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 shall be carried out in compliance with the principles of voluntariness and confidentiality. Key population groups include: persons who use injection drugs, men who have sex with men, sex workers, and transgender persons (aged 18 and over) and persons whose freedom is restricted, serving a sentence in places of deprivation of liberty, detained and placed in special institutions.
Footnote. Paragraph 3 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).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 preventive services to key population groups at trust points, stationary trust points, mobile trust points, friendly offices located in medical and non-governmental organizations, includes the implementation of HIV prevention activities 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 per representative of key population groups (distribution of medical products 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, discussions 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 living with HIV infection about ARV therapy, the need for adherence to ARV therapy (hereinafter - the information and educational component);
4) pre- and post-test counseling on issues related to HIV infection, STIs, viral hepatitis;
5) with testing for HIV, STIs, viral hepatitis; including the use of multiplex rapid tests, pregnancy tests;
6) with counseling on the provision of pre-exposure and post-exposure prophylaxis, maintenance substitution therapy with opiate agonists.
The coverage of testing of key population groups should be at least 95% of the coverage of prevention programs.
The coverage of PWID with preventive services, which includes an information and educational component, distribution of condoms, syringes should be at least 70% or more of the estimated number.
The coverage of sex workers with preventive services, which includes an information and educational component and distribution of condoms, should be at least 80% or more of the estimated number.
The coverage of MSM with preventive services, which includes an information and educational component, distribution of condoms, lubricants should be at least 30% or more of the estimated number.
Indicators of work among key population groups: 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 95% of the number involved in prevention programs.
Indicators of work 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.
Footnote. Paragraph 9 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).10. The working hours of stationary and mobile trust points shall be determined by the organizations in which they are located; a stationary trust point shall be opened at the rate of one trust point per 500 or more persons of the estimated number of key population groups, taking into account the epidemiological situation. The equipment of stationary and mobile trust points at healthcare organizations operating in the field of HIV prevention and non-governmental organizations shall be formed in accordance with Appendix 3 to the Rules.
Footnote. Paragraph 10 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).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 shall be carried out in accordance with the legislation on the activities of non-governmental organizations in the Republic of Kazakhstan and the Code of the Republic of Kazakhstan "On Public Health and the Healthcare System", and shall be carried out by the authorized body in the field of healthcare and local executive bodies of regions, cities of republican significance and the capital.
Non-governmental organizations shall carry out activities to prevent HIV infection by involving representatives of key groups in preventive programs, providing services from testing to adherence to treatment for people living with HIV infection.
Footnote. Paragraph 14 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).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. Provision of pre-exposure and post-exposure prophylaxis shall be 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 healthcare. Medical healthcare organizations operating in the field of HIV infection prevention shall plan and purchase express tests in a timely manner, based on probable needs.
Footnote. Paragraph 17 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).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. A monitoring visit for the purpose of assessing the quality of rapid HIV testing shall be conducted once a year in healthcare organizations and non-governmental organizations using rapid HIV tests (at least 50 services per year) by specialists from healthcare organizations operating in the field of HIV prevention.
Footnote. Paragraph 19 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).20. Biobehavioral studies shall be conducted annually to determine the prevalence of HIV infection among PWID, SW, and MSM. The list of services for conducting biobehavioral studies among key population groups shall be formed in accordance with Appendix 5 to the Rules.
Footnote. Chapter 2 has been supplemented with paragraph 20 in accordance with the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).21. The list of services for conducting information work among the population shall be determined in accordance with Appendix 6 to the Rules.
Footnote. Chapter 2 has been supplemented with paragraph 21 in accordance with the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).| 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 | 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 Rules for conducting | |
| preventive measures of | |
| HIV infection |
Equipping stationary and mobile trust points at healthcare organizations operating in the field of HIV prevention and non-governmental organizations
Footnote. Appendix 3 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).
№ | Stationary trust point | number |
1 | Irradiator, bactericidal shielded stationary | 1 |
2 | Laboratory timer | 1 |
3 | Single-door medical cabinet | 1 |
4 | Computer | 1 |
5 | Printer | 1 |
6 | Document cabinet | 1 |
7 | Clothing cabinet | 1 |
8 | Medical table | 2 |
9 | Table | 1 |
10 | Chairs | 2 |
11 | First aid kit, including Naloxone | 1 |
12 | Blood pressure monitor | 1 |
13 | Telephone | 1 |
№ | Mobile trust point | number |
1 | Medical cabinet | 1 |
2 | Bactericidal irradiator | 1 |
3 | Laboratory timer | 1 |
4 | Medical table | 1 |
5 | First aid kit, including Naloxone | 1 |
6 | Blood pressure monitor | 1 |
| Appendix 4 | |
| to the Rules for conducting | |
| preventive measures of | |
| HIV infection |
Equipping friendly offices at healthcare organizations operating in the field of HIV prevention and non-governmental organizations
Footnote. Appendix 4 is in the wording of the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).
№ | Friendly office (gynecologist + dermatovenerologist) | number |
1 | Computer | 1 |
2 | Printer | 1 |
3 | Fluorescent lamp for diagnostics of fungal diseases (Wood's lamp) | 1 |
4 | Binocular biological microscope with immersion | 1 |
5 | Shielded bactericidal irradiator | 2 |
6 | Mobile single-reflector medical lamp | 1 |
7 | Chamber for storing sterile instruments | 1 |
8 | Set of dermatovenerologist's instruments | 2 |
9 | Set of obstetrician-gynecologist's instruments | 2 |
10 | Medical couch | 1 |
11 | Doctor's medical table | 1 |
12 | Nurse's table | 1 |
13 | Medical doctor's chair | 1 |
14 | Nurse's chair | 1 |
15 | Patient's chair | 2 |
16 | Medical screen | 1 |
17 | Medical cabinet for documentation | 1 |
18 | Medical cabinet for clothes | 1 |
19 | Measuring tape | 1 |
20 | Kidney-shaped tray | 1 |
21 | Stopwatch | 1 |
22 | Glass for disinfectant solution | 1 |
23 | Medical thermometer | 5 |
24 | Blood pressure monitor | 1 |
25 | Phonendoscope | 1 |
26 | Medical spatula | 20 |
27 | Magnifying lamp | 1 |
28 | Medical scales with height meter | 1 |
29 | Mobile instrument table | 1 |
30 | Gynecological chair | 1 |
31 | Diathermocoagulator | 1 |
32 | Small surgical kit | 1 |
33 | Colposcope | 1 |
| Appendix 5 | |
| to the Rules for conducting | |
| preventive measures of | |
| HIV infection |
List of services for conducting bio behavioral researches among key population groups
Footnote. The rules have been supplemented by Appendix 5 in accordance with the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall be enforced upon expiry of ten calendar days after the day of its first official publication).
№ | Medical service code | Name of a medical service | Frequency of services per person from the key population group | Proportion of services from the number of key population group participants |
1.1 | Consultation: doctor - epidemiologist | 1 | 45 % | |
2.2 | Consultation: assistant epidemiologist | 1 | 55 % | |
3.3 | B06.856.005 | Determination of antibodies to HIV 1,2 in a dry drop of capillary blood by ELISA | 1 | 90 % |
4.4 | B03.860.003 | Determination of total antibodies to HIV-1,2 and p24 antigen by express method | 1 | 10 % |
5.5 | B06.854.005 | Determination of antibodies to hepatitis C in a dry drop of capillary blood by ELISA | 1 | 100 % |
6.6 | B06.853.005 | Determination of antibodies to Treponema pallidum in a dry drop of capillary blood by ELISA | 1 | 100 % |
7 | D99.296.013 | Finger blood sampling | 1 | 100 % |
8 | Containers for the safe collection and disposal of medical waste (hereinafter referred to as CBW) | 12 | 100 % | |
9 | Disposal of CBW | 12 | 100 % |
| Appendix 6 | |
| to the Rules for conducting | |
| preventive measures of | |
| HIV infection |
List of services for conducting information work among the population
Footnote. The rules have been supplemented by Appendix 6 in accordance with the order of the Minister of Healthcare of the Republic of Kazakhstan dated 11.07.2024 № 55 (shall come into effect upon expiry of ten calendar days after the day of its first official publication).
№ | Name of the service | Number | Frequency of services |
1 | Banners | 1 | 1 per 100,000 population |
2 | Videos | 1 | per year |
3 | Billboards | 1 | per year |
4 | Poster stands | 1 | per 1 medical organization, including pretrial detention centres and penal institutions |