On the approval of the rules for the implementation of measures to prevent HIV infection

New Unofficial translation

Order of the Minister of Health of the Republic of Kazakhstan dated October 19, 2020 No. ҚР DSM-137/2020. Registered with the Ministry of Justice of the Republic of Kazakhstan on October 21, 2020 No. 21467

      Unofficial translation

      In compliance with paragraph 2 of Article 99 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On people's health and the health care system" ORDER:

      1. To approve the rules for carrying out measures for the prevention of HIV infection in accordance with the appendix to this order.

      2. The Department for Organization of Medical Aid of the Ministry of Health of the Republic of Kazakhstan, in the manner prescribed by the legislation of the Republic of Kazakhstan, shall ensure:

      1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;

      2) posting this order on the Internet resource of the Ministry of Health of the Republic of Kazakhstan after its official publication;

      3) within ten working days after the state registration of this order, submission to the Legal Department of the Ministry of Health of the Republic of Kazakhstan information on the implementation of the activities provided for in subparagraphs 1) and 2) of this paragraph.

      3. Control over the execution of this order shall be entrusted to the supervising Vice-Minister of Health of the Republic of Kazakhstan.

      4. This order shall be enforced upon the expiration of ten calendar days after the day of its first official publication.

      The Ministry of Healthcare
      of the Republic of Kazakhstan А. Tsoy

  Appendix
to the order of the Minister of Healthcare
of the Republic of Kazakhstan October 19, 2020
№ RK MH-137/2020

Rules for the implementation of measures to prevent HIV infection

Chapter 1. General provisions

      1. These Rules for the implementation of measures to prevent HIV infection (hereinafter referred to as the Rules) have been developed in accordance with paragraph 2 of Article 99 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On people's health and the health care system" and determine the procedure for carrying out preventive measures to prevent HIV infections.

      2. The rules are intended for state and non-state, including nongovernmental organizations working in the field of HIV prevention.

      3. Preventive measures for the population and key population groups are carried out in compliance with the principles of voluntariness and confidentiality.

      4. The following concepts are used in these Rules:

      1) HIV - human immunodeficiency virus;

      2) HIV infection - a chronic infectious disease caused by the human immunodeficiency virus, characterized by a specific damage to the immune system and leading to its slow destruction until the formation of acquired immunodeficiency syndrome;

      3) outreach work - work on the principle of "peer-to-peer", a method of interaction with key populations who do not visit trust points and friendly offices, in places of their gathering for the implementation of preventive measures; as well as work with people living with HIV infection on adherence to antiretroviral therapy (hereinafter referred to as ARV therapy), prevention of HIV infection in sexual partners and other services;

      4) outreach worker - a representative of key populations, people living with HIV infection or their immediate environment, who provides access to key populations and groups of people living with HIV;

      5) social worker - an employee who provides special social services and (or) evaluates and determines the need for special social services, having the necessary qualifications that meet the established requirements;

      6) sex workers - adult women, men and transgender persons (18 years old and older) who, on a regular or irregular basis, provide sexual services in exchange for money or goods;

      7) friendly office - a specially organized point for the provision of preventive and therapeutic and diagnostic assistance for sexually transmitted infections, HIV-infected people and key populations on a free basis on the principle of voluntariness and confidentiality;

      8) pre-exposure prophylaxis - antiretroviral therapy applied to uninfected people to prevent HIV infection;

      9) post-exposure prophylaxis - antiretroviral therapy used to reduce the risk of contracting HIV after a possible infection;

      10) database of individual registration of clients - a program designed to monitor and assess the coverage of key populations and people living with HIV infection with prevention programs;

      11) trust point - a specially organized point where preventive services are provided to key population groups on a free basis on the basis of anonymity, voluntariness and confidentiality;

      12) key population groups - population groups that are at increased risk of contracting HIV infection due to the characteristics of their lifestyle;

      13) epidemiological monitoring of the prevalence of HIV infection among key populations - studies to study risk factors for infection, the prevalence of HIV infection, viral hepatitis, syphilis;

      14) consumables - means used in prevention programs for free distribution, include: disposable syringes, alcohol wipes, condoms, lubricants, naloxone, rapid tests, printed information and educational materials, antiretroviral drugs for pre-exposure prophylaxis and post-exposure prophylaxis of HIV infection.

Chapter 2. HIV prevention activities

      5. Measures to prevent HIV infection are carried out by:

      1) conducting epidemiological monitoring of the prevalence of HIV infection among the population, including key populations;

      2) informing various groups of the population about HIV infection through information materials, social networks and the media;

      3) integration of HIV prevention issues into the education system and workplaces;

      4) providing key population groups with treatment and prophylactic services in trust points, friendly offices;

      5) placement and implementation of state social grants and state social orders through non-governmental organizations;

      6) ensuring the infectious safety of donation and transplantation, as well as when providing the population with services related to the violation of the integrity of the skin and mucous membranes;

      7) prevention of transmission of HIV infection from mother to fetus and child;

      8) providing pre-exposure and post-exposure prophylaxis;

      9) providing antiretroviral therapy to reduce the risk of HIV transmission from the moment of diagnosis.

      6. Epidemiological monitoring of the prevalence of HIV infection among the population, including among people who inject drugs (hereinafter - PWID), men who have sex with men (hereinafter - MSM), sex workers (hereinafter - SW) is carried out by medical organizations that carry out activities in the field of HIV prevention as follows:

      1) by the method of selective biobehavioral research using international recommendations;

      2) using the electronic sentinel epidemiological surveillance system "e-SS";

      3) ensuring a sufficient volume of test systems for the determination of antibodies to HIV, syphilis, viral hepatitis "C" and consumables in accordance with the sample size and volume of studies to control the quality of the serological stage of epidemiological monitoring of the prevalence of HIV infection;

      4) with the provision of remuneration in the amount of at least 0.5 monthly calculation index for each participant of PWID, MSM, SW, for MSM and PWID - an additional 0.5 monthly calculation index for each participant included in the study (no more than 3 people).

      7. Information on HIV infection is carried out by state and non-state organizations, including nongovernmental organizations working in the field of HIV prevention in accordance with the requirements of the legislation on the media through information materials, social networks and the media:

      1) as a social advertisement in accordance with the current legislation on advertising; using modern informational means of the Internet and telecommunication media technologies. With the use of outdoor advertising (banners, billboards) and printed information materials (posters, leaflets, booklets);

      2) using the principle of integrated communications: combination of PR (public relations); actions aimed at direct contact with the target audience and direct advertising - television, outdoor, print advertising;

      3) by conducting information campaigns using the media, on an ongoing basis and at least once a year;

      5) taking into account the main directions and principles of conducting.

      8. Integration of HIV prevention issues into the education system and at workplaces is carried out by state and non-state, including nongovernmental organizations working in the field of HIV prevention and provides for the inclusion of:

      1) in the education system: compulsory hours in the curriculum of secondary, secondary specialized and higher education systems, for pupils and students and in advanced training institutes for teachers, educators;

      2) In the workplace: Skills in applying universal precautions in occupational health and safety programs, including induction safety briefings on an ongoing basis.

      9. Provision of treatment and prevention services to key population groups in trust points, stationary trust points, mobile trust points, friendly offices located in medical and nongovernmental organizations, includes taking measures to prevent HIV infection with the involvement of outreach workers and social workers:

      1) with the possibility of assigning a unique identification code on an anonymous and confidential basis, in accordance with Appendix 1 to the Rules;

      2) with the free provision of consumables for one representative of key populations (distribution of medical devices free of charge: disposable syringes, preferably with a small dead volume, alcohol wipes, condoms, lubricants, naloxone) in accordance with Appendix 2 to the Rules;

      3) with an information and educational component: mini-sessions, conversations or distribution of information and educational materials on HIV infection, viral hepatitis, sexually transmitted infections (hereinafter - STIs), concerning forms of behavior that reduce the risk of infection, informing people, people living with HIV about ARV therapy, the need for adherence to ARV therapy (hereinafter - the informational and educational component);

      4) before and after test counseling on HIV infection, STIs, viral hepatitis;

      5) with testing for HIV, STI;

      6) advising on the provision of pre-exposure and post-exposure prophylaxis, supportive opiate agonist substitution therapy.

      Coverage of testing of key populations should be at least 80% of the coverage of prevention programs.

      Coverage of preventive services for PWID, which includes an information and educational component, distribution of condoms and syringes, should be at least 60% or more of the estimated number.

      Coverage of prevention services for sex workers, which includes an information and educational component and distribution of condoms, should be at least 80% or more of the estimated number.

      Coverage of preventive services for MSM, which includes an information and educational component, distribution of condoms and lubricants, should be at least 20% or more of the estimated number.

      Performance indicators among key populations: the workload per 1 outreach worker is 70 people or more, with the constant involvement of new people in prevention programs. The number of people tested for HIV infection is at least 80% of the number of people involved in prevention programs.

      Performance indicators among people living with HIV: the workload per 1 outreach worker is at least 60 people and the workload per 1 social worker is at least 30 people.

      10. The work schedule of stationary trust points is determined by the organizations in which they are located, a stationary trust point is opened at the rate of one trust point for 500 or more persons of the estimated number of key populations, taking into account the epidemiological situation and equipment, in accordance with Appendix 3 to the Rules.

      11. Mobile trust points use equipped transport for regular travel to places of concentration of key population groups, in order to carry out preventive measures according to the schedule and the developed route, at the rate of at least 1 mobile trust point per organization.

      12. In friendly offices, diagnostics and treatment of STIs is carried out in accordance with the clinical protocols for the diagnosis and treatment of STIs, approved by the joint commission on the quality of medical services under the authorized body in the field of health; execution and maintenance of primary medical documentation, in the form approved by the authorized body in the field of health in accordance with subparagraph 31) of article 7 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On people's health and the health care system" and equipment, in accordance with Appendix 4 to the Rules ...

      13. Monitoring and assessment of coverage of key populations and people living with HIV is carried out by maintaining a database of individual records of clients and corresponding forms of accounting and reporting documentation by specialists from health care organizations working in the field of HIV prevention and nongovernmental organizations.

      14. The placement and implementation of state social grants and state social orders through non-governmental organizations is carried out in accordance with the legislation on the activities of non-governmental organizations in the Republic of Kazakhstan.

      15. Ensuring the infectious safety of donation and transplantation, as well as in the provision of services to the population related to the violation of the integrity of the skin and mucous membranes is carried out:

      1) healthcare organizations operating in the field of blood services, in accordance with regulatory legal acts approved by the authorized body;

      2) in accordance with the rules approved by the authorized body.

      16. Prevention of transmission of HIV infection from mother to fetus and child is carried out in accordance with the recommendations of clinical protocols for the diagnosis and treatment of HIV infection in adults and children, approved by the joint commission on the quality of medical services under the authorized body in the field of health.

      17. The provision of pre-exposure and post-exposure prophylaxis is carried out in accordance with the recommendations of the clinical protocols for the diagnosis and treatment of HIV infection in adults and children, approved by the joint commission on the quality of medical services under the authorized body in the field of health. Medical healthcare organizations operating in the field of HIV prevention plan and purchase rapid tests, antiretroviral drugs for pre-exposure and post-exposure prophylaxis among the population and key populations in a timely manner, based on probable needs.

      18. The provision of antiretroviral therapy to reduce the risk of HIV transmission from the moment of diagnosis is carried out in accordance with the recommendations of the clinical protocols for the diagnosis and treatment of HIV infection in adults and children, approved by the joint commission on the quality of medical services under the authorized body in the field of health, with the involvement of services of outreach workers and social workers.

      19. External quality control of rapid HIV testing is carried out once a year in healthcare organizations and nongovernmental organizations that use rapid HIV tests (at least 50 services per year) by specialists of healthcare organizations working in the field of HIV prevention.

  Appendix 1
to the Regulations
for undertaking activities for
prevention of HIV infection

Unique identification code

      In order to ensure anonymity, confidentiality, to minimize the likelihood of repetition and ease of recovery, a unique identification code (hereinafter - UIC) of the client of the trust point is used.

      The unique identification code is made up of the first 2 letters of the mother's name, the first 2 letters of the father's name, gender (1 - male or 2 - female) and the last two digits of the year of birth. In the absence of parents or one of the parents, conditional names are applied at the request of the client.

      For example: mother - Gulnara, father - Renat, male, born in 1978, UIC - GURE 178

First 2 letters of mother’s name of the client

First 2 letters of father’s name of the client

Sex
male-1
female-2

Two last numbers is the year when the client was born

GU

RE

1

78

  Appendix 2
to the Regulations
for undertaking activities for
prevention of HIV infection

Rates of free provision of consumables per representative of key populations and / or people living with HIV

Activities

Number during the year, not less

1

for 1 person who injects drugs: syringes of different volumes

200

2

for 1 person who injects drugs: condoms

50

3

for 1 person who injects drugs: alcohol wipes

at the rate of 1 napkin per 1 syringe

4

naloxone

at the rate of 1% of the number of PWID covered by prevention programs

5

per sex worker: condoms

200

6

per 1 man who has sex with a man, trans: condom

150

7

per 1 man who has sex with a man, transgender: lubricants

150

8

for 1 person living with HIV: condom

100

9

express tests

for 80% of key populations covered by prevention programs

  Appendix 3
to the Regulations
for undertaking activities for
prevention of HIV infection

Equipping trust points at health care organizations operating in the field of HIV prevention and nongovernmental organizations

Trust point

Quantity

1

Irradiator, bactericidal screened stationary

1

2

Laboratory timer

1

3

Single-leaf medical cabinet

1

4

A computer

1

5

a printer

1

6

Documentation cabinet

1

7

Wardrobe

1

8

Medical table

2

9

Table, chairs


10

First aid kit, including the drug "Naloxone"

1

11

Tonometer

1

12

Telephone set

1

  Appendix 4
to the Regulations
for undertaking activities for
prevention of HIV infection

Equipping friendly offices at healthcare organizations operating in the field of HIV prevention and non-governmental organizations

Friendly office (gynecologist + dermatovenerologist)


1

A computer

1

2

a printer

1

3

Fluorescent lamp for the diagnosis of fungal diseases (Wood's lamp)

1

4

Binocular biological microscope with immersion

1

5

Shielded germicidal irradiator

2

6

Medical single-reflector mobile lamp

1

7

Sterile instrument storage room

1

8

Dermatovenereologist tool kit

2

9

Obstetrician-gynecologist's tool kit

2

10

Medical couch

1

11

Medical doctor's table

1

12

Nurse table

1

13

Doctor's chair

1

14

Nurse chair

1

15

Patient chair

2

16

Medical screen

1

17

Medical cabinet for documentation

1

18

Medical closet for clothes

1

19

Measuring tape

1

20

Kidney tray

1

21

Stopwatch

1

22

Glass for disinfection solution

1

23

Medical thermometer

5

24

Tonometer

1

25

Phonendoscope

1

6

Medical spatula

20

27

Magnifier Lamp

1

28

Medical scales with stadiometer

1

29

Tool table movable

1

30

Gynecological chair

1

31

Diathermocoagulator

1

32

Small surgical kit

1


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