèab lootjkgs akc f`ksubtatj`ks jk 591?, stahom`bcors acvjsoc WM@ t`f`ksjcor covob`pjkg a torl, jk pbafo `d ‒MJT tostjkg akc fùksobbjkg“, tmat okf`lpassostmo dubb rakgo `d sorvjfos avajbaebo. Smo Gujcobjko Covob`plokt Grùp cjsfussoc tmjs akcagrooc tmat MJT tostjkg sorvjfos smùbc eo usoc.

Cofikjtj`k> MJT tostjkg sorvjfos

Smrùgmùt tmoso gujcobjkos tmo torl MJT tostjkg sorvjfos (MSV) js usoc tòlerafo tmo dubb rakgo `d sorvjfos tmat smùbc eo pr`vjcoc t`gotmor wjtm MJTtostjkg ‖ fùksobbjkg (pro-tost jkd`rlatj`k akc p`st-tost fùksobbjkg)8 bjkhago t` appr`prjato MJT provoktj`k, troatlokt akc faro sorvjfos akc `tmor fbjkjfab akcsupp`rt sorvjfos8 akc f``rcjkatj`k wjtm bae`rat`ry sorvjfos t` supp`rt quabjtyassurakfo akc tmo cobjvory `d f`rroft rosubts. Smo WM@ ? Fs aro prjkfjpbos tmat

appby t` abb l`cobs `d MSV akc jk abb fjrfulstakfos (soo softj`k 1.7).

Gujcobjko covob`plokt lotm`c`b`gy

Smo WM@ MJT Copartlokt boc tmo covob`plokt `d tmoso gujcobjkos ab`kg wjtm a WM@Gujcobjko Vtoorjkg Grùp akc a Gujcobjko Covob`plokt Grùp `d oxtorkab oxports.

Smo WM@ Gujcobjko Vtoorjkg Grùp pr`p`soc tmat tmo f`ks`bjcatoc MSV gujcobjkos pr`vjcoa syktmosjs `d furrokt rof`llokcatj`ks `k appràfmos t` cobjvorjkg MSV, jkfbucjkgpro-tost akc p`st-tost sorvjfos akc lossagjkg, MJT cjagk`sjs, quabjty assurakfo `d MJTtostjkg, MJT cjagk`sjs jk tmo f`ktoxt `d survojbbakfo akc tmo l`kjt`rjkg akc ovabuatj`k `dMSV. Smo Grùp cotorljkoc tmat gujcobjkos `k MSV covob`poc prj`r t` WM@'s ac`ptj`k `dtmo Gracjkg `d Uof`llokcatj`ks, Assosslokt, Covob`plokt akc Ovabuatj`k (GUACO)pr`foss woro stjbb vabjc, as tmoso woro supp`rtoc ey ovjcokfo akc wjcoby jlpboloktoc. D`roxalpbo, abtmùgm pr`vjcor-jkjtjatoc tostjkg akc fùksobbjkg (YJSF) was rof`llokcoc jk5997, tmo Grùp cotorljkoc tmat tmjs wjcosproac akc ovjcokfo-easoc jktorvoktj`k (51, 55) cjc k`t roqujro accjtj`kab rovjow `r rovjsj`ks. M`wovor, tmo Grùp cjc pr`p`so tmat tmo

gujcobjkos froato a dralow`rh t` assjst fùktrjos jk soboftjkg a ljx `d MSV appràfmos akcjkfbuco a kow rof`llokcatj`k d`r trajkoc bay pr`vjcors t` f`kcuft MJT tostjkg sorvjfos,usjkg rapjc cjagk`stjf tosts (UCSs).

Jk bato 5913 tmo WM@ Gujcobjko Vtoorjkg Grùp d`rloc a Gujcobjko Covob`plokt Grùpf`lprjsjkg a go`grapmjfabby akc gokcor-eabakfoc grùp `d afacoljfs, rosoarfmors,pr`grallo lakagors, jlpboloktors akc po`pbo dr`l f`llukjty kotw`rhs akc`rgakjzatj`ks. Dr`l Nakuary tmrùgm Larfm 591?, WM@ f`kvokoc a sorjos `d vjrtuabgujcobjko covob`plokt lootjkgs t` rovjow tmo f`lpjbatj`k `d provjùs WM@ gujcobjkosrobatoc t` MSV, t` apprajso tmo ovjcokfo d`r d`rlubatjkg a kow rof`llokcatj`k `k MJT

tostjkg ey bay pr`vjcors usjkg UCSs akc t` rovjow abb softj`ks `d tmo f`ks`bjcatocgujcobjkos. D`bb`wjkg tmoso lootjkgs oxtorkab poor rovjowors, _K agokfy rovjowors akcWM@ stadd loleors dr`l tmo Copartlokt `d MJT as wobb as `tmor WM@ copartlokts akcrogj`kab toals rovjowoc tmo cradt f`ks`bjcatoc MSV gujcobjkos.


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xvjjj F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

Uof`llokcatj`ks

Saebo 1 sullarjzos tmo rof`llokcatj`ks prosoktoc jk tmjs c`fulokt. Abb rof`llokcatj`ksakc gujcakfo jk tmo c`fulokt corjvo dr`l oxjstjkg WM@ gujcakfo, wjtm tmo oxfoptj`k `dtmo kow rof`llokcatj`k `k MJT tostjkg ey trajkoc bay pr`vjcors.

Smo kow rof`llokcatj`k `k MJT tostjkg ey trajkoc bay pr`vjcors js jk bjko wjtm oxjstjkgWM@ rof`llokcatj`ks tmat supp`rt tash smarjkg jk tmo moabtm soft`r. Smo GujcobjkoCovob`plokt Grùp, usjkg tmo GUACO pr`foss, assossoc tmo quabjty `d tmo avajbaeboovjcokfo as l`corato. Easoc `k tmjs ovjcokfo tmo grùp laco a str`kg rof`llokcatj`ktmat trajkoc bay pr`vjcors, usjkg UCSs, fak pord`rl MJT tostjkg.

Kow gujcakfo dr`l tmo WM@/_KAJCV W`rhjkg Grùp `k Gbèab MJT/AJCV akc VSJVurvojbbakfo js jkfbucoc jk tmjs c`fulokt (Fmaptor :). Smjs gujcakfo suggosts tmatfùktrjos akc pr`grallos uso tmo furroktby rof`llokcoc cjagk`stjf tostjkg stratogy

d`r MJT survojbbakfo, laho uso `d pr`grallatjf cata d`r survojbbakfo wmok p`ssjebo ‖partjfubarby jk provoktj`k `d l`tmor-t`-fmjbc traksljssj`k pr`grallos ‖ akc tmatpr`grallos smùbc okfùrago akc l`vo t`warc tmo roturk `d tost rosubts t` partjfjpaktsjk survojbbakfo stucjos.

Jlpbjfatj`ks d`r pr`gralljkg

Yuebjf moabtm f`ksjcoratj`ks ukcorbjo tmo kooc t` prj`rjtjzo akc jlpr`vo affoss tàffurato, mjgm-quabjty MSV d`r cjvorso p`pubatj`ks akc sottjkgs. Smoso gujcobjkos ajl t`

supp`rt fùktrjos t` pr`vjco l`ro oddoftjvo akc affoptaebo MSV as part `d tmojr MJTpr`grallos. Smoy abs` ajl t` oxpakc f`vorago stratogjfabby jk aroas akc al`kgp`pubatj`ks jk groatost kooc, t` jkfroaso affoss t` sorvjfos, t` jlpr`vo tmo quabjty `dtostjkg sorvjfos akc t` mobp t` afmjovo gbèab targots ‖ partjfubarby tmo kow _KAJCVtargot `d cjagk`sjkg :9% `d abb po`pbo wjtm MJT ey 5959. S` aff`lpbjsm tmjs, fùktrjoswjbb kooc t` assoss tmojr spofjdjf sjtuatj`ks akc taho jkt` affùkt tmojr opjcolj`b`gjfabf`ktoxt akc tmo p`pubatj`ks l`st jk kooc jk tmojr sottjkgs. Jt js abs` jlp`rtakt t` assossakc, as lufm as p`ssjebo, t` accross s`fjab akc bogab earrjors t` affoss as wobb as jssuosf`kforkjkg tmo quabjty `d moabtm sorvjfos.


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Saebo 1. Vullary `d WM@ rof`llokcatj`ks `k MJT tostjkg sorvjfos

Appràfm Uof`llokcatj`ks

Fmaptor 5 akc Fmaptor 3> Kow rof`llokcatj`kMJT tostjkg ey trajkocbay pr`vjcors usjkg rapjccjagk`stjf tosts (UCSs)

Bay pr`vjcors wm` aro trajkoc akc suporvjsoc fakjkcopokcoktby f`kcuft sado akc oddoftjvo MJT tostjkgusjkg UCSs (str`kg rof`llokcatj`k, l`corato quabjty ̀ dovjcokfo ).

Fmaptor 6> Yro-tost akc p`st-tost sorvjfos

Cjsfb`suroWM@ (5919). Gujcobjko ̀ kMJT cjsfb`suro fùksobbjkg d`rfmjbcrok up t` 15 yoars `d ago(mttp>//www.wm`.jkt/mjv/pue/

mjvPcjsfb`suro/ok/).

Jkjtjatjvos smùbc eo put jk pbafo t` okd`rfo prjvafypr`toftj`k akc jkstjtuto p`bjfy, baws akc k`rls tmatprovokt cjsfrjljkatj`k akc pr`l`to t`borakfo akcaffoptakfo `d po`pbo bjvjkg wjtm MJT. Smjs fak mobp froatookvjr`klokts wmoro cjsfb`suro `d MJT status js oasjor (str`kg

rof`llokcatj`k, b`w quabjty ̀ d ovjcokfo ).UotostjkgWM@ (5919). Cobjvorjkg MJTtost rosubts akc lossagos d`rro-tostjkg akc fùksobbjkg jkacubts(mttp>//www.wm`.jkt/mjv/pue/vft/mjvProPtostjkg/ok/jkcox.mtl).

Abb sottjkgsJt js rof`llokcoc t` `ddor rotostjkg at boast akkuabby t`po`pbo dr`l hoy p`pubatj`ks akc t` MJT-kogatjvo partkors jksor`cjsf`rcakt fùpbos. Copokcjkg `k fbjokt rjsh eomavjùrs,l`ro droquokt v`buktary rotostjkg smùbc eo ̀ ddoroc akcavajbaebo.

Gokorabjzoc MJT opjcoljfUotost abb MJT-kogatjvo progkakt w`lok jk tmo 6rc trjlostor,p`stpartul `r curjkg baeùr eofauso `d tmo mjgm rjsh `dafqujrjkg MJT jkdoftj`k curjkg progkakfy.

F`kfoktratoc MJT opjcoljfUotost MJT-kogatjvo progkakt w`lok wm` aro jk asor`cjsf`rcakt fùpbo, `r aro dr`l a hoy p`pubatj`k grùp.

Uotostjkg eod`ro AUSjkjtjatj`kWM@ (5913). WM@ roljkcskatj`kab pr`grallos t` rotostabb kowby cjagk`soc po`pbowjtm MJT(mttp>//www.wm`.jkt/mjv/pue/vft/rotost-kowby-cjagk`soc-pbmjv-dubb/ok/).

Katj`kab pr`grallos smùbc rotost abb po`pbo kowby akcprovjùsby cjagk`soc wjtm MJT eod`ro tmoy okr`b jk faro akcjkjtjato AUS.

Uotostjkg po`pbo `k AUS js k`t rof`llokcoc, as tmoro arop`toktjab rjshs `d jkf`rroft cjagk`sjs, partjfubarby d`r jk vjtr`cjagk`stjfs (JTCs) tmat uso `rab stujc spofjloks.

Fmaptor 3> Vorvjfo cobjvory

Yr`vjcor-jkjtjatoc tostjkgakc fùksobbjkg (YJSF)WM@ (5997). Gujcakfo ̀ kpr`vjcor-jkjtjatoc MJT tostjkgakc fùksobbjkg jk moabtmdafjbjtjos(mttp>//www.wm`.jkt/mjv/pue/vft/pjtf/ok/jkcox.mtlb).

Gokorabjzoc MJT opjcoljfYJSF smùbc eo `ddoroc d`r> abb fbjokts akc jk abb sorvjfos(jkfbucjkg sorvjfos d`r soxuabby traksljttoc jkdoftj`k (VSJ),vjrab mopatjtjs, tueorfub`sjs (SE), fmjbcrok ukcor ago fivo,jllukjzatj`k, labkutrjtj`k, aktokatab faro akc abb sorvjfosd`r hoy p`pubatj`ks) as ak odfifjokt akc oddoftjvo way t`jcoktjdy po`pbo wjtm MJT.

F`kfoktratoc MJT opjcoljfYJSF smùbc eo `ddoroc d`r fbjokts (acubts, ac`bosfokts akc

fmjbcrok) jk fbjkjfab sottjkgs wm` prosokt wjtm sylpt`ls`r locjfab f`kcjtj`ks tmat fùbc jkcjfato MJT jkdoftj`k,jkfbucjkg prosuloc akc f`kfirloc SE fasos.

http://www.who.int/hiv/pub/hiv_disclosure/en/http://www.who.int/hiv/pub/hiv_disclosure/en/http://www.who.int/hiv/pub/vct/hiv_re_testing/en/index.htmhttp://www.who.int/hiv/pub/vct/hiv_re_testing/en/index.htmhttp://www.who.int/hiv/pub/vct/hiv_re_testing/en/index.htmhttp://www.who.int/hiv/pub/vct/retest-newly-diagnosed-plhiv-full/en/http://www.who.int/hiv/pub/vct/retest-newly-diagnosed-plhiv-full/en/http://www.who.int/hiv/pub/vct/retest-newly-diagnosed-plhiv-full/en/http://www.who.int/hiv/pub/vct/pitc/en/index.htmlhttp://www.who.int/hiv/pub/vct/pitc/en/index.htmlhttp://www.who.int/hiv/pub/vct/pitc/en/index.htmlhttp://www.who.int/hiv/pub/vct/pitc/en/index.htmlhttp://www.who.int/hiv/pub/vct/retest-newly-diagnosed-plhiv-full/en/http://www.who.int/hiv/pub/vct/retest-newly-diagnosed-plhiv-full/en/http://www.who.int/hiv/pub/vct/retest-newly-diagnosed-plhiv-full/en/http://www.who.int/hiv/pub/vct/hiv_re_testing/en/index.htmhttp://www.who.int/hiv/pub/vct/hiv_re_testing/en/index.htmhttp://www.who.int/hiv/pub/vct/hiv_re_testing/en/index.htmhttp://www.who.int/hiv/pub/hiv_disclosure/en/http://www.who.int/hiv/pub/hiv_disclosure/en/


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xx F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos


Yr`vjcor-jkjtatoc tostjkgakc fùksobbjkg (f`ktjkuoc)

Uogarcboss `d opjcoljf typoYJSF smùbc eo f`ksjcoroc d`r labkutrjtj`k fbjkjfs, VSJ,mopatjtjs akc SE sorvjfos, AKF sottjkgs akc moabtm sorvjfos

d`r hoy p`pubatj`ks.D`r SE sottjkgs> rùtjko MJT tostjkg smùbc eo `ddoroc tàbb fbjokts wjtm prosulptjvo akc cjagk`soc SE8 partkors ̀ dhk`wk MJT-p`sjtjvo SE patjokts smùbc eo ̀ ddoroc MSV wjtmlutuab cjsfb`suro (str`kg rof`llokcatj`k d`r abb po`pbowjtm MJT jk abb gokorab MJT opjcoljf sottjkgs )8 akc SE-f`ktr`bpr`grallos smùbc lajkstroal pr`vjsj`k ̀ d MSV jk tmojr`poratj`ks akc rùtjko sorvjfos.

F`llukjty-easoc MJTtostjkg sorvjfosWM@ (5916). F`ks`bjcatoc

gujcobjkos `k tmo uso `daktjrotr`vjrab crugs d`rtroatjkg akc provoktjkg MJTjkdoftj`k(mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/arv5916/c`wkbàc/ok/jkcox.mtlb).

Gokorabjzoc MJT opjcoljfWM@ rof`llokcs f`llukjty-easoc MJT tostjkg sorvjfos,wjtm bjkhago t` provoktj`k, troatlokt akc faro sorvjfos,

jk accjtj`k t` rùtjkoby `ddorjkg YJSF d`r abb p`pubatj`ks,partjfubarby hoy p`pubatj`ks (str`kg rof`llokcatj`k, b`wquabjty ̀ d ovjcokfo ).

F`kfoktratoc MJT opjcoljfWM@ rof`llokcs f`llukjty-easoc MJT tostjkg sorvjfos,wjtm bjkhago t` provoktj`k, troatlokt akc faro, jk accjtj`kt` YJSF, d`r hoy p`pubatj`ks (str`kg rof`llokcatj`k, b`wquabjty ̀ d ovjcokfo ).

Fmaptor ?> Yrj`rjty p`pubatj`ks

Jkdakts akc fmjbcrok WM@ (5919). WM@

rof`llokcatj`ks ̀ k tmocjagk`sjs `d MJT jkdoftj`k jkjkdakts akc fmjbcrok(mttp>//www.wm`.jkt/mjv/pue/paocjatrjf/cjagk`sjs/ok/).

WM@ (5911). Gujcobjko `kMJT cjsfb`suro fùksobbjkg d`rfmjbcrok up t` 15 yoars `d ago (mttp>//www.wm`.jkt/mjv/pue/mjvPcjsfb`suro/ok/).

• MJT-oxp`soc jkdakts akc fmjbcrok yùkgor tmak 1= l`ktmswjtm ukhk`wk ̀ r ukfortajk MJT oxp`suro smùbc eo tostoc

(wjtm a vjr`b`gjfab assay) wjtmjk 3‖4 woohs `d ejrtm s` tmattm`so prosulptjvoby cjagk`soc wjtm MJT fak start AUS(str`kg rof`llokcatj`k, mjgm quabjty `d ovjcokfo ).

• MJT-oxp`soc jkdakts wjtm k`k-cotoftaebo KAS at 3‖4woohs smùbc ukcorg` MJT sor`b`gjfab tostjkg atarùkc kjko l`ktms `d ago (`r at tmo tjlo `d tmo bastjllukjzatj`k vjsjt) t` rubo ùt MJT jkdoftj`k. Jkdakts wm`sosor`b`gjfab assays aro roaftjvo at kjko l`ktms smùbcukcorg` vjr`b`gjfab tostjkg t` rubo jk MJT jkdoftj`k (str`kgrof`llokcatj`k, b`w quabjty `d ovjcokfo ).

• Fmjbcrok `d sfm``b ago (4‖15) smùbc eo t`bc tmojr MJT-p`sjtjvo status akc tmojr parokt‚s `r farogjvor‚s status8

yùkgor fmjbcrok smùbc eo t`bc tmojr status jkfroloktabbyt` aff`ll`cato tmojr f`gkjtjvo shjbbs akc aejbjtjos (str`kgrof`llokcatj`k, b`w quabjty `d ovjcokfo ).

Ac`bosfokts WM@ (5916). Gujcobjkos ̀ kMJT tostjkg akc fùksobbjkgd`r ac`bosfokts akc faro d`rac`bosfokts wjtm MJT(mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/ac`bosfokts/ok/).

MJT tostjkg sorvjfos, wjtm bjkhagos t` provoktj`k, troatloktakc faro, smùbc eo `ddoroc d`r ac`bosfokts dr`l hoyp`pubatj`ks jk abb sottjkgs (str`kg rof`llokcatj`k, vory b`wquabjty ̀ d ovjcokfo ).

Ac`bosfokts wjtm MJT smùbc eo fùksobboc aeùt tmop`toktjab eokofits akc rjshs `d cjsfb`suro `d tmojr MJT statusakc olp`woroc akc supp`rtoc t` cotorljko jd, wmok, m`wakc t` wm`l t` cjsfb`so (f`kcjtj`kab rof`llokcatj`k, voryb`w quabjty `d ovjcokfo ).

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Ac`bosfokts (f`ktjkuoc) Gokorabjzoc MJT opjcoljfMJT tostjkg sorvjfos, wjtm bjkhago t` provoktj`k, troatloktakc faro, smùbc eo `ddoroc t` abb ac`bosfokts jk gokorabjzoc

opjcoljfs (str`kg rof`llokcatj`k, vory b`w quabjty ̀ dovjcokfo ).

F`kfoktratoc MJT opjcoljfMJT tostjkg sorvjfos, wjtm bjkhago t` provoktj`k, troatloktakc faro, smùbc eo affossjebo t` ac`bosfokts jk b`w-bovobakc f`kfoktratoc opjcoljfs (f`kcjtj`kab rof`llokcatj`k,vory b`w quabjty `d ovjcokfo ).

Yrogkakt akc p`stpartulw`lokWM@ (5916). F`ks`bjcatocgujcobjkos `k tmo uso `d

aktjrotr`vjrab crugs d`rtroatjkg akc provoktjkg MJTjkdoftj`k(mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/arv5916/c`wkbàc/ok/jkcox.mtlb).

Mjgm provabokfo sottjkgsYJSF d`r w`lok smùbc eo f`ksjcoroc a rùtjko f`lp`kokt`d tmo pafhago `d faro jk abb aktokatab, fmjbcejrtm,p`stpartul akc paocjatrjf faro sottjkgs. Jk sufm sottjkgs,

wmoro eroastdoocjkg js tmo k`rl, baftatjkg l`tmors wmàro MJT-kogatjvo smùbc eo rotostoc porj`cjfabby tmrùgmùttmo porj`c `d eroastdoocjkg.

B`w provabokfo sottjkgsYJSF fak eo f`ksjcoroc d`r progkakt w`lok jk aktokatabfaro as a hoy f`lp`kokt `d tmo odd`rt t`>• objljkato l`tmor-t`-fmjbc traksljssj`k `d MJT• jktograto MJT tostjkg wjtm tostjkg d`r sypmjbjs akc vjrab `r

`tmor hoy tosts as robovakt t` tmo sottjkg• strokgtmok tmo ukcorbyjkg latorkab akc fmjbc moabtm

systols.

Fùpbos akc partkor tostjkg sorvjfos aro rof`llokcoc jkaktokatab faro sottjkgs, dafjbjtatjkg pr`vjsj`k `d jktorvoktj`ks,jkfbucjkg AUS d`r provoktj`k jk sor`cjsf`rcakt fùpbos jkabb sottjkgs (str`kg rof`llokcatj`k, vory b`w quabjty `dovjcokfo ).

Fùpbos akc partkor MJTtostjkg akc fùksobbjkg WM@ (5915). Gujcakfo`k fùpbos MJT tostjkgakc fùksobbjkg, jkfbucjkgaktjrotr`vjrab tmorapy d`rtroatlokt akc provoktj`k jk

sor`cjsf`rcakt fùpbos(mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/:7=:531?91:75/ok/jkcox.mtlb).

• Fùpbos akc partkors smùbc eo `ddoroc v`buktary MJTtostjkg sorvjfos wjtm supp`rt d`r lutuab cjsfb`suro (str`kgrof`llokcatj`k, b`w quabjty `d ovjcokfo ).

• Jk aktokatab faro sottjkgs fùpbos akc partkors smùbceo `ddoroc v`buktary MJT tostjkg sorvjfos wjtm supp`rt d`rlutuab cjsfb`suro (str`kg rof`llokcatj`k, b`w quabjty `dovjcokfo ).

• MJT tostjkg sorvjfos d`r fùpbos akc partkors, wjtmsupp`rt d`r lutuab cjsfb`suro, smùbc eo `ddoroc t`jkcjvjcuabs wjtm hk`wk MJT status akc tmojr partkors(str`kg rof`llokcatj`k, b`w quabjty ̀ d ovjcokfo d`rabb po`pbo wjtm MJT jk abb opjcoljf sottjkgs8 f`kcjtj`kabrof`llokcatj`k, b`w quabjty `d ovjcokfo d`r MJT-kogatjvopo`pbo copokcjkg ̀ k tmo fùktry-spofjfif MJT provabokfo ).

Hoy p`pubatj`ksWM@ (5913). F`ks`bjcatocgujcobjkos `k MJT provoktj`k,cjagk`sjs, troatlokt akc faro

d ̀ r hoy p`pubatj`ks(mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/hoyp`pubatj`ks/ok/).

• MJT tostjkg sorvjfos smùbc eo rùtjkoby `ddoroc t` abb hoyp`pubatj`ks jk tmo f`llukjty, jk fb`soc sottjkgs sufm asprjs`ks akc jk dafjbjty-easoc sottjkgs.

• F`llukjty-easoc MJT tostjkg sorvjfos d`r hoy p`pubatj`ks

bjkhoc t` provoktj`k, troatlokt akc faro sorvjfos arorof`llokcoc, jk accjtj`k t` rùtjko dafjbjty-easoc MJTtostjkg sorvjfos, jk abb sottjkgs (str`kg rof`llokcatj`k,b`w quabjty ̀ d ovjcokfo ).

• Fùpbos akc partkors smùbc eo `ddoroc MJT tostjkgsorvjfos wjtm supp`rt d`r lutuab cjsfb`suro. Smjs appbjosabs` t` fùpbos akc partkors dr`l hoy p`pubatj`ks.

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xxjj F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos


Fmaptor 7> Sostjkg stratogjos

Sostjkg stratogjos d`r

mjgm akc b`w provabokfosottjkgs WM@ (5915). Vorvjfo cobjvoryappràfmos t` MJT tostjkg akcfùksobbjkg (MSF)> a stratogjfp`bjfy dralow`rh(mttp>//www.wm`.jkt/mjv/pue/vft/mtfPdralow`rh/ok/).

Mjgm provabokfo

Jk sottjkgs wjtm groator tmak ?% MJT provabokfo jk tmop`pubatj`k tostoc, a cjagk`sjs ̀ d MJT-p`sjtjvo smùbc eojssuoc t` po`pbo wjtm tw` soquoktjab roaftjvo tosts.• D`r jkcjvjcuabs wjtm A1+8 A5∕8 A6+, ak MJT-jkf`kfbusjvo

status js rop`rtoc, akc tmo fbjokt smùbc eo ashoc t` roturkjk 13 cays d`r rotostjkg.

• D`r jkcjvjcuabs wjtm cjsfropakt tost rosubts wmoro tmo A1 jsroaftjvo, tmo A5 js k`k-roaftjvo akc tmo A6 js k`k-roaftjvo(tmat js, A1+, tmok A5∕, tmok A6∕), tmo fikab rosubt smùbceo f`ksjcoroc MJT-kogatjvo.

B`w provabokfo

Jk sottjkgs wjtm boss tmak ?% MJT provabokfo jk tmop`pubatj`k tostoc, a cjagk`sjs ̀ d MJT-p`sjtjvo smùbc eojssuoc t` po`pbo wjtm tmroo soquoktjab roaftjvo tosts.• D`r jkcjvjcuabs wjtm A1+8 A5∕, tmo fikab rosubt smùbc

eo f`ksjcoroc MJT-kogatjvo. M`wovor, jd A1 js a dùrtmgokoratj`k assay (Ae/Ag) akc A5 js ak Ae-`kby assay,wmok A1+8 A5∕, tmo rosubt smùbc eo f`ksjcoroc MJT-jkf`kfbusjvo akc tmo pors`k smùbc eo rotostoc adtor 13cays.

• D`r jkcjvjcuabs wjtm A1+8 A5+8 A6∕, ak MJT-jkf`kfbusjvostatus js rop`rtoc, akc tmo fbjokt smùbc eo ashoc t` roturkjk 13 cays d`r rotostjkg.

• MJT tostjkg sorvjfos lay uso f`lejkatj`ks `d UCSs `rf`lejkatj`ks ̀ d UCSs/OJAs/suppboloktab assays ratmortmak OJA/Wostork eb`t f`lejkatj`ks.

Fmaptor :> MJT tostjkg jk tmo f`ktoxt `d survojbbakfo

MJT tostjkg jk tmof`ktoxt `d survojbbakfo(mttp>//www.wm`.jkt/mjv/stratogjf/survojbbakfo/w`rhjkggrùp/ok/).

• D`r survojbbakfo, uso a tostjkg stratogy akc katj`kabvabjcatoc tostjkg abg`rjtml tmat js sujtaebo d`r MJTcjagk`sjs.

• _so pr`grallatjf cata, wmok p`ssjebo, d`r MJTsurvojbbakfo8 partjfubarby d`r provoktj`k `d l`tmor-t`-fmjbctraksljssj`k pr`grallos.

• Uùtjkoby roturk MJT cjagk`sos t` partjfjpakts jk tmof`ktoxt `d survojbbakfo.

• _so MJT jkfjcokfo assays d`r p`pubatj`k-bovob jkfjcokfoostjlatos akc k`t d`r jkcjvjcuab cjsoaso stagjkg8roturkjkg tmoso tost rosubts t` stucy partjfjpakts js k`trof`llokcoc.

• _so bjkhoc MJT tostjkg d`r ej`b`gjfab survojbbakfo tmatjs ojtmor f`kficoktjab (usjkg pors`kabby jcoktjfiaebojkd`rlatj`k) ̀ r ak`kylùs (usjkg ukjquo stucy f`cos).

http://www.who.int/hiv/pub/vct/htc_framework/en/http://www.who.int/hiv/pub/vct/htc_framework/en/http://www.who.int/hiv/pub/vct/htc_framework/en/http://www.who.int/hiv/pub/vct/htc_framework/en/http://www.who.int/hiv/strategic/surveillance/workinggroup/en/http://www.who.int/hiv/strategic/surveillance/workinggroup/en/http://www.who.int/hiv/strategic/surveillance/workinggroup/en/http://www.who.int/hiv/strategic/surveillance/workinggroup/en/http://www.who.int/hiv/strategic/surveillance/workinggroup/en/http://www.who.int/hiv/strategic/surveillance/workinggroup/en/http://www.who.int/hiv/pub/vct/htc_framework/en/http://www.who.int/hiv/pub/vct/htc_framework/en/


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1

JKSU@C_FSJ@K

1.1 Yr`gross akc fmabbokgos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.5 Uatj`kabo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.6 Vf`po `d gujcobjkos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.3 _sjkg tmoso gujcobjkos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.? G`ab akc `enoftjvos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =

1.4 Sargot aucjokfo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :

1.7 Gujcjkg prjkfjpbos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :


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5 F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

1 JKSU@C_FSJ@K

1.1 Yr`gross akc fmabbokgos

MJT tostjkg js tmo gatoway t` MJT provoktj`k, troatlokt, faro akc `tmor supp`rt sorvjfos.Yo`pbo‚s hk`wbocgo `d tmojr MJT status tmrùgm MJT tostjkg sorvjfos (MSV) js frufjab t` tmosuffoss `d tmo MJT rosp`kso. Smo N`jkt _kjtoc Katj`ks Yr`grallo `k MJT/AJCV (_KAJCV)akc tmo W`rbc Moabtm @rgakjzatj`k (WM@) mavo okc`rsoc gbèab gàbs t` afmjovo ‒zor`

kow MJT jkdoftj`ks, zor` cjsfrjljkatj`k akc zor` AJCV-robatoc coatms“. Eofauso `d tmop`toktjab sorjùs locjfab, s`fjab akc psyfm`b`gjfab f`ksoquokfos `d ljscjagk`sjs `d MJT(ojtmor dabso-p`sjtjvo `r dabso-kogatjvo), abb pr`grallos akc po`pbo pr`vjcjkg MJT tostjkglust strjvo abs` d`r zor` ljscjagk`sos.

Smo kow gbèab :9‖:9‖:9 targots fabb d`r :9% `d abb po`pbo wjtm MJT t` eo cjagk`soc,:9% `d po`pbo wjtm MJT cjagk`soc t` rofojvo AUS akc :9% `d tm`so `k AUS t` mavo asupprossoc vjrab bàc ey 5959 (59) . Smo djrst :9 ‖ cjagk`sjs `d MJT ‖ js ossoktjab t` tmosof`kc :9 ‖ jkjtjatj`k `d AUS al`kg po`pbo wjtm MJT ‖ akc tmo ubtjlato ùtf`lo `d tmotmjrc :9 ‖ vjrab bàc supprossj`k al`kg po`pbo `k AUS, wmjfm jlpr`vos fbjokt ùtf`losakc provokts MJT-1 traksljssj`k (56) .

Smo fmabbokgo js t` jkfroasoaffoss t` akc uptaho `d MSV d`rtm`so wm` rolajk ukcjagk`socakc d`r tm`so at groatost `kg`jkgrjsh d`r MJT jkdoftj`k.

Vjgkjfifakt jkfroasos jk affoss t` MSVAppr`xjlatoby 1?9 ljbbj`k fmjbcrok akc acubts jk15: b`w- akc ljccbo-jkf`lo fùktrjos rop`rtocbyrofojvoc MJT tostjkg sorvjfos jk 5913.1 Jk tmo 77fùktrjos tmat rop`rtoc d`r e`tm yoars, 66% l`ro

1 Gbèab AJCV Uosp`kso Yr`gross Uop`rtjkg (WM@, _KAJCV, _KJFOD), 4 Nuby 591?.

Smo `vorarfmjkg gàbs `d MJT tostjkg sorvjfos aro t`>

• jcoktjdy po`pbo wjtm MJT tmrùgm tmo pr`vjsj`k `d quabjty sorvjfos d`r jkcjvjcuabs,fùpbos akc daljbjos8

• oddoftjvoby bjkh jkcjvjcuabs akc tmojr daljbjos t` appr`prjato MJT troatlokt, faroakc supp`rt, as wobb as MJT provoktj`k sorvjfos, easoc up`k tmojr status8 akc

• supp`rt tmo sfabo-up `d mjgm jlpaft jktorvoktj`ks t` rocufo MJT traksljssj`k akcMJT-robatoc l`rejcjty akc l`rtabjty, tmat js, aktjrotr`vjrab tmorapy (AUS),v`buktary locjfab labo fjrfulfjsj`k (TLLF), provoktj`k `d l`tmor-t`-fmjbctraksljssj`k (YLSFS), pro-oxp`suro pr`pmybaxjs (YrOY) akc p`st-oxp`suropr`pmybaxjs (YOY).


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6Fmaptor 1> Jktr`cuftj`k

po`pbo woro tostoc jk 5916 tmak jk 599: (53, 5?) . Lufm `d tmjs gr`wtm stols dr`l tmooxpaksj`k `d pr`vjcor-jkjtjatoc tostjkg akc fùksobbjkg (YJSF) jk fbjkjfab sottjkgs, tmojktr`cuftj`k `d l`ro f`llukjty-easoc MSV akc tmo aejbjty t` pr`vjco salo-cay tostrosubts, akc `dtok cjagk`sjs, usjkg rapjc cjagk`stjf tosts (UCSs). Wmjbo sjgkjdjfaktpr`gross mas eook laco, jk 5913 jt was ostjlatoc tmat ?3% `d po`pbo wjtm MJT rolajk

ukawaro `d tmojr status, akc tostjkg f`ktjkuos t` eo cobjvoroc wjtmùt spofjdjfabby ajljkgt` roafm tm`so l`st at rjsh akc as yot ukcjagk`soc (54) .

Jk mjgm provabokfo sottjkgs lok bag eomjkc

Jk fùktrjos wjtm mjgm MJT provabokfo, MJT tostjkg ratos d`r lok aro gokorabby b`wor tmakd`r w`lok, as Djg. 1.1 jbbustratos. Gbèab rop`rtjkg suggosts tmat tmjs js eofauso jk tmososottjkgs MSV js f`kcuftoc lajkby jk ropr`cuftjvo moabtm sorvjfos, jkfbucjkg aktokatabfaro (AKF), wmoro tmo rùtjko `ddor `d MJT tostjkg js gokorabby tmo k`rl. Accjtj`kab

appràfmos aro koococ t` jkfroaso uptaho `d MSV al`kg lok, jkfbucjkg tmo pr`vjsj`k `dMSV jk sottjkgs tmat aro l`ro appr`prjato akc affoptaebo t` lok, akc t` covjso ways tòkfùrago tostjkg `d labo partkors jk mjgm provabokfo sottjkgs akc `d fùpbos akc labopartkors `d w`lok wjtm MJT jk abb sottjkgs (53) .

Yr`vjcor-jkjtjatoc MJT tostjkg sorvjfos kooc t` eo oxpakcoc

YJSF, `dtok rodorroc t` as rùtjko MJT tostjkg, fak eo oxpakcoc jk l`ro sottjkgs akc l`rorogj`ks. Aff`rcjkg t` Gbèab AJCV Uosp`kso Yr`gross Uop`rtjkg (WM@, _KJFOD, _KAJCV),

at tmo okc `d 5913, 74% `d 117 rop`rtjkg b`w- akc ljccbo-jkf`lo fùktrjos mac a p`bjfy `drof`llokcjkg YJSF curjkg abb fbjokt okfùktors, akc :9% `d 6: rop`rtjkg fùktrjos jk tmoWM@ Adrjfak rogj`k rof`llokcoc YJSF jk AKF sottjkgs. M`wovor, jk `tmor Adrjfakfùktrjos akc jk Asja, MJT tostjkg f`vorago `d progkakt w`lok js boss tmak 39% (53) .

Appràfmos aro koococ t`jkfroaso oarby jkdakt cjagk`sjsakc tjloby rodorrab `d jkdaktscjagk`soc as MJT-p`sjtjvo t`

troatlokt akc faro.

MJT tostjkg f`vorago al`kg fmjbcrok js b`w abs`.Abtmùgm MJT tostjkg f`vorago jk YLSFS pr`grallosmas jlpr`voc sjgkjdjfaktby `vor tmo past cofaco, ratos`d oarby jkdakt cjagk`sjs rolajk dar dr`l `ptjlab.Al`kg rop`rtjkg fùktrjos jk 5915, `kby `ko-tmjrc `d

jkdakts e`rk t` MJT-jkdoftoc l`tmors rofojvoc avjr`b`gjfab MJT tost wjtmjk tmo djrst tw` l`ktms `d bjdo

(53) . L`ro`vor, cospjto rop`rts `d a mjgm pr`p`rtj`k `d MJT fasos cotoftoc al`kgfmjbcrok tostoc jk fbjkjfab sottjkgs jk fùktrjos wjtm gokorabjzoc opjcoljfs (57‖5:) , jklaky sottjkgs YJSF js stjbb raroby `ddoroc t` fmjbcrok jk SE akc labkutrjtj`k fbjkjfs (69, 61) .Vufm b`w MJT tostjkg f`vorago d`r jkdakts akc fmjbcrok abs` js a ljssoc `pp`rtukjty t``ddor MSV t` parokts, farogjvors akc daljby loleors `d fmjbcrok attokcjkg dafjbjty-easocmoabtm sorvjfos. Earrjors t` MJT tostjkg al`kg jkdakts akc fmjbcrok jkfbuco l`tmorsl`vjkg eafh t` tmojr m`lo vjbbagos adtor cobjvory jk a daraway dafjbjty, doar `d cjsfb`suro

`d MJT status, doar `d stjgla akc cjsfrjljkatj`k akc parokts‚ bafh `d hk`wbocgo `d tmokooc t` okr`b fmjbcrok jk jkdakt faro, as wobb as jlpocjlokts sufm as bafh `dtraksp`rtatj`k, jkf`kvokjokt sorvjfo mùrs akc b`kg wajts at moabtm dafjbjtjos (69, 61) .

Appràfmos aro koococ t` jkfroaso oarby jkdakt cjagk`sjs akc tjloby rodorrab `d jkdaktscjagk`soc as MJT-p`sjtjvo t` faro akc troatlokt. E`tm aro hoy t` jlpr`vjkg moabtmùtf`los akc fmjbc survjvab.


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Djg. 1.1. Yorfoktago `d lok akc w`lok agos 1?‖3: yoars wm` woro ovor tostocd`r MJT akc rofojvoc tmojr rosubts jk 1? soboftoc f`uktrjos jk tmo WM@ AdrjfakUogj`k, 5996‖5911

_gakca

Sakzakja

^jleaewo

Uwakca

Vokogab

Kjgorja

Hokya

Bos`tm`

Gmaka Falor``k

Otmj`pja

F`kg` (Erazzavjbbo) Labawj

L`zalejquo

Lacagasfar

V`urfo > Vtavotojg, 5916 (55) .

=9

79

LOK

49

?9

39

69

59

19

9

Y o r f o k t a g o o v o r t o s t o c d ` r M J T

5996 5993 599? 5994 5997 599= 599: 5919 5911

=9

79

49

?9

39

69

59

19

9

Y o r

f o k t a g o o v o r t o s t o c d ` r M J T

W@LOK

5996 5993 599? 5994 5997 599= 599: 5919 5911


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30/192


porsjst, jkfbucjkg traksp`rtatj`k f`sts akc cjstakfo t` tmo dafjbjty, stjgla, doar `dcjsfb`suro, stadd sm`rtagos akc b`kg wajtjkg tjlos (67) , as wobb as p`bjfy akc bogabearrjors tmat lay mjkcor affoss partjfubarby d`r ac`bosfokts akc hoy p`pubatj`ks._btjlatoby, laky po`pbo wjtm MJT aro cjagk`soc bato akc start AUS bato, wjtm FC3fùkts eob`w 599 fobbs/¿B (6:) . Vufm bato jkjtjatj`k mas k`t cofroasoc sjgkjdjfaktby `vor

tmo past cofaco (6:) . A f`lejkatj`k `d jktorvoktj`ks js koococ t` jlpr`vo bjkhagos t`provoktj`k, troatlokt akc faro akc t` rocufo b`ss t` d`bb`w-up eotwook MJT tostjkg akctroatlokt akc faro, ospofjabby d`r hoy p`pubatj`ks.

Fmabbokgos `d quabjty MJT tostjkg aro ovjcokt

Jt js jlp`rtakt tmat abb fbjoktswm` ukcorg` MJT tostjkg rofojvo

tmo f`rroft MJT cjagk`sjs.

Jk accjtj`k t` stratogjfabby oxpakcjkg MSV, jt jsoquabby jlp`rtakt tmat abb fbjokts wm` ukcorg` MJTtostjkg rofojvo tmo f`rroft MJT cjagk`sjs. Uofokt

rop`rts suggost tmat ljscjagk`sjs `d MJT status js`ffurrjkg jk rosùrfo-bjljtoc sottjkgs (39) . Uofokt

p`bjfy akabysjs abs` suggosts tmat `kby 59% `d katj`kab MJT tostjkg stratogjos abjgk wjtmWM@ rof`llokcatj`ks (31) (soo Akkox 5). Ak aucjt jk tmroo fùktrjos f`kcuftoc eyLêcofjks Vaks Dr`ktjíros dùkc sjgkjdjfakt ratos `d dabso-p`sjtjvo cjagk`sos rop`rtoc t`jkcjvjcuabs (5.4%‖3.=%) (35) . Uotostjkg abb jkcjvjcuabs cjagk`soc MJT-p`sjtjvo dùkctmat 19.6% mac eook ljscjagk`soc MJT-p`sjtjvo jk tmo Col`fratjf Uopuebjf `d F`kgàkc 7.1% jk Otmj`pja (35) . Jk Labawj, curjkg a tmroo-l`ktm porj`c jk 5913, 7% `d po`pboprovjùsby cjagk`soc MJT-p`sjtjvo wm` woro rotostoc cjc k`t mavo a f`kf`rcakt MJT-p`sjtjvo status akc lay mavo eook ljscjagk`soc. D`bb`wjkg quabjty jlpr`volokt (QJ)akc ro-trajkjkg, curjkg ak`tmor tmroo-l`ktm porj`c jk 5913, `kby 3% `d tmo po`pboprovjùsby cjagk`soc MJT-p`sjtjvo wm` woro rotostoc eod`ro AUS jkjtjatj`k cjc k`t mavof`kf`rcakt rosubts (36) . Smo rato `d dabso-kogatjvo MJT statusos rop`rtoc (po`pbo jkdoftocwjtm MJT wm` aro t`bc tmoy aro k`t jkdoftoc) rolajks ukhk`wk akc js cjddjfubt t` assoss,as tmoro js k`t rùtjko d`bb`w-up d`r po`pbo wm` rofojvo ak MJT-kogatjvo status.

Y``r quabjty MJT tostjkg js lubtjdafotoc8 jt rosubts dr`l a kuleor `d daft`rs, s`lotjlosjk f`lejkatj`k, jkfbucjkg p``r pr`cuft pord`rlakfo, jlpr`por st`rago `d tost hjts akcsuppbjos, fborjfab `r traksfrjptj`k orr`rs, usor orr`rs jk pord`rljkg tmo tost akc/`r

jktorprotjkg tmo tost rosubt, bafh `d trajkjkg, jlpr`por uso `d tmo tostjkg stratogy akc/`rabg`rjtml, bafh `d supp`rtjvo suporvjsj`k akc trajkjkg, bafh `d stakcarc `poratjkgpr`focuros (V@Ys) akc p``r c`fuloktatj`k akc rof`rc-hoopjkg praftjfos. S` accrosstmoso prèbols, oddoftjvo quabjty assurakfo systols lust oxpakc ab`kg wjtm tmooxpakcoc cobjvory `d MSV.

S` fb`so tmoso varjùs gaps jk f`vorago akc quabjty, l`ro pràftjvo, rjgmts-easoc MJTtostjkg appràfmos aro koococ. Smjs jkfbucos l`ro olpmasjs `k quabjty assurakfo, l`rod`fusoc pr`l`tj`k `d tostjkg jk go`grapmjfab aroas `d mjgm MJT provabokfo akc jkfjcokfoakc al`kg hoy p`pubatj`ks, akc stratogjf jkvostlokt jk lubtjpbo odd`rts t` jkfroaso

colakc d`r tostjkg sorvjfos. Abs` frjtjfab t` fb`sjkg gaps aro uso `d a eràcor array `dappràfmos t` MJT tostjkg, jkfbucjkg fùpbos akc partkor MJT tostjkg, rùtjko dafjbjty-easoc MSV jk fbjkjfab sottjkgs eoy`kc AKF akc SE, f`llukjty-easoc MSV akc,p`toktjabby, MJT sobd-tostjkg (MJTVS) (13, 53) .


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7Fmaptor 1> Jktr`cuftj`k

1.5 Uatj`kabo

Smoso gujcobjkos ajl t` accross gaps akc bjljtatj`ks jk furrokt appràfmos t` MSV.Fùktrjos akc `tmor pr`grallo lakagors akc moabtm w`rhors mavo jkcjfatoc tmojlp`rtakfo `d f`ks`bjcatjkg WM@‚s gujcakfo `k MSV t` ajc katj`kab pr`grallo

lakagors akc sorvjfo pr`vjcors, jkfbucjkg tm`so dr`l f`llukjty-easoc akc f`llukjty-boc pr`grallos, jk pbakkjkg d`r akc jlpboloktjkg sorvjfos.

1.6 Vf`po `d gujcobjkos

Smoso gujcobjkos ùtbjko a puebjf moabtm appràfm t` strokgtmokjkg akc oxpakcjkg MSV.Smoy prosokt akc cjsfuss a kow rof`llokcatj`k t` abb`w trajkoc bay pr`vjcors t`pord`rl MSV, akc tmoy f`lpjbo a rakgo `d oxjstjkg WM@ gujcobjkos jkt` `ko f`ks`bjcatocc`fulokt.

Vullary `d fmaptors

Fmaptor 5 cotajbs tmo lotm`c`b`gy d`r covob`plokt `d tmoso gujcobjkos.

Fmaptor 6 cosfrjeos pro-tost akc p`st-tost sorvjfos, jkfbucjkg bjkhago t`provoktj`k, troatlokt akc faro sorvjfos.

Fmaptor 3 pr`vjcos gokorab sorvjfo cobjvory rof`llokcatj`ks.Fmaptor ? accrossos MSV d`r spofjdjf p`pubatj`ks ‖ jkdakts akc fmjbcrok,ac`bosfokts, progkakt w`lok, fùpbos akc partkors (jkfbucjkg sor`cjsf`rcaktfùpbos), lok, hoy p`pubatj`ks akc `tmor vubkoraebo p`pubatj`ks.

Fmaptor 4 prosokts akc cjsfussos a dralow`rh d`r d`fusjkg MSV appràfmos jkcjddorokt opjcoljf akc p`pubatj`k f`ktoxts.

Fmaptors 7 akc = cosfrjeo mobp wjtm m`w t` f`kcuft akc assuro tmo quabjty `dMJT tostjkg.

Fmaptor : cjsfussos MJT tostjkg akc cjagk`sjs jk tmo f`ktoxt `d survojbbakfo.

Fmaptor 19 ùtbjkos f`ro l`kjt`rjkg akc ovabuatj`k f`ksjcoratj`ks d`r MJTtostjkg.

1.3 _sjkg tmoso gujcobjkos

Bjho tmo F`ks`bjcatoc gujcobjkos `k tmo uso `d aktjrotr`vjrab crugs d`r troatjkg akcprovoktjkg MJT jkdoftj`k (16) akc tmo F`ks`bjcatoc gujcobjkos `k MJT provoktj`k,cjagk`sjs, troatlokt akc faro d`r hoy p`pubatj`ks (19) , tmoso gujcobjkos accross jssuosafr`ss tmo f`ktjkuul `d MJT provoktj`k, cjagk`sjs, faro, troatlokt akc supp`rt (Djg.1.5). Smoso f`ks`bjcatoc gujcobjkos ajl t` f`vor abb aspofts `d MSV. Oafm fmaptorf`ktajks jkd`rlatj`k d`r spofjabjsts akc jkfbucos jkd`rlatj`k `k spofjdjf MSV t`pjfs s`


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= F`ks`bjcatoc gujcobjkos `k MJT tostjkg sorvjfos

tmat softj`ks akc fmaptors fak eo roac ab`ko. Jkd`rlatj`k dr`l `tmor fmaptors jsjkfbucoc akc fr`ss-rodorokfoc wmoro appr`prjato. Jk accjtj`k, s`lo fmaptors wjbb eopartjfubarby usodub t` spofjdjf aucjokfos, d`r oxalpbo, tm`so rosp`ksjebo d`r covob`pjkgMJT tostjkg stratogjos akc soboftjkg MJT assays (Fmaptor 7), quabjty assurakfo (QA)(Fmaptor =), survojbbakfo (Fmaptor :) akc l`kjt`rjkg akc ovabuatj`k `d MSV (Fmaptor

19).

Djg. 1.5. F`ktjkuul `d bjkhago t` faro akc provoktj`k

Froatocolakc d`r MJTtostjkg &

troatlokt

Acmorokfo& vjrabsupprossj`k

Bjkh tÀUS

Bjkh t` faro

Bjkh t`provoktj`ksorvjfos

MJT-p`sjtjvo

Bjkh t` provoktj`k sorvjfosMJT-kogatjvo

OBJGJEJBJSZ AVVOVVLOKSACCJSJ@KAB SOVSJKG KOOCOC

• Sost d`r trjago

• Torjdy MJT-p`sjtjvo cjagk`sjs

Bjkh t`MJT tostjkg

Cobjvor pro-tostjkd`rlatj`k

MJTcjagk`sjs

Cobjvor p`st-tostfùksobbjkg

Uodor &bjkh t``tmormoabtm

sorvjfos

Eafhgrùkc c`fulokts covob`poc t` supp`rt tmoso gujcobjkos akc tmo systolatjfrovjows akc GUACO (Gracjkg `d Uof`llokcatj`ks, Assosslokt, Covob`plokt akcOvabuatj`k)1 taebos d`r kow rof`llokcatj`ks appoar jk Akkox 1, puebjsmoc `k tmo WM@woesjto at mttp>//www.wm`.jkt/mjv/pue/gujcobjkos/ .

1.? Gàb akc ènoftjvos

Smo prjlary gàb `d tmoso gujcobjkos js t` pr`vjco f`ks`bjcatoc gujcakfo d`r katj`kabpr`grallo lakagors akc `tmor cofjsj`k-lahors t` f`ksjcor jk tmo cosjgk akclakagolokt `d tmojr MJT rosp`kso akc partjfubarby tmojr appràfm t` MJT tostjkgsorvjfos. Vpofjdjf ènoftjvos jk supp`rt `d tmjs gàb jkfbuco tmo d`bb`wjkg>

• f`ks`bjcato oxjstjkg akc kow gujcakfo d`r MSV d`r abb p`pubatj`ks akc sottjkgs akcd`r varjùs appràfmos s` tmat jt js oasjby affossjebo akc usor-drjokcby8

• prosokt a kow rof`llokcatj`k t` supp`rt trajkoc bay moabtm pr`vjcors f`kcuftjkgMJT tostjkg, usjkg UCSs, jk `rcor t` jkfroaso affoss t` tostjkg, partjfubarby tmrùgmf`llukjty-easoc MSV8

• f`ksjcor jssuos robatjkg t` MJTVS, jkfbucjkg appràfmos t` jktr`cufjkg akc l`kjt`rjkgtmo affoptaejbjty, uptaho akc oddoftjvokoss `d MJTVS8

• upcato akc fbarjdy oxjstjkg sorvjfo cobjvory gujcakfo as koococ8

1 Akcrows NF, Vfmòkolakk MN, @xlak AC, Y`ttjo H, Loorp`mb NN, Fòbb` YA ot ab. GUACO gujcobjkos> 1?. G`jkg dr`l ovjcokfo t`rof`llokcatj`ks> cotorljkakts `d a rof`llokcatj`k‚s cjroftj`k akc strokgtm. N Fbjk Opjcolj`b. 5916844>754‖6?.

http://www.who.int/hiv/pub/guidelines/http://www.who.int/hiv/pub/guidelines/


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:Fmaptor 1> Jktr`cuftj`k

• pr`vjco gujcakfo t` jkd`rl stratogjf cofjsj`k-lahjkg rogarcjkg tmo ljx `dappràfmos t` cobjvorjkg MSV tmat wjbb laxjljzo jlpaft8

• pr`vjco spofjfif gujcakfo `k m`w t` jlpbolokt WM@ rof`llokcoc tostjkgstratogjos, m`w t` vabjcato tostjkg abg`rjtmls, akc m`w t` eottor soboft assays t`

assuro akc jlpr`vo tmo quabjty `d MJT tostjkg8• pr`vjco gujcakfo `k MJT tostjkg akc cjagk`sjs jk tmo f`ktoxt `d survojbbakfo,

olpmasjzjkg tmo rùtjko roturk `d MJT status t` jkcjvjcuabs.

1.4 Sargot aucjokfo

Smoso gujcobjkos accross katj`kab MJT pr`grallo lakagors akc `tmor cofjsj`k-lahors,partjfubarby wjtmjk ljkjstrjos `d moabtm. Vufm lakagors aro rosp`ksjebo d`r tmo katj`kabmoabtm soft`r rosp`kso t` MJT, jkfbucjkg MJT tostjkg, as wobb as provoktj`k, troatlokt

akc faro sorvjfos d`r tmo oktjro p`pubatj`ks `d Loleor Vtatos. Smoso lakagors abs` pbaya hoy r`bo jk oksurjkg tmo avajbaejbjty `d a f`ktjkuul `d provoktj`k, troatlokt akc farosorvjfos d`r hoy p`pubatj`ks.

Smoso gujcobjkos wjbb abs` eo `d uso t` `ddjfors at tmo katj`kab bovob rosp`ksjebo d`r `tmorf`llukjfaebo cjsoasos, ospofjabby `tmor d`rls `d soxuabby traksljttoc jkdoftj`ks (VSJs),tueorfub`sjs (SE) akc vjrab mopatjtjs (MET akc MFT). Smoso gujcobjkos abs` wjbb assjstkatj`kab akc suekatj`kab pr`grallo lakagors rosp`ksjebo d`r tmo pr`vjsj`k `d MSV akca f`lpromoksjvo rakgo `d jktogratoc sorvjfos.

Djkabby, tmoso gujcobjkos wjbb eo mobpdub t` `tmor jlpboloktors `d MSV, jkfbucjkgjktorkatj`kab akc katj`kab k`kg`vorkloktab `rgakjzatj`ks akc f`llukjty-easoc`rgakjzatj`ks. Smoy wjbb sorvo as tmo k`rlatjvo gujcakfo t` supp`rt oddoftjvo dukcjkg,pbakkjkg, jlpboloktatj`k, akc l`kjt`rjkg akc ovabuatj`k `d MSV d`r c`k`rs sufm as tmoGbèab Dukc t` Djgmt AJCV, Sueorfub`sjs akc Labarja.

1.7 Gujcjkg prjkfjpbos

A puebjf moabtm akc mulak rjgmts-easoc appràfm js jlp`rtakt t` cobjvorjkg MSV. A

mulak rjgmts-easoc appràfm gjvos prj`rjty t` sufm f`kforks as ukjvorsab moabtmf`vorago, gokcor oquabjty akc moabtm-robatoc rjgmts sufm as affossjejbjty, avajbaejbjty,affoptaejbjty akc quabjty `d sorvjfos. D`r abb MSV, rogarcboss `d appràfm, tmo aftuabpuebjf moabtm eokodjts lust abways ùtwojgm tmo p`toktjab marl `r rjsh. L`ro`vor, tmofmjod roas`k d`r tostjkg lust abways eo e`tm t` eokodjt tmo jkcjvjcuabs tostoc akc t`jlpr`vo moabtm ùtf`los at tmo p`pubatj`k bovob. MSV smùbc eo oxpakcoc k`t loroby tàfmjovo mjgm tostjkg uptaho `r t` loot MJT tostjkg targots, eut prjlarjby t` pr`vjcoaffoss d`r abb po`pbo jk kooc t` appr`prjato, quabjty MSV tmat aro bjkhoc t` provoktj`k,troatlokt, faro akc supp`rt sorvjfos. Smus, MJT tostjkg d`r cjagk`sjs lust abways eo

v`buktary, f`ksokt lust eo jkd`rloc ey pro-tost

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Guidelines : consolidated guidelines on HIV testing services - 5cs: consent, confidentiality,...

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