**7.1 ART initiation and managing clients on ART**

Fast track linkage to ART initiation, determine eligibility criteria and reason to defer ART, select the correct regimen, and provide key adherence messages for adults, children, and adolescents, including lifestyle modification.


Identify eligibility for prophylaxis such as TB preventive therapy (TPT), and cotrimoxazole preventive therapy for infections (CPT).

Monitoring clients on ART.

Quality care at the follow-up visits promotes adherence, achieves and sustains viral suppression, minimizes side effects and toxicities, and promotes quality of life.

Viral load monitoring and management – to determine clinical, virologic, and immunological response to ART, management of viral load results in infants, children, adolescents, ANC pregnant women, and adults and conduct routine viral load monitoring.

Implement interventions to suppress viral load, including enhanced adherence support.

Provide clinical support to staff – experienced NIMART nurses in the health facility are expected to provide support to pre-service trained nurses, those newly trained, and staff on interpretation of guidelines, results, and ART initiation, and interventions and can be trained as clinical nurse mentors through the district clinical mentorship programme to transfer skill, knowledge to newly trained nurses thus improve clinical competence in the management of PLWH. They can also provide in-service training to keep staff and NIMART-trained nurses up-to-date with current development and research.

Data management and quality improvement – NIMART nurses are responsible for documentation of clinical findings, results, and interventions, and this should be legible, signed, and dated as per record management policy. Data management requires systems and processes, including clinical records audits to identify gaps and develop a quality improvement plan and projects to improve such gaps.
