shkar]btßmÖeday³

bkERbeRkApøÚvkarCaPasaExGrBIPasaGg;eKøs
sUmemtþaGFüaRs½ycMeBaHkMhusqÁgénGkçraviruT§TaMgLay
1
matika
GarmÖkfa>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>3
esckIþEføgGMNrKuN>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>4
esckIþepIþménkmGviFIsikSa>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>5
bBa¢IraynamGkSrkat;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>6
m:UDulTI1³B½t’manCamUldæansIþGMBIemeraKeGds_-CMgWeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>9
m:UDulTI2³ karmak;gaynigerIseGIgBak;B½n§nwgemeraKeGds_-CMgWeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>25
m:UDulTI3³ karcmøgemeraKeGds_BImþayeTAkUn ¬MTCT¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>37
m:UDulTI4³ karbgáarkarcmøgemeraKeGds_BImþayeTAkUn ¬ PMTCT¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>43
4>1³ karbgáarbzménkarcmøgemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>45
4>2³ karbgáarkarmankUnmintambMNgenAelI®sIþpÞúkemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>59
4>3³ karbgáarkarcmøgemeraKeGds_BI®sIþpÞúkemeraKeGds_eTAkUnrbs;Kat; ¬ PMTCT ¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>63
4>3>1³ esva PMTCT karBüa)alnigkarbgáareday»sfRbqaMgemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>65
4>3>2³ kaeEfTaMenAeBlmanépÞeBaH eBlQWeBaHsRmalnigsRmal karEfTaMeRkaysRmalnigkartamdanEfTaMbnþ>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>83
4>3>3³ karciBaw©mkUnkñúgbribTénemeraKeGds_-CMgWeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>103
4>3>4³ suvtißPaBenAkEnøgeFIVkar>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>121
4>4³ karEfTaMnigKaMRTbnþ>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>135
m:UDulTI5³ kaeEfTaMdl;Gñkpþl;RbwkSa>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>147
m:UDulTI6³ kartamdannigvaytémø>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>155
cemIøy³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>171
bBaI¢rayÉksareyag>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>181

2
 GarmÖkfa
bc©úb,nñenH RbeTskm<úCaKWCaRbeTsEdlkMBugEtRbQmnwgkarrIkraldalénemeraKeGds_-CMgWeGds_d¾xøaMgCageKenAkñúgtMbn;GasIu. xN³EdleRbva:Lg;énGñk
qøgemeraKeGds_enAkm<úCa)anFøak;cuHkñúgcMeNamRkúmRbQmx<s; eK)ansegáteXIjfaeRbva:Lg;én®sIþmanépÞeBaHpÞúkemeraKeGds_Edl)anmkTTYlesvaEfTaMépÞeBaH
hak;dUcCaminmankarERbRbÜleLIy ¬2>2° enAqñaM 2003¦. kMeNInGRtaénGñkqøgemeraKeGds_fIH )anekIteLIgtamry³karcmøgemeraKeGds_BImþayeTAkUn.
karcmøgemeraKeGds_BImþayeTAkUnKWCabBaðacMeBaHmuxmYyEdlraCrdæaPi)al CaBiessRksYgsuxaPi)alRtÚvedaHRsayCabnÞan; edIm,ICYyTb;sáat;karcmøg
emeraKeGds_BImþayeTAkUnEdlecHEtmankMeNInekIneLIgCalMdab;. edIm,IpSBVpSay[)anTUlMTUlayBIcMeNHdwgsIþGMBIemeraKeGds_-CMgWeGds_ CaBiesskarbgáarkar
cmøgemeraKeGds_BImþayeTAkUndl;m®nIþRBmTaMgbuKÁliksuxaPi)alnana RksYgsuxaPi)al)anseRmcGnuBaØat[mCÄmNÐlCatiKaMBarmatanigTark eroberogCaesovePA
sRmab;bNþúHbNþalenHeLIg.
esovePAbNþúHbNþalsIþGMBIkarbgáarkarcmøgemeraKeGds_BImþayeTAkUnenH KWCamKÁúeTsk_mYyd¾sMxan;nigCaCMnYydl;m®nIþ-buKÁlikTaMgLaykñúgkarGnuvtþn_pþl;
esvaEfTaM Büa)alnigKaMRTd¾manRbsiTi§PaBx<s;dl;®sIþmanépÞeBaHTaMgLay CaBiess®sIþmanépÞeBaHpÞúkemeraKeGds_RBmTaMgkUnnigRKÜsarrbs;Kat;.
PMñeBj/éf¶TI6 Exemsa qñaM2007

É>]> sa®sþacarü eGg hYt

rdæelxaFikarRksYgsuxaPi)al

3
 esckIþEføgGMNrKuN
esovePAsRmab;bNþúHbNþalsIþGMBIkmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUnEdl)aneroberogEksRmÜlCafIH RtÚv)anbBa©b;CasßaBredaymankarcUlrYmBI
RKb;édKUrYmkargarCaeRcInEdl)anpþl;Camtieyabl;d¾mansar³sMxan;.
´sUmsMEdgnUvGMNrKuNya:gRCaleRCACUndl;smaCik smaCikaénRkúmkargarbec©keTsénkmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn Edl)ancMNay
eBlevlad¾mantémøcUlrYmpþl;CaCMnYybec©keTskñúgkarerobcMesovePAbNþúHbNþalenHeLIg.
´sUmEføgGMNrKuNCaBnwøkdl;GgÁkarsuxPaBBiPBelak mUlniFiGgÁkarshRbCaCatiedIm,Ikumar nig mUlniFisklRbyuT§nwgCMgWeGds_ rebgnig RKúncaj;
Edl)an]btßmÖKaMRTCafvikasRmab;erobcMesovePAbNþúHbNþalsIþGMBIkmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn EdlCamKÁúeTsk_sRmab;m®nIþ- buKÁlikenAtammnIÞr
eBTünigmNÐlsuxPaBnana kñúgkarGnuvtþn_pþl;esvaEfTaMbnþmYyEdlmanlkçN³RKb;RCúgeRCay
eqIøytbeTAnwgyuT§sa®sþénkarTTYl)anCasklénGñkpÞúkemeraKeGds_-CMgWeGds_kñúgkarbgáarEfTaM Büa)al nigkarKaMRT.
´sUmEføgGMNrKuNCaBiessdl;m®nþI-buKÁlikénkariyal½ykmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn Edl)ancMNayGs;kmøaMgkaycitþnigeBlevla
kñúgkarBinitüEktRmÚvGtßn½y nigbkERbÉksarsRmab;karbNþúHbNþalenH.
smiTi§pld¾FMeFgenHKWepIþmecjBIkarKaMRTya:geBjTMhwgrbs;RksYgsuxaPi)al. CacugbB©ab; ´sUmsMEdgnUvkardwgKuNya:gRCaleRCAcMeBaHRksYgsuxaPi)al
EdlCanic©kalEtgEtKaMRTdl;kic©KaMBarsuxPaBmatanigTark CaBiesskmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn[mandMeNIrkarrlUneTAmuxCanirnþr_.
PMñeBj/éf¶TI6 Exemsa qñaM2007

sa®sþacarü KMu kaNal;

RbFanmCÄmNÐlCatiKaMBarmatanigTark
4
esckIþepIþménkmGviFIsikSa
rebobeRbIR)as;esovePA
esovePAsRmab;sikçakamenH KWCamKÁúeTsk_d¾sMxan;rbs;GñkenAkñúgkarsikSaenH. GñkRtÚvrkSavaCab;nwgxøÜnGñkRKb;eBlevla. enAkñúgTMB½rbnÞab;eTAenH GñknwgeXIjman
vtßúbMNgénkarbNþúHbNþal skmHPaBénkarbNþúHbNþal søaysRmab;bBa©aMg nigcMNucsMxan;²énm:DU ulnImYy². GñkmincaM)ac;eFIVkarkt;smÁal;CalMGitenAkñúgeBl
sikSaeT. EteTaHbICaya:gNakIþ GñkGaceXIjmancMNucKYr[cab;GarmHN_xøHEdlGñkRtÚvkarkt;RtaTuk dUcCa]TahrN_Edl)anmkBIkarBiPakSa. GñknwgeXIjman
esckIþGFib,ayxIø²énskmHPaBsikSa. RKÚsRmbsRmÜlnwgBnül;Gñk[kan;EtlMGitBIskmHPaBnImYy².

esovePAenHk¾manpÞúknUvTRmg;EbbbTkrNIsikSanigbBaI¢epÞógpÞat;sRmab;eFIVlMhat; RBmTaMgB½t’manCamUldæansRmab;m:UDulxøH. cemøIyénsMNYrnImYy²manP¢ab;enA

EpñkxageRkayénesovePAnImYy².

sUmrkSaesovePAenHTukenAeRkayeBlbBa©b;vKÁsikSa nigsUmeRbIR)as;vaCaÉksareyagsRmab;karGnuvtþn_rbs;Gñk.

5
bBaI¢rayBaküsresrCaGkSrkat;;
3TC LamIvuyDIn (Lamivudine)
AIDS cegáameraKsBaØaEdleFIV[RbB½n§srIragÁkaycuHexSay (Acquired Immune Deficiency Syndrome)
ANC karEfTaMépÞeBaHmuneBlsRmal (Antenatal Care)
ART karBüa)aleday»sfRbqaMgemeraKeGds_ (Antiretroviral Therapy)
ARV »sfRbqaMgemeraKeGds_ (Antiretroviral “drug”)
AZT hSIúdUvuyDIn (Zidovudine)
BCC karR)aRs½yTak;TgEdlnaM[mankarpøas;bþÚr\riyabf (Behaviour Change Communication)
CBO GgÁkarEdleFIVkarenAtamshKmn_ (Community-based Organization)
CoC karEfTaMBüa)albnþ (Continuum of Care)
CoCCC KN³kmHkarsRmbsRmÜlkarEfTaMBüa)albnþ (Continuum of Care Coordination Committee)
CPA kBa©b;skmHPaBb®gÁb; (Complementary Package of Activities)
CPN+ bNþajGñkpÞúkemeraKeGds_enARbeTskm<úCa (Cambodian Network of PLHA)
CSW ®sIþrksIupøÚvePT (Commercial Sex Worker)
FBO GgÁkarsasna (Faith-based Organization)
Hb eGm:UkøÚb‘Ín (Haemoglobin)
HBC karEfTaMenAtampÞH (Home-based Care)
HC mNÐlsuxPaB (Health Center)
HCBC karEfTaMenAtamshKmn_nigenAtampÞH (Home-and Community-based Care)
HCW(s) buKÁliksuxaPi)al (Health Care Worker”s”)
HFBC karEfTaMenAtamRKwHsßansuxaPi)al (Health Facility-based Care)
HIV emeraKeGds_ (Human Immunodeficiency Virus)
HIV+ manpÞúkemeraKeGds_ (HIV infected or HIV positive)
HIV- KHanpÞúkemeraKeGds_ (HIV negative)
HSS kareFIVGegátRsavRCaveRbv:aLg;énkarqøgemeraKeGds_ (HIV Sentinel Survey “Cambodia”)
NMCHC mCÄmNÐlCatiKaMBarmatanigTark (National Maternal and Child Health Center)
NVP eNvIra:BIn (Nevirapine)
IDU Gñkcak;eRKÓgejón (Injecting Drug User)
6
IEC B½t’man Gb;rM nig TMnak;TMng (Information Education Communication)
IPD GKarsRmab;GñkCMgWsRmakBüa)al (Inpatient Department)
M&E kartamdannigvaytémø (Monitoring and Evaluation)
MMM mNÐlmitþCYymitþ (Mondul Mith Chuoy Mith “Friends Help Friends Centre”)
mmm mNÐlmitþCYymitþsRmab;kumar (Little Mondul Mith Chouy Mith “for children”)
MoH RksYgsuxaPi)al (Ministry of Health)
MPA kBa©b;skmHPaBGb,brima (Minimum Package of Activities)
MSM bursEdlrYmePTCamYyburs (Men who have sex with men)
MTCT karcmøgemeraKeGds_BImþayeTAkUn (Mother-to-Child transmission of HIV infection)
NCHADS mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,knigkameraK (National Center for HIV/AIDS, Dermatology, and STD)
OD RsúkRbtibtiþ ¬sRmab;karRKb;RKgsuxaPi)alEdlGacman2 b¤ eRcInRsúkrdæ)al¦ (Operational District)
OI CMgW»kasniym (Opportunistic Infection)
OPD GKarBinitüCMgWeRkA (Outpatient Department)
PCP CMgWehImsYtEdlbgáedayemeraK (Pneumocystis carinii Pneumonia) (renamed Pneumocystic jirovecii)
PHD mnIÞrsuxaPi)alextþ (Provincial Health Departement)
PLHA GñkpÞúkemeraKeGds_¼CMgWeGds_ (Person or people Living with HIV/AIDS)
PLHA-SG RkúmKaMRTGñkpÞúkemeraKeGds_¼CMgWeGds_ (People Living wth HIV/AIDS Support Group)
PMTCT karbgáarkarcmøgemeraKeGds_BImþayeTAkUn (Prevention of Mother-to-Child Transmission of HIV infection)
RH mnIÞreBTübEg¥k (Referral Hospital)
RTI karbgáeraKqøgenApøÚvbnþBUC (Reproductive Tract Infection)
STD CMgWkameraK (Sexually Transmitted Disease)
STI CMgWkameraK (Sexually Transmitted Infection)
TB CMgWrebg (Tuberculosis)
TB/HIV CMgWrebg¼eGds_ (Dual or co-infection with both TB and HIV)
TWG Rkúmkargarbec©keTs (Technical Working Group)
UNICEF mUlniFirbs;GgÁkarshRbCaCatiedIm,Ikumar (United Nations Children’s Fund)
USAID Pñak;garGPivDÆn_GnþrCatishrdæGaemrik (United States Agency for International Development)
VCCT karpþl;RbwkSanigeFIVetsþQamedaysH½RKcitþnigrkSakarsm¶at; (Voluntary Confidential Counselling and Testing)
WHO GgÁkarsuxPaBBiPBelak (World Health Organization)
7
8
m:UDulTI1
B½t’manCamUldæansIþBIemeraKeGds_-CMgWeGds_

vtßúbMNg
enAcugbBa©b;énm:UDulenH sikçakamTaMgGs;Gacnwg³
1>GFib,ayGMBIeGBIedmIsa®sþénemeraKeGds_enAkm<úCa
2>kMNt;niymn½yénBakü HIV nig AIDS
3>BiPakSaGMBIkarvivtþn_énemeraKeGds_enAkñúgxøÜnmnusS
4>kMNt;)anGMBIktþaRbQmnwgkarcmøgemeraKeGds_
5>raybBaI¢sIþGMBI\riyabfEdlnaM[mankarcmøgnigminnaM[mankarcmøg

  ry³eBl³ 2ema:g10naTI

9
skmHPaBTI1³ emeron³³ karrIkraldalénemeraKeGds_-CMgWeGds_enAelIBiPBelaknigenAkm<úCa
» søayTI5³ cMNaMfa kñúgcMeNamGñkqøgfIHTaMgGs;enATUTaMgBiPBelakman segçbkarrIkraldalCasklénemeraKeGds_-Cm¶WeGds_enAqñaM2005³
13PaKry KWCakumarEdlmanGayueRkam15qñaM tamkar)a:n;RbmaNrbs; UNAIDS/WHO qñaM2005
» søayTI6³ cMNaMfa eTaHbICacMnYnGñkpÞúkemeraKeGds_enAkm<úCa)anFøak;cuH cMnYnRbCaCnEdlrs;enACamYyemeraK man38>6lannak; EdlenAkñúgenaH
eGds_ qñaM2005 mankumarGayueRkam15qñaMcMnYn2>3
ehIyk¾eday k¾cMnYnenHFøak;cuHEtelIGñkpÞúkemeraKeGds_CabursEt lannak;
b:u:eNÑaH. rIÉcMnYn®sIþpÞúkemeraKeGds_minFøak;cuHeT. cMnYnRbCaCnEdleTIbnwgqøgemeraK man4>1lannak; EdlenAkñúgenaH man
» elIsøayTI7³ cMNaMelIcMNucRkhm. vatMNagBIkarcmøgeraKeGds_BI eGds_fHI qña2M 005 kumarGayueRkam15qñaM cMnYn540/000
nak; Ã
mþayeTAkUnEdlkMBugEtekIneLIg.
cMnYnRbCaCnEdlsøab;edaysarCm¶W man2>8lannak; EdlenAkñúgenaHman
» elIsøayTI8³ cMNaMfa eTaHbICakarqøgkñúgcMeNam®sþIrksIupøÚvePT)anFøak; eGds_ qñaM2005 kumarGayueRkam15qñaMcnM Yn380/000
cuHxøaMgk¾eday k¾cMnYn®sIþpÞúkemeraKeGds_EdlmkesvaEfTaMépÞeBaHmin nak;
mankarpøas;bþÚrKYr[kt;smÁal;eT Ã PaKeRcInénkumarEdleTIbnwgqøgfHIenH KWqøgtamry³BImþayeTAkUn
5

cMnYnRbCaCnkm<úCaGayuBI 15-49qñaM smamaRténkarqøgemeraKeGds_EbgEckeTAtamrebobénkarcmøg

Edl)an)a:n;sGanfamanpÞúkemeraKeGds_-Cm¶WeGds__ 1990-2003 100%
1992-2002

80% mþayeTAkUn
180,000 158,300 158,900 155,900 60%
149,900
160,000 147,300
142,100
132,900
140,000 srub 123,100
120,600
40% burseTARsIþ
120,000 burs 101,900 102,500 99,100
95,700 92,700
100,000 RsþI 85,600 81,100 84,600

80,000
75,200
20%
RsIþrksIupøÚvePT
cMnYn

65,600
60,800
60,000 45,700
eTAbuurs
56,400 56,400 56,800 57,200 57,500 57,700 57,500
40,000 33,700 51,600
18,700
39,500 0%
20,000

1996

1998
1995

1997

1999

2002
1992

1993

1994

2000

2001
1,150 4,300
24,800
0 12,000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 ®sþIrksIupøÚvePTeTAburs ®sþIrksIupøÚvePT bþeI TARbBn§
qñaM RbBn§eTAbþI mþayeTAkUn édKUEdlmin)anerobkar
6 6
*HIV Sentinel Surveillance, NCHADS, MOH 2003 HIV Sentinel Surveillance, NCHADS, MOH 2003

10
 eRbva:Lg;énemeraKeGds__enAkm<úCa karqøgemeraKeGds_enAelIRsIþ nigkumarenAkm<úCa
kñúgcMeNamRkumEdl)aneFIVGegátBIqñaM 1996-2003
45.0 42.8 ƒ enARbeTskm<úCabc©úb,nñ kñúgcMeNamRbCaCnEdlqøgemeraKeGds_ manRsIþRbEhl
39.1
40
50 PaKry Ã
40.0 38

35.0
32.1
ƒ kñúgcMeNamGñkqøgemeraKeGds_fIH EdlmanGayuBI 15-49qñaM Ã

PaKry 30.1
30.0 28
qñaM2003 manRsIþRbEhl 6/350 nak;nigburs 1/700nak;
RsþImkBinitüépÞeBaH
t
25.0
20.8
ƒ manTarkEdleTIbnwgekItcMnYnBI 7/000 eTA 10/000 nak;RbQmnwgkarqøg
20.0 18.4 18.4

b:UlIs emeraKeGds_BImþayCaerogral;qñaM ÃÃ
15.6
15

ƒ mankrNIqøgfHIrhUtdl; 40PaKry GacbNþalmkBIkarcmøgBImþayeTAkUn

14.4
15.0
RsþIrksIupøÚvePTedayRbeyal 11.7
ÃÃÃ
10.0
RsþIrksuIpøÚvePTedaypÞal;
IDFSW: 4.3 4.5 4.4 4.2 3.9
Indirect female sex worker 5.0 3.5 3.1 2.7
DFSW:
Direct female sex worker *HIV Sentinel Surveillance, NCHADS, MOH 2003
1.9 2.3 2.5 2.5 2.5 2.4 2.3 2.1 ÃÃCalculated
from estimated births (WHO World Health Report 2005, Cambodia) x HIV prevalence
0.0
ÃÃ ÃProjections
for HIV.AIDS in Cambodia: 2000-2010. The Cambodia Working Group on HIV/AIDS Projection,
1996 1997 1998 1999 2000 2001 2002 2003 8 9
November 2002.
* HIV Sentinel Surveillance, NCHADS, MOH 2003, adjusted weighted data, smoothed with EPP

skmHPaBTI2³ bMpusKMnit³ plb:HBal;énemeraKeGds_enAkm<úCa

» RKÚnwgesIñ[GñkKitdl;sMNYr³ plb:HBal;énemeraKeGds_-Cm¶WeGds_enAkm<úCa
etIplb:HBal;énemeraKeGds_enAkm<úCamanGIVxøH? enAqñaM 2003 eK)an)a:n;sHanfa manRbCaCneBjv½yRbmaN
Ã
123>100nak; manpÞúkmeraKeGds_enAkm<úCa
ebIKHankarBüa)aleT RbCaCnTaMgenH nwg³
ƒFøak;xøÜnQW minGaceFIVkar)an nigminGacEfrkSaRKYsarrbs;eK)an
ƒCayfaehtuvanwgvivtþeTArkCm¶WeGds_ nig TIbBa©b;QaneTArkkarsøab;
GñkpÞúkemeraKeGds_TaMgenaHGac³
ƒcmøgemeraKeGds_eTAédKUrYmePTrbs;Kat;
ƒcmøgemeraKeGds_eTAkUnrbs;Kat;
ƒbnSl;TuknUvkumarkMRBa
11
*HIV Sentinel Surveillance, NCHADS, MOH 2003 (adult aged 15-49)

11
skmHPaBTI3³ BaküKnwøH³ niymn½yénBaküü emeraKeGds_-CMgWeGds__
» RKÚnwgsYrfa³ etIemeraKeGds_ (HIV) nigCm¶WeGds_ (AIDS) CaGIV?
1>> etIemeraKeGds_mann½yfaya:gdUcemþc? emeraKeGds_ Cm¶WeGds_
HIV AIDS
2> etICMgWeGds_mann½yfaya:gdUcemþc?
SHuman mnusS SAcquired minEmnBIkMeNIt
» bnÞab;mkRKÚnwgsMu[GñkeqIøy nigTuk»kas[GñkeFIVkarBiPakSaKñaGMBIbBaða SImmunodeficiency SImmuno- RbB½nk § arBar
PaBcuHexSayénRbB½n§karBar
enaH SDeficiency PaBcuHexSay
SVirus vIrus
SSyndrome cegáameraKsBaØa
emeraKeGds_ KWCavIrusmYyRbePT ehAfa KWCacegáameraKsBaØaEdlvivtþenAelIGñkpÞúk
RetrovirusEdleFIV[RbB½n§karBarrag emeraKeGds_ enAeBlEdlRbB½n§karBarrag
kayrbs;mnusScuHexSay kayFøak;cuHexSay. 13

HIV-1 nig HIV-2 Bakübec©keTs

enATUTaMgBiPBelakmanemeraKeGds_ 2RbePT³
S HIV-1 nig HIV-2
- emeraKeGds_enHqøgtamviFIdUcKña S HIV+ b¤ HIV viC¢man
- mankarbgáedayCm¶W»kasniymRbhak;RbEhlKña
- HIV-1 maneRcInCaTUeTAenAelIBiPBelak. eKeXIjvIrusRbePTenHmanenAkmú<úCa mann½yfa mnusSmñak;qøgemeraKeGds_ enAeBleFIVetsþQamlT§plbgðaj
nigenARbeTs xøHénPUmiPaKGasIuGaeKñy_
fa viC¢man.
etI HIV-2 xusBI HIV-1 ya:gdUcemþcxøH?
S HIV-2 RtUv)anrkeXIjCaeRcInenAGaRhiVkxaglic RbeTsGg;ehÁaLa nigRbeTs S HIV- b¤ HIV GviC¢man
mU:sSmbik
S HIV-2 mingayqøgdUc HIV-1eT mann½yfa mnusSmñak;min)anqøgemeraKeGds_eT b¤lT§pletsþQamrbs;eK
S HIV-2 vivtþyWtCag HIV-1 bgðajfaGviC¢man.
S karcmøgBImþayeTAkUn cMeBaH HIV-2 kMrekItmanNas;.
15
14

12
skmHPaBTI4³ bMpusKMnit³ plb:HBal;énemeraKeGds_eRkayBIqøg
» sRmab;skmHPaBenH GñknwgRtÚveFIVkarCaKU²
» RKÚnwgsYrGñkfa³
1> etIemeraKeGds_man\Ti§BlGIVeTAelIragkayrbs;mnusS?
2> etImanGIVekIteLIgenAeBlEdlmnusSmñak;qøgemeraKeGds_?

RbB½n§karBarrbs;mnusS nig ekasika CD4 karrab;cMnYnekasika CD4 nig Cm¶W

SmnusSEdlmansuxPaBl¥ manRbB½n§karBarrwgmaM. RbB½n§enHGac
karBarsrIragÁRbqaMgnwgCmW¶nana
SekasikaQam :s :CaRbB½n§karBarmYyya:gsMxan;
SekasikaQam :s :mYyRbePTehAfa CD4 mansBaØasMKal;
enAépÞxagelIénekasika
ScMnYnekasika CD4 enHGacrab;)antamkarBinitüQam
SkareFIVetsþenHKWCaviFId¾l¥sMrab;RtYtBinitüemIlRbB½n§karBarsrIragÁ
kay faetIvaenAmandMeNIrkarl¥RbesIr b¤ cuHexSay.
SmnusSEdlmanRbB½n§PaBsuaMFmHta manekasika CD4 cenøaHBI
450 eTA1500 kñúgmYymIlIEm:RtKUbQam
SebIsinCacMnYnekasika CD4 Føak;cuHTabCag 450 ¼ mm3 GñkpÞúk
emeraKeGds_ GacepIþmmankarbgáeraKepSg²eTot¬rYmmanCm¶W
»kasniym¦
SebIsinCacMnYnekasika CD4 Føak;cuHTabCag 200 ¼ mm3 GñkpÞúk
17
emeraKeGds_GacRbQmnwgCm¶WqøgF¶n;F¶r nig Cm¶WmharIk.
18

13
 etIemeraKeGds_manskmGPaBGIVxøH ?
emeraKeGds_³
S eFIV[b:HBal;dl;ekasikaénRbB½n§karBar-CaBiessekasika CD4
S emeraKeGds_)aneRbIR)as;ekasika CD4 EdlrgnUvkarb:HBal;
edIm,IeFIVkarBRgIkcMnYnvIrusfIH
S vasMlab;ekasika CD4
S emeraKeGds_GacbMEbkxøÜnkñúg1éf¶)anRbEhl 10 ekadi
S ekasika CD4 RbEhl 200lan RtUv)anbMpøajerogral;éf¶
¬xøÜnmnusSGacplitekasika CD4 RbmaN100lan Caerogral;éf¶¦
bnÞúkvIrus KWCabrimaNvIrusenAkñúgQam. eKGacvas;)anedayeFIVetsþ HIV-RNA
19
PCR
etIemeraKeGds_b:HBal;dl;GIVxøH?
S emeraKeGds_vayRbhareTAelIekasika CD4 nigbMpøajRbB½n§karBarsrIragÁ
bniþcmþg²
S GñkpÞúkemeraKeGds_cab;epIþmcuHexSayehIygaynwgTTYlrgnUvkarqøgeraK
epSg²
- Cm¶WEdlGacekItmanCajwkjab;enAelImnusSFmHta
- Cm¶W»kasniymBiess² EdlekItmanEtelIGñkpÞúkemeraKeGds_
S GñkpÞúkemeraKeGds_Føak;xøÜnQWkan;EtxøaMgeLIg nigQaneTArkkarsøab;
20

skmHPaBTI5³ emeron³³ karvivtþn_BIGñkpÞúkemeraKeGds_eTACaGñkCMgWeGds__

» karvivtþn_BIemeraKeGds_eTACaCMgWeGds_³ søayTI22 karvivtþn_énemeraKeGds_ ¬1¦
1000

» smÁal;faetI ekasikaCD4Føak;cuHenAeBlEdlbnÞúkemeraKeGds_eLIg ekasikaCD4 bnÞúkvIrus

cMnYnekasika CD4
ya:gdUcemþcxøH?

eTIbnwgqøg minTan;maneraKsBaØa maneraKsBaØa

200
qøg Æ Cm¶WeGds__
ry³eBlcMh
0
0 1 2 3 4 5 1 2 3 4 5 6 7 8 9 10 11
¬KitCaqñaMeRkayBIqøgemeraKeGds_¦ 22
¬KitCaEx¦

14
 karvivtþn_énemeraKeGds_ ¬2¦ karvivtþn_énemeraKeGds__ ¬3¦
etI Sero-conversionmann½yfadUcemþc?
S GñkpÞúkemeraKeGds_)anbegIátnUvGgÁbdibkçR)aNRbqaMgemeraKeGds_
karqøgemeraKeGds_enAdMNak;kaldMbUg³ S GgÁbdibkçR)aNenHGacemIleXIjtamry³kareFIVetsþrkGgÁbdibkçR)aNemeraKeGds_
S ekItmaneLIgenAkñúgry³eBl2-3s)þah_dMbUgeRkayBIqøg etICaFmHtamanGIeV kIteLIg?
S enAeBlEdleTIbnwgqøgfIH² cMnYnemeraKeGds_enAkñúgxøÜn)anekIneLIgy:agqab;rh½s
S GñkpÞúkemeraKeGds_GacmansuxPaBl¥enAry³eBlenH b¤ ¬bnÞúkvIrusekIneLIg¦
S GacmanRKun knÞÜlrmas; nig eLIgkUnkNþúr S 4-6 s)þah_eRkay ¬CYnkalrhUtdl;3Ex¦ srIragÁcab;epIþmplitGgÁbdibkçR)aN
RbqaMgnwgemeraKeGds_. enAeBlenaHkareFIVetsþQamcab;epIþmeXIjmanviC¢man.
¬eraKsBaØaénCm¶WeGds_RsYcRsav¦
ry³eBlcMh ³ mann½yfabuKlÁ manpÞúkemeraKeGds_ehIy
23
EtGgÁbdibkçR)aNminTan;plit. enAeBlenaHlT§pletsþGacGviC¢man. 24

karvivtþn_énemeraKeGds__ ¬4¦ dMNak;kalKIønikénCm¶WeGds_rbs;GgÁkarsuxPaBBiPBelak

S dMNak;kalminTan;maneraKsBaØa
enAry³eBlb:unHanqñaMdMbUgbnÞab;BIqøgemeraKeGds_ brimaNemeraK)anfycuHbniþcmþg²
RbB½n§karBarcuHexSaybniþc k¾b:uEnþGacenAdMeNIrkarl¥RbesIr.
S dMNak;kalmaneraKsBaØa
eRcInqñaMbnÞab;mkbrimaNemeraKeGds_)ancab;epIþmekIneLIgCafIHmþgeTot. RbB½n§PaBsuaM
)ancuHexSayya:gxøaMg. GñkCm¶WgaynwgTTYlrgnUvCm¶WqøgnanaEdlCaFmHtaGacBüa)al
)an.
S dMNak;kalCm¶WeGds_
enAkñúgdMNak;kalenH RbB½n§PaBsuaM)anrgnUvkarxUcxatya:gF¶n;F¶r ehIyGñkCm¶WRbQm
nwgCm¶WqøgF¶n;F¶rEdlKMramkMEhgdl;CIvit.
GgÁkarsuxPaBBiPBelak)anerobcMbegIátRbB½n§cMNat;fñak;KøInikénCm¶WeGds_
EdlGaceRbIR)as;sMrab;vaytémøsPaBénCm¶WeGds_edaysBaØaKøInik dUcCa³
SebIsinGtifiCnfIHmñak;RtUv)ansgS½yfamanpÞúkemeraKeGds_ nig
RtUvkarbBa¢Ún[eTA eFIVetsþQamrkemeraKeGds_edaysH½RKcitþ
SsPaBF¶n;F¶rrbs;buKÁlEdlrgeRKaHedaysaremeraKeGds_-
Cm¶WeGds_ya:gdUcemþc?
SGñkCm¶Wdl;eBlEdlRtUvBüa)aleday»sfRbqaMgemeraKeGds_ehIyb¤enA
¬ART¦
RbB½n§dMNak;kalKøInikénCm¶WeGds_manPaBxusKñarvagmnusSeBjv½y nigkumar.
25 26

15
 dMNak;kalTI1énCm¶WeGds_elImnusSeBjv½y³ dMNak;kalTI2énCm¶WeGds_elImnusSeBjv½y³
minTan;maneraKsBaØa manCm¶WminsUvF¶n;F¶r
S minRskTMgn; S RskTMgn;ticCag10°
S minmaneraKsBaØa S mandMe)A b¤ eRbHcEgVkbbUrmat; (ANGULAR CHEILITIS)
S rmas;BgEbk (seborrhoea or prurigo)
b¤k¾ S man Herpes Zoster kñúgry³eBl5qñaMknøgeTAenH Angular cheilitis

S RKan;EtmankUnkNþúrBaseBjxøÜn PGL (Persistent Generalized S manCm¶WrlakpøÚvdegIðmEpñkxagelI ekItsacuHsaeLIg (sinusitis or otitis)

Lymphadenophathy) S dMe)Amat;ekItsacuHsaeLIg
nig b¤ lT§PaBGnuvtþkMritTI1³ GñkCm¶WenAmanskmHPaBFmHta Herpes Zoster
PGL: mankUnkNþúrenAsgxagk minmankarQWcab;eT 27
nig b¤ lT§PaBGnuvtþkMritTI2³ GñkCm¶WmaneraKsBaØa b:uEnþenAmanskmHPaBFmHta 28

dMNak;kalTI3énCm¶WeGds_elImnusSeBjv½y³
dMNak;kalTI4énCm¶WeGds_elImnusSeBjv½y³
manCm¶WeGds_F¶n;F¶r
manCm¶WF¶n;F¶rmFüm lkçN³EdlbBa¢ak;BIsPaBCm¶WeGds_man³
S RskTMgn;elIsBI 10PaKry
SGñkCm¶WmansPaBsÁmkMRBwg
SmanCm¶WrlakeRsamxYrk,al
S pSitkñúgmat; b¤ SpSitenApøÚvbMBg;Gahar
S Herpes Simplex ulcerations ry³eBlelIsBI1ExenARbdab;bnþBUC nig enArn§KUf
S Oral hairy leukoplakia SrlakeRsamxYrk,aledayBBYkemeraK Cryptococcal Meningitis
S rakelIsBI 1Ex SrebgeRkAsYt
S RKunekþAKHanmUlehtu elIsBI1Ex pSitkñúgmat; -Pneumocystis Carinii ¬ehImsYt¦
SCm¶W»kasniymepSgeTot³
S pSitenATVarmaselIsBI1Ex -Toxoplasmosis of the brain
S rebgsYtkñúgkMLúgeBl1qñaMknøgeTA -Cryptosporidiosis manCamYynwgCm¶WrakelIsBI1Ex
S Cm¶WqøgedayemeraK)ak;etrIF¶n;F¶r ¬rlaksYt/ bgáeraKenAsac;dMu.l.¦ -Cytomegalovirus (CMV) infection
SCm¶WmharIkTak;TgnwgCm¶WeGds_
nig b¤ lT§PaBGnuvtþkMritTI3³ edkelIERKticCag50PaKrykñúg1éf¶ kñúgExknøgeTAenH. -Lymphoma
29 -mharIkmat;s,ÚnF¶n;F¶r lT§PaBGnuvtþkMritTI4³ edkelIERKeRcInCag 50PaKry
30
-Kaposi’s Sarcoma kñúgExknøgeTAenH.
16
 » BinitüemIlBIdMNak;kalKIønikénCMgWeGds_enAsøayTI31 sMNYr søayTI31 dMNak;kal
burspÞúkemeraKeGds_Gayu25qñaMmñak; mandMe)ApSitenAmat;nigmanrakmþgmáal
» cUreqIøynwgsMNYredayemIlkñúgesovePAsRmab;sikçakam 1 ry³eBlCag1Ex
¬kñúg]bsm<½n§TI1¦ 2 ®sI þpÞúkemeraKeGds_Gayu40qñaMmñak; manehImkUnkNþúrtUc²enAknigeRkamekøók
rbs;Kat;. Kat;mansuxPaBl¥nigenAeFIVskmHPaB)anFmHta
3 buRKúrnspÞry³eBl3ExmkehI
úkemeraKeGds_Gayu36qñaMmñak; manrUbragsÁmy:agxøaMg t¥ÚjEt¥rfaman
ynigminGaceRkakecjBIERK)aneT
®sIþpÞúkemeraKeGds_Gayu30qñaMmñak; manCMgWrebgsYtnigmanekIt Herpes
4 Zoster elIRTÚgrbs;nag
5 elI®sIþrksIupøÚvePTpÞúkemeraKeGds_Gayu28qñaMmñak; manekIt Herpes Zoster
enAelIépÞmuxrbs;nag nigrmas;BgEbkeBjxøÜnTaMgGs;
6 bumanrlakeRsamxY
rspÞúkemeraKeGds_Gayu34qñaMmñak; mandMe)Akñúgmat;nigCMuvijmat; nig
rk,aledayemeraK Cryptococcal Meningitis
skmHPaBTI6³ eFIVkargarCaRkúm³ karcmøgemeraKeGds__
» GñknwgRtÚv)anEckCa3Rkúm
» RkúmnImYy²nwgeFIVkarry³eBl5naTI edIm,IeqIøynwgsMNYrdUcteTA³
RkúmTI1³ etIsarFaturavénragkayNaxøHEdlGaccmøgemeraKeGds_?
RkúmTI2³ etIktþaGIVxøHEdlbegIáneRKaHRbQmnwgkarcmøgemeraKeGds_?
RkúmTI3³ erobrab;GMBIviFIEdlGaccmøgnigviFIEdlminGaccmøgemeraK
eGds_
» RkúmnImYy²nwgeLIgmkbgðajBIkargarrbs;RkúmxøÜn nigsresrcemøIy
enAelIkþarexon
17
 karcmøgemeraKeGds_
viFIcmøgemeraKeGds_EdlmaneRcInCageKbMputKWtamry³ karrYmePT
CaBiesskarrYmePTCamYyePTpÞúyKña.
etIsarFaturavénsrIragÁNaxøHEdlGaccmøgemeraKeGds_)an?
SsarFatuEdlcmøgxøaMg
- Qam/ sarFaturavénsrIragÁ CalikasrIragÁ
- Twkkam/ TwkrMGilTVarmas
- sarFaturavénsrIragÁdéTeTot ¬TwkePøaH Twkqw¥gxñg TwkeRsamsYt>>>¦

RsIþEdlsißtkñúgv½ybnþBUC gayRbQmnwgkarqøgemeraKeGds_Nas;. SsarFatuEdlcmøgmFüm

- TwkedaHmþay
vabNþalmkBIkarrYmePTCamYyédKUmanpÞúkemeraKeGds_edaymin)an
karBar. SsarFatuEdlminqøg
- Twkenam lamk TwksMe)ar TwkEPñk Twkmat; kMhak TwkRkBH ejIs.
33 34

emeraKeGds_ emeraKeGds_
ktþaEdlbegIánnUveRKaHRbQmnwgkarcmøgemeraKeGds_ Gaccmøg)antamry³ minGaccmøg)antamry³
karrYmePT
b burédKUs³ EmidlKH
c StamTVarmas/ tammat;/ tamrn§KUf karb:HBal;ral;éf¶
édKUEdlmanpÞúkemeraKeGds_³ anpÞúkemeraKeGds_³ Sb:HBal;pÞal;CamYysarFaturavénsrIragÁ S TTYlTan)ayb¤mðÚbCamYyKña
manbnÞúkvIrusx<s; EdlmanpÞúkemeraKeGds_ ¬Twkkam
n)ankat;Es,kRKbcuglwgÁ S
b
c
manekasika CD4 Tab b¤
RsIþ³ RBhHcarIy_ TwkrMGilTVarmas¦ eRbIR)as;bnÞb;TwkrYmKña
BIImþayeTAkUn S elg b¤ eFIVkarCamYyKña
SenAeBlmanépÞeBaH S eRbIsMelokbMBak;cUlKña
SenAeBlQWeBaHsMral b¤sMral b¤ S
édKUmñak;manpÞúkemeraKeGds__ nigmñak;eTotKHanpÞúkemeraKeGds_ SenAeBlbMe)AedaHkUn eTAelgpÞHGñkpÞúkemeraKeGds_
•RsTab;Pñasrlat; karb:HBal;Qam S niyayCamYyGñkpÞúkemeraKeGds_
•manQamenAeBlrYmePT Scak;bBa¢ÚlQam S b:HBal;GñkpÞúkemeraKeGds_
Smutm¢úl b¤ karmutrbYsepSg²
•manCm¶WkameraK 35 SeRbIm¢úlsWraMugrYmKña enAeBlcak;eRKOgejón mUsxaM 36

18
skmHPaBTI7³ sMNYrnigcemøIy³ sMNYrEdlEtgEtsYrjwkjab;;
» RKÚnwgbgðajsMNYrelIsøayTI38
» latkEnøgkñúgbnÞb;[)anTUlay nigGñkRtÚvQrenAxagNamYyénbnÞb;
» PaKImçagKWCaGñkeqIøyfa { ca+ b¤ )aT } nigPaKImçageTotKWCaGñkeqIøyfa
{ eT }
» eqIøysMNYrmþgmñak;²
» eqIøycemIøyénsMNYrnImYy²edayQrenAmçagExS EdlCaEpñktMNag
[cemIøybs;Kat;.
]³ RbsinCaGñkKitfacemøIy { ca+ b¤ )aT } 100PaKry ehIy
GñkRtÚveTAQrenAxagcemIøy{ ca+ b¤ )aT } . pÞúyeTAvij RbsinCaGñk
KitfacemøIy{eT} 100PaKry ehIy GñkRtÚveTAQrenAxagcemIøy
{eT }.
RbsinCaGñkminc,as;kñúgcitþ KitfacemøIyenaHGaRs½yeTAnwgsßanPaB
Cak;Esþg GñkRtÚvQrenARtg;cMNuckNþal b¤enAEk,rxagcugExSEdl
tMNag[cemøIyrbs;Gñk
» RKÚsRmbsRmÜlnwgeFIVkarbgðaj[GñkeXIjCamun edIm,I[GñkGacyl;)an
19
s søayTI38 c
1 etImnusSmñak;GacqøgemeraKeGds_)anEdrb¤eT RbsinCaKat;
hUb)ayrYmtuCamYynwgGñkpÞúkemeraKeGds_?
2 etIqHbmñak;RbQmnwgkarqøgemeraKeGds_Edrb¤eT RbsinCaKat;
begIátkUn[®sIþpÞúkemeraKeGds_mñak;edaymineRbIeRsaméd?
3 enAkñúgfñak;eronmYy RbsinebImankumarpÞúkemeraKeGds_mñak;
eronenAkñúgfñak; etIkumardéTeTotRbQmnwgkarqøgemeraKeGds_
Edrb¤eT?
4 etIbursmñak;GacqøgemeraKeGds_)anEdrb¤eT RbsinCaKat;rYm
ePTCamYyGñkpÞúkemeraKeGds_tamrn§lamk?
5 etI ®sIþGacqøgemeraKeGds_Edrb¤eT RbsinCabursmñak;rYmePTCa
mYy®sIþBIrnak;kñúglkçN³CaRkúmEtmanBak;eRsamGnam½y?
cMNucKnwøH

m:UDulTI1³ cMNucKnwøH
ƒ emeraKeGds_KWCavIrusmYyRbePTEdlbMpøajRbB½n§PaBsuMakarBarragkayrbs;mnusS
EdlnaM[gayqøgnUvCMgW»kasniymepSg²
ƒ ry³eBlcab;BIkarqøgemeraKeGds_rhUtdl;dMNak;kalcugeRkayénCMgWeGds_
mankarERbRbÜlBImnusSmñak;eTAmnusSmñak;. k¾b:uEnþGñkxøHGacrs;enArhUtelIs
BI15qñaM
ƒ viFIcmøgemeraKeGds_EdlmaneRcInCageKenATUTaMgBiPBelak KWtamry³karrYmePT
pÞúyKña
ƒ ®sIþmanépÞeBaHEdlpÞúkemeraKeGds_GaccmøgemeraKeGds_eTAkUnrbs;Kat;
ƒ kumarkm<úCaRbmaN7>000eTA10>000nak; RtÚv)an)a:n;RbmaNfa
RbQmnwgkarqøgemeraKeGds_BImþayCaerogral;qñaM.

20
]bsm½<n§TI1
dMNak;kalKIønikénCMgWeGds_rbs;GgÁkarsuxPaBBiPBelakenAelImnusSeBjv½y
dMNak;kalTI1
ƒ KHaneraKsBaØa
ƒ mankUnkNúþúrCab;Canic©nigsayPayRKb;TIkEnøg
lT§PaBGnuvtþkRmit1 (Performant scale ): KHaneraKsBaØa manskmHPaBFmHta
dMNak;kalTI2
ƒ cuHTm¶n;ticCag10PaKryénTm¶n;xøÜn
ƒ manecjsBaØaelIEs,ktictYc [Seborrheic dermatitis/ rmas; /CMgWpSitenARkck (Fungal nail infections) dMe)Akñúgmat;sarcuHsareLIg (Recurrent oral
ulcers), angular cheilitis]
ƒ Herpes Zoster kñúgGMLúg5qñaMcugeRkay
ƒ rlakpøÚvdegðImEpñkxagelIsarcuHsareLIg ¬]³rlak Sinus eday)ak;etrI ¦(Bacterial sinusitis)
lT§PaBGnuvtþkRmit2 ¬Performant scale 2¦³³ maneraKsBaØa (Symptomatic)/manskmHPaBFmHta (Normal activity)
dMNak;kalTI3
ƒ cuHTm¶n;elIsBI10PaKryénTm¶n;xøÜn
ƒ rakruaMér:edayminGacBnül;)anmanry³eBlelIsBI1Ex (Unexplained chronic diarrhea)
ƒ RKúnekþAGUsbnøayminGacBnül;)an ]³RKúnelaHb¤Cab;Canic© (Intermittent or constant) elIsBI1Ex
ƒ CMgWpSitkñúgmat; [Oral candidiasis (thrush)]
ƒ CMgW Oral hairy leucoplakia
ƒ CMgWrebgsYt
ƒ CMgWbgáeday)ak;etrIF¶n;F¶rdUcCa CMgWehImsYt CMgWrlaksac;dMumanxÞúH (Pneumonia, Pyomyositis)
lT§PaBGnuvtþkRmit3 ¬Performant scale 3¦ ³ kñúg1éf¶sRmakCab;nwgERKticCag50PaKry ry³eBl1ExknøgeTA

21
 dMNak;kalTI4
ƒ sÁmkMRBwgedaysarCm¶WeGds_ (HIV Wasting Symdrome) k¦
ƒ Cm¶WehImsYteday PCP ƒ Cm¶WpSitenAkñúgbMBg;Gahar kñúgbMBg;degðIm TgsYt b¤sYt
ƒ Cm¶WToxoplasmosisenAxYrk,al (Cerebral toxoplasmosis) ƒ Atypical mycobacteriosis disseminated or pulmonary
ƒ Cryptosporidiosisnigmanrakry³eBl 1Ex ƒ Non-typhoid Salmonella septicaemia
ƒ Cm¶WrebgeRkAsYt
ƒ Cryptococcosis extrapulmonary ƒ Cm¶W Lymphoma
ƒ Cm¶WbgáeLIgeday Cytomegalovirus (CMV,Cm¶sW rIragÁdéTeToteRkABIefIøm Rkelonb¤ ƒ Cm¶WmharIk (Kaposi’s Sarcoma)
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ƒ Herpes Simplex Virus ekItmanenAelIEs,knigPñas ry³eBlelIsBI1Ex b¤ekIt
enAelIsrIragÁkñúgeBaH
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Éksareyag³ World Health Organization (WHO). 2004. Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public
health approach, 2003 Revision, Appendix D: WHO staging system for HIV infection and disease in adults and adolescents, p. 42.

22
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Éksareyag³ World Health Organization (WHO). 2004. Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a
public health approach, 2003 Revision, Appendix E: WHO staging system for HIV infection and disease in children, p. 44

1
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23
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26
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7 nig karrMelaPsiT§imnusS 8

27
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10

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11
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12

28
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15 etIBaküTaMgenaHCaBakümak;gayEdrb¤eT? 16

29
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18

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19 20

30
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31
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22
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25
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naTIGVI nigTTYlxusRtÚvelIGIVxøH?
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bnßykarmak;gaynigerIseGIgenAkEnøgeFIVkar?
32
enAfñak;shKmn_
S pþl;karGb;rMnigbNþúHbNþalGMBIemeraKeGds_-Cm¶WeGds_ kñúgbMNgbegáIncMeNHdwg
nig karyl;dwgdl;³
- GñkEdleKeCOTukcitþ nigemdwknaMsasna
- qHbburaN RKUburaN
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- Gñklk;dUrenAtamshKmn_
S elIkkMBs;skmHPaBnigeFIVGnþraKmn_dl;karbgáarkarcmøgemeraKeGds_BImþayeTA
kUn eRBaHvaCasmasPaKmYyénesvaEfTaMsuxPaBEdr.
S PaBCaédKUenAkñúgshKmn_
S karcUlrYmrbs;GñkpÞúkemeraKeGds_-GñkCm¶WeGds_enARKb;TIkEnøg
S TMnak;TMngCacMhsIþBIemeraKeGds_-Cm¶WeGds_mansar³sMxan;Nas;
edIm,ICYyeFIV[bBaða emeraKeGds_-Cm¶WeGds_eTACaerOgFmHta
nigCYykat;bnßyPaBmak;gaypgEdr.
26
» RKÚTukeBl10naTI sRmab;[GñkBiPakSa
» sikçakammñak;²kñúgRkúmnImYy²nwgeLIgbgðajBIKMnitrbs;RkúmxøÜn
» sresrKMnitTaMgenaHenAelIkþarexonnigBiPakSava
» søayTI28-34 segçbtYnaTIrbs;esvabgáarkarcmøgemeraKeGds_BI
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eGds_BImþayeTAkUn kñúgkareqIøytbeTAnwgkarmak;gaynigerIseGIg
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GñkRKb;RKgnigbuKÁliksuxaPi)almantYnaTIeFIVkarRbqaMgnwgbriyakasmak;gaynwgerIseGIgEdlTak;TgeTA
nwgemeraKeGds_-Cm¶WeGds_ edIm,I³ GñkRKb;RKgkmHviFI edIrtYy:agsMxan;kñúgkarGnuvtþn_nigBRgwgeKalneya)ay nig nItiviFI
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S bNþúHbNþaldl;buKÁliksuxaPi)al rYmmankarBiPakSaBIkarmak;gayTak;TgnwgemeraKeGds_-Cm¶WeGds_ - PaBesIHKñakñúgkarTTYlesvaEfTaMnigBüa)al
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[bBaðaemeraKeGds_-Cm¶WeGds_køayeTACaerOgFmHta
S begáInkarcUlrYmrbs;édKUnigRKYsar
SkarrkSakarsm¶at;
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karciBa©wmkUn
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S [GñkpÞúkemeraKeGds_-GñkCm¶WeGds_ cUlrYmkmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUneRBaH³ SkarbgáareRkayRbQmnwgkarqøgemeraKeGds_kñúgkargar
- GñkpÞúkemeraKeGds_-Cm¶WeGds_ GacbNþúHbNþal[køayCaGñkpþl;RbwkSa)an
28
SraykarN_nigdak;Bin½ycMeBaHkarRbRBwRtþi b¤ \riyabfEdleFIVeLIgkñúgn½yRbmaf 29
- BYkeKGacCYyENnaMGñkCm¶WdéTeTot[eTArkesvaepSg²EdlmanenAkñúgmnÞIreBTü mak;gay.

kareFIV»üEbkkarsm¶at;
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karkMNt;dwgBIsßanPaBpÞúkemeraKeGds_rbs;RsIþ
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nig RtUvGnuvtþ
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eFIV[Ebkkarsm¶at;
30

33
 tYnaTInigkarTTYlxusRtUvénbuKÁliksuxaPi)al
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pÞúkemeraKeGds_kIþ minmanpÞúkemeraKeGds_kIþ
ƒ buKÁliksuxaPi)alRtUv³
- PJak;rlwkedayxøÜnÉg
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- cUlrYmya:gskmH
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emeraKeGds_kIþ minmanpÞúkemeraKeGds_kIþ
ƒ begIánkaryl;dwgrbs;buKÁlBI\riyabfnigPasamak;gayEdlGacman b¤
kareFIV[Ebkkarsm¶at;
ƒ sikSaBIGak,kiriya karsnñidæan b¤ PaBlMeGogrbs;buKÁlcMeBaHGñkpÞúkemeraK
eGds_-Cm¶WeGds_
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mnusSEdlminEmnCaRkumRbQmx<s;. karRsémKitdl;RbePTmnusSEdl
rgeRKaHedaysaremeraKeGds_-Cm¶WeGds_BImunmk GacminBitteTAeToteT.
31
32

2-karTTYl)annUvB½t’mannigmancMeNHdwgRKb;RKan; 3-karcUlrYmy:agskmG
ƒ kMNt;rkpñt;KMnit nigBaküccamGaramTak;TgnwgemeraKeGds_-Cm¶WeGds_Edl
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ƒ BiPakSaBITsSn³P½nþRcLMenAeBlNaEdlsmRsbenAeBlpþl;esvabgáarkarcmøg
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ƒ KaMRTsiTi§RsIþ edIm,I[Kat;dwgfa siTi§enaHKWCaGIV nig TTYlCMnYy)anya:gdUcemþc
- dwgfakarmankarKaMRTGIVxøH
- eFIVkarbBa¢Únnigtamdan
ƒ RtUvdwgBIGMeBIhwgSakñúgRKYsarEdlGacekItmaneLIg RtUvsYrBIbBaðaenH RtUvdwgBI - elIkTwkcitþ[mankarKaMRTmitþGb;rMmitþ KaMRTdl;GñkpÞúkemeraKeGds_[R)ab;BI
sßanPaBrbs;Kat;[eKdwg
TIkEnøgEdlRtUvbBa©ÚnGñkCm¶WeTATTYlesva - elIkkMBs;[kEnøgeFIVkarpþl;PaBkk;ekþAdl;GñkpÞúkemeraKeGds_
ƒ RtUvdwgBIesvaEfTaMsuxPaBnigKaMRTdéTeTot sMrab;GñkpÞúkemeraKeGds_ karekIneLIgnUvkarecjmuxénGñkpÞúkemeraKeGds_ bBa¢ak;nUvkarTTYlsÁal;BIshKmn_
kan;EtekIneLIg
33 34

34
cMNucKnwøH
m::UDulTI2³ cMNucKnwøH
ƒ karmak;gayqøúHbBa©aMgGMBIGakb,kiriya . karerIseGIgEsþgecjCaskmHPaB
ƒ karerIseGIgEtgEtRtÚv)ankMNt;kñúgnamsiTi§mnusSnigkarpþl;siT§idl;nrNamñak;
ƒ KMnitmak;gayGacnaMQaneTArkkarerIseGIgnigkarrMelaPsiT§imnusS
ƒ mnusSpÞúkemeraKeGds_RKb;rUbmansiT§iesrIPaBeCospuBIkarerIseGIg
ƒ karmak;gayEdlTak;TgnwgemeraKeGds_-CMgWeGds_ GaceFVI[GñkpÞúkemeraKeGds_ minh‘anmkTTYlesvaEfTaM nig³
ƒ minh‘anbgðajsßanPaBpÞúkemeraKeGds_rbs;xøÜn
ƒ bnßykarTTYlykviFIciBa©wmkUnedaysuvtßiPaB
ƒ min)anTTYlkarGb;rM karpþl;RbwkSanigkarBüa)al.
ƒ buKÁlikesvabgáarkarcmøgemeraKeGds_BImþayeTAkUn manParkic©eKarBnUvsiTi§®sIþnigburs eTaHbICaGñkenaH
manpÞúkemeraKeGds_kIþ b¤minmanpÞúkemeraKeGds_kIþ.
buKÁlikesvabgáarkarcmøgemeraKeGds_BImþayeTAkUn Gac³
- CYykat;bnßykarmak;gaynigkarerIseGIgEdlmanenAkñúgRKwHsßansuxaPi)al kñúgshKmn_nigenAfñak;Cati.
- edIrtYCaKMrUedayBüa)alGñkpÞúkemeraKeGds_-CMgWeGds_ [dUcKñanwgkarBüa)alCMgWdl;GñkCMgWdéTeTot
EdlKHanemeraKeGds_Edr.
- [GñkpÞúkemeraKeGds_-CMgWeGds_ )ancUlrYmkñúgRKb;skmHPaBénkmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn
- elIkTwkcitþ[mankarcUlrYmBIbursEdlCaédKUnigelIkkm<s;[mankarKaMRTBIshKmn_.

35
36
m:UDulTI3
karcmøgemeraKeGds_BImþayeTAkUn(MTCT)

vtßúbMNg

enAcugbBa©b;énm:UDulenH sikçakamTaMgGs;Gacnwg³
1> BiPakSaGMBIkarCab;Bak;B½n§rvagkarmanépÞeBaHnig®sIþmanpÞúkemeraKeGds_
2> Bnül;GMBIkarcmøgemeraKeGds_BImþayeTAkUn (MTCT): etIvaCaGIV? etIvaekIteLIgenA
eBlNa? nigetIkarRbQmnwgkarqøgemeraKeGds_manTMhMb:uNÑa?
3> kMNt;)anGMBIktþaRbQmnwgkarcmøgemeraKeGds_BImþayeTAkUn

  ry³eBlénkarsikSa³ 1ema:g40naTI

37
skmHPaBTI1³ sMNYrnigcemIøy³ karmanépÞeBaHnigkarqøgemeraKeGds__
» enAkñúgskmHPaBenH GñknwgBiPakSaelIsMNYrGMBIemeraKeGds_
elI®sIþmanépÞeBaHÃ
» RKÚnwgesIñ[GñkQrenAcMkNþalbnÞb;. mçagénbnÞb;RtÚv)ankMNt;
faCacemøIy ¬RRtwmRtÚv¦ nigmçageTotCacemøIy ¬xus¦
» GansMNYrTI1 rYcedIreTAQrenAmçagénbnÞb;EdlGñkKitfa
tMNag[cemøIyEdlRtwmRtÚv
» RKÚTuk»kasdl;GñkkñúgkarBiPakSacemøIyehIyGñkGacpøas;bþÚr
citþeTAQrenAxagmçageTot)an ebIsinCaGñkcg;dUr
søayTI5 t¼x
1 karmanépÞeBaHCamUlehtuEdleFIV[CMgeW Gds_mankarvivtþn_eTAmuxya:gelOn
2 emeraKeGds_minGacbNþaleGaykUnkñúgépÞmanrUbragminFmHtaeT
bBaðaemeraKeGds_-CMgWeGds_enAelI®sIþépÞeBaHmansPaBGaRkk;Cag®sIþEdl
3
KHanépÞeBaH
4 ®sþImanépÞeBaHpÞúkemeraKeGds_ TMngCamankarrlUtkUnb¤kUnsøab;kñúgeBaH
eRcInCagGñkCa
5 ®sIþpÞúkemeraKeGds_manlT§PaBbnþBUCdUc®sIþEdlKHanpÞúkemeraKeGds_Edr
6 CMgWeGds_minTak;TgeTAnwgkarsRmalminRKb;Exb¤kUnekItminRKb;KILÚeLIy
karsøab;CMuvijkMeNItb¤karsøab;énTarkeTIbekIt manlkçN³dUcKña
7 cMeBaHTarkEdlekItBImþaymanpÞúkb¤KHanpÞúkemeraKeGds_
8 ®sþImanépÞeBaHGaccmøgemeraKeGds_eTAkUnrbs;Kat;

skmHPaBTI2³ karBiPakSa³³ etIGñkFøab;manbTBiesaFn_GIVxøHTak;Tgnwg®sIþmanépÞeBaHpÞúkemeraKeGds_?

lMhat;enHpSarP¢ab;BIskmHPaBmun². RKÚsRmbsRmÜlnwg[GñkKitBIsMNYrxageRkamnigdwknaMRkúmeFIVkarBiPakSa
» etIIbTBiesaFn_GIVxøHEdlGñkFøab;CYbRbTHkúñúgkargarCamYy®sIþmanépÞeBaHpúÞúkemeraKeGds_
» etIGñkmanEdleFIVkartamdan®sIþmanépÞeBaHpÞúkemeraKeGds_Edrb¤eT? etIlT§plénépÞeBaHrbs;®sIþya:gNaEdr? cuHcMENkÉTarkvij?
» etIerOgEdlBYkGñkelIkeLIg manCab;Tak;TgeTAnwgcemøIyénsMNYrxagelIEdrb¤eT? b¤k¾manPaBxusKña?
» ebIsinCavaxusKña etIehtuGIV)anCavaxusKñaya:gdUecñH?
» søayTI7-8 segçbcMNucsIþGMBIkarqøgemeraKeGds_nigkarmanépÞeBaH.

38
 karmanépÞeBaHnigkarqøgemeraKeGds_¬1¦ karmanépÞeBaHnigkarqøgCm¶WeGds_ ¬2¦
S karmanépÞeBaH hak;dUcCamin)aneFIV[emeraKeGds_mankarvivtþn_eTAmux S RsIþpÞúkemeraKeGds_ ¬CaBiesskñúgdMNak;kalcugeRkayénCm¶WeGds_¦
elOnenaHeT RbQmnwgkarekIneLIgén³
S emeraKeGds_minEmnCamUlehtuénkMeNItminFmHtaeT - karrlUtkUn
- kUnsøab;kñúgeBaH
S bBaðaEdlTak;TgnwgemeraKeGds_mandUcKña TaMgRsIþmanépÞeBaH TaMgRsIþmin - karsøab;kUnCMuvijkMeNIt ¬søab;munkñúgeBlkMBugekItb¤eRkayeBlekIt¦
manépÞeBaH - kUnekItminRKb;TMgn;
S lT§PaBbnþBUCminmankarb:HBal;eT elIkElgEtkñúgdMNak;kaleGds_F¶n;
- sMralkUnminRKb;Ex
F¶renAeBlEdlcMNg;énkarrYmePTfycuH. S emeraKeGds_GaccmøgBImþayeTATark)an
7 8

skmHPaBTI3³ srIr³eraKsa®sþénkarcmøgemeraKeGds_BImþayeTAkUn karRbQmm nig ktþabgáeRKaHRbQmm

søayTI10-14 Bnül;fa karcmøgemeraKeGds_BImþayeTAkUn? eBlevlanigrebobénkarcmøg nig ktþaEdlnaM[mankarcmøgenH?
karcmøgemeraKeGds_BImþayeTAkUn etIemeraKeGds_cmøgBImþayeTAkUntamrebobNa?
SkarcmøgemeraKeGds_BImþayeTAkUn KWenAeBlEdlkUnqøgemeraKeGds_BImþay SeBlkMBugmanépÞeBaH ³CaFmHta sukmantYnaTICar)aMgkarBarmYyraraMgmin
rbs;va [emeraKeGds_qøgBImþayeTAkUn. k¾b:uEnþ enAeBlEdlsukmanbBaðaemeraK
SkarcmøgenHGacekIteLIg kúñúgkMLúg ³ eGds_GaccmøgeTAkUn)an
- eBlkMBugmanépÞeBaH SeBlQWeBaHsMralnigsMral ³karpøas;bþÚrQam b¤ sarFaturavrbs;srIr³
- eBlQWeBaHsMral nig sMral epSgeTotkñúgkMLúgeBlQWeBaHsMral
- eBlbMe)AedaHkUn SeBlbMe)AedaHkUn ³
SeKGacehAmüa:geTotfa karcmøgpÞal;b¤karcmøgCMuvijkMeNIténemeraKeGds_ enAkñúgTwkedaHmþaymanemeraKeGds_EdlGaccmøgeTATark)an.
cUrcgcaM ³
SmþayGacmindwgfaxøÜnKat;manpÞúkemeraKeGds_eT
SkarcmøgminGacdwgTukCamun)aneT Ref: Transplacental transmission of HIV: a potential role for HIV binding lectins

SRtUvRbugRby½tñkMueFIVkarsþIbenÞas b¤ erIseGIg nigmak;gaycMeBaHmþay

E.J. Soilleux, N. Coleman / The International Journal of Biochemistry & Cell Biology 35 (2003) 283–287
10 11

39
» Rsémfa mankumar100nak;ekItBImþaypÞúkemeraKeGds_ RtÚv)anciBaw©meday
edaHmþayry³eBl2qñaM ¬søayTI12¦
lT§plénkUnEdlekItBImþaymanpÞúkemeraKeGds_
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emeraKeGds_BmI aþ yeTAkUn eGds_eT
rhUtdl;Gayu2qñaM
» mankumarcMnYn5-10nak;nwgGacqøgemeraKeGds_enAeBlmanépÞeBaH RbEhl 5-15nak;
5-10nak; 15nak; qøgkñúg
» kumarcMnYnRbEhl15nak;nwgGacqøgemeraKeGds_enAeBlQWeBaHnigsRmal qøgenA qøgenAeBl kMLúgeBl
eBlman QWeBaH bMe)AedaH
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» mankumarcMnYnBI5-15nak;nwgGacqøgemeraKeGds_enAeBle)AedaHmþay nigsMral qñaM
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edaHmþay¦
» dUecñHcMnYnsrubénkumarEdlGacqøgemeraKeGds_manBI25-40nak;. Tark 25-40nak; ngw qøgemeraKeGds_BmI aþ y
12

etImanktþaRbQmGIVxøHEdlCMruj[mankar ktþaRbQmdéTeTotEdlCMruj[mankar
cmøgemeraKeGds_BImþayeTAkUn ? cmøgemeraKeGds_BImþayeTAkUn
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KWenARKb;eBlEdlmþaymanbnÞúkemeraKeGds_x<s;kñúgQam. SmþaymanCm¶WkameraK SEbkeRsamTwkePøaHyUr
SsukmankarkøayeraK SiviFIénkarsMraledaymanGnþraKmn_
dUcCaCm¶WRKuncaj;CaedIm SkarsMralkUnTImYyénkUnePøaH¬Gac
mþaymanbnÞúkemeraKeGds_x<s;GaRs½yeday SmþaymanCm¶WxVHGaharUbtßmÖ kUnePøaHBIrb¤ kUnbI¦
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14
13 RbqaMgemeraKeGds_

40
skmHPaBTI4³ BiPakSakrNII ³ etI®sIþpÞúkemeraKeGds_KYrmankUnEdrb¤eT?
» RKÚnwg[GñkBiPakSaelIsarxageRkamenH
BiPakSa³ TsSn³KaMRT nig TsSn³RbqaMg
{®sIþpÞúkemeraKeGds_minKYrmanépÞeBaHb¤mankUneT?}
» eFIVkarCECkEvkEjkKaMRT b¤ RbqaMgcMeBaH®sIþpÞúkemeraKeGds_ RsþImanpÞúkemeraKeGds_minKYrmanépÞeBaH b¤ mankUneT.
Edlcg;mankUn cUrBiPakSa
» ]TahrN_manenAxageRkam

16

TsSn³KaMRT[RsIþpÞúkemeraKeGds_mankUn
SRKb;RsþITaMgGs;mansiT§ieRCIserIskarmankUn
SenAeBlTTYl)annUvesvaBüa)al EfTaM nigKaMRTEdlmanKuNPaBx<s; RsþIpÞúk
emeraKeGds_Gacrs;enAedaysuxPaBl¥kñúgry³eBleRcInqñaM
SkarmankUneFVI[RsþImanGarmHN_rIkray ehIyGacBRgwgTMnak;TMngrvagbþI nig
RbBn§pgEdr.
SkarmankUnCaerOgFmHCati
SkarKHankUnGaceFIV[RKYsarTTYlrgnUvkarmak;gay.
17
TsSn³RbqaMgnwgkarmankUnrbs;RsIþpÞúkemeraKeGds_
SeGds_KWCaCm¶WF¶n;F¶r. mþaynwgFøak;xøÜnQW nig minGacEfrkSaRKYsarrbs;Kat;)an
SeGds_eFIV[bnÞúkfvikaRKYsarFøak;kñúgsPaBF¶n;F¶r. sßanPaBenHnwgkan;EtGaRkk;
eLIg RbsinebIKat;mankUn
SeGds_KWCaCm¶WmYyEdlKMramdl;CIvit. mþaynwgsøab;edaybnSl;TuknUvkumarkMRBa
SsgÁmGacminGnuBaØat[RsþIpÞúkemeraKeGds_mankUn)aneT. mþaynwgkøayCamux
sBaØaénkarmak;gay nigerIseGIg
karrMlUtkUnRsbc,ab; KWCaCMerIsd¾smRsbmYysMrab;;RsIþpÞúkemeraKeGds_. esva
BnüarkMeNItGacpþl;B½t’mandl;RsþI BImeFüa)ay nigTIkEnøgEdlRsIþGacTTYl
)annUvesvarMlUtkUnedayRsbc,ab;nigmansuvtißPaB. 34
18

41
cMNucKnwøH

m:UDulTI3³ cMNucKnwøH

ƒ karmanépÞeBaHminman\Ti§BlGIVeTAelICMgWeGds_eT
ƒ ®sIþmanépÞeBaHpÞúkemeraKeGds_ gayRbQmnwgplvi)akxøH²enAeBlmanépÞeBaH dUcCa
karrlUtkUn kUnekItminRKb;Ex
ƒ karqøgemeraKBImþayeTAkUn GacekIteLIgkñúgGMLúgeBlmanépÞeBaH eBlQWeBaHsRmal
nigsRmal b¤k¾enAeBlbMe)AkUnedayedaH
ƒ eRKaHénkarcmøgemeraKeGds_BImþayeTAkUnmanBI25°eTA40° RbsinCaKHan
GnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUneT
ƒ ktþasMxan;bMputEdlRbQmnwgkarcmøgRKb;eBlevla KWbnÞúkemeraKeGds_rbs;mþay.

42
m:,UDulTI4
karbgáarkarcmøgemeraKeGds_BImþayeTAkUn

esckIþepIþm yuT§viFIRKb;RCúgeRCay edIm,IbgáarkarqøgemeraKeGds_cMeBaHTarknigkumar

4>1 karbgáarbzménkarqøgemeraKeGds_
4>2 karbgáarkarmankUnmintambMNgcMeBaH®sIþpÞúkemeraKeGds_
4>3 bgáarkarcmøgemeraKeGds_BImþayeTAkUn
4>4 pþl;karBüa)alEfTaMngi KaMRTdl;®sIpþ úÞkemeraKeGds_ kUnrbs;Kat; nigRKÜsarrbs; Kat;

vtßúbMNg
enAcugbBa©b;énm:UDulenH sikçakamTaMgGs;nwgGac³ Bnül;GMBIyuT§sa®sþRKb;RCúgeRCaykñúgkarkat;
bnßykarqøgemeraKeGds_cMeBaHTarknigkumar
1> karbgáarbzménkarqøgemeraKeGds_
2> karbgáarkarmankUnmintambMNgcMeBaH®sIþpÞúkemeraKeGds_
3> bgáarkarcmøgemeraKeGds_BImþayeTAkUn
4> karpþl;karBüa)al EfTaMnigKaMRTdl;®sIþpÞúkemeraKeGds_ kUnrbs;Kat; nigRKÜsarrbs;Kat;

43
esckIþepIþm

yuT§sa®sþRKb;RCúgeRCaykñúgkarbgáarkarcmøgemeraKeGds_cMeBaH
Tarknigkumar
karkat;bnßykarqøgemeraKeGds_cMeBaHTarknigkumartRtÚv[manyuT§sa®sþmYy
EdlmanlkçN³RKb;RCúgeRCay rYmmanyuT§viFIsMxan;²4KW³
1> karbgáarbzménkarqøgemeraKeGds_
2> karbgáarkarmankUnmintambMNg cMeBaH®sIþpÞúkemeraKeGds_
3> bgáarkarcmøgemeraKeGds_BImþayeTAkUn
4> karpþl;karBüa)alEfTaMnigKaMRTdl;®sIþpÞúkemeraKeGds_ kUnrbs;Kat;
nigRKÜsarrbs;Kat;

44
 4>1
karbgáarbzménkarcmøgemeraKeGds_

vtßúbMNg
enAcugbBa©b;énvKÁenH sikçakamTaMgGs;Gacnwg³
1> GFib,ayGMBICeRmIssRmab;bgáarbzménkarqøgemraKeGds_
2> Bnül;GMBIsar³sMxan;énkarpþl;RbwkSanigeFIVetsþQamsRmab;bgáarkarcmøgemeraKeGds_BImþayeTAkUn
3> kMNt;)anBIKuNsm,tiþnigKuNvibtiþénkareFIVetsþQamcMeBaH®sIþmanépÞeBaH
4> GFib,ayGMBIkarpþl;RbwkSanigeFIVetsþQamnigrkSakarsm¶at;edaysH½RKcitþdl;®sIþmanépÞeBaH
5> erobrab;GMBIeKalkarN_ENnaM sIþGMBIkareFIVetsþQamrkemeraKeGds_edaysH½RKcitþnigrkSakarsm¶at;
6> kMNt;)annUvPaBxusKñarvagetsþrkemeraKeGds_ nigBnül;GMBInItiviFIénkareFIVetsþQam
7> Bnül;GMBIGtßn½yénlT§pletsþ nigry³eBlcMhénemeraKeGds_
8> GFib,ayGMBInItiviFIénkareFIVetsþQamrkemeraKeGds_enAelIkumarRbQm

  ry³eBlénkarsikSa³ 2ema:g30naTI

45
skmHPaBTI1³ bMpusKMnit³ karbgáarkarcmøgemeraKeGds__
» RKÚnwg[GñkbeBa©jKMnitrkviFankarN_bgáarkarqøgemeraKeGds_enAkñúg
EpñkTI1-3 EdlmanenAkúñgsøayTI8
» kMNt;cMNaM³ GnþraKmn_ VCCT nig PMTCT nwgbBa¢ak;enAkñúgm:UDulbnÞab;
karbgáarbzménkarqøgemeraKeGds_
KMnitpþÜcepIþmGMBIsuxPaBsaFarN³
emeraKeGds_minGaccmøgeTATark)aneT ebIsinCamþayminmanpÞúkemeraKeGds_.
cMnYnRsIþpÞúkemeraKeGds_Gackat;bnßy)aneday ³
SeyageTAelIktþaCaeRcIndUcCa PaBRkIRk PaBGviC¢a karbMBanpøÚvePT nig
tamry³KMnitpþÜcepIþmEpñksuxPaBsaFarN³rYmman ³
1> bgáarkarcmøgtamQam
2> pþÜcepIþm[mankarpøas;bþÚr\riyabf
3> RKb;RKgCm¶WkameraK
4> karpþl;RbwkSanigeFIVetsþQamedays½HRKcitþnigrkSakarsm¶at;
5> GnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUn ¬vKÁTI3¦
8

1-bgáarkarcmøgemeraKeGds_tamQam 2-pþÜcepIþm[mankarpøas;bþÚr\riyabf ¬1¦

yuT§viFI A B C
SRsavRCavrkemeraKeGds_enAelIRKab;Qam nigplitplEdlplitBIQam S (A)³ tmkarrYmePT
TaMgGs;
-minRtUvrYmePT b¤
SRtUvGnuvtþCanic©nUvkarbgáarCaskl
-minRtUvqab;RbLÚkkñúgkarrYmePT
S (B)³ esHaHs½HRKmYyTl;nwgmYy

9 10

46
 pþÜcepIþm[mankarpøas;bþÚr\riyabf ¬2¦ pþÜcepIþm[mankarpøas;bþÚr\riyabf ¬3¦
(c)³ eRbIeRsamGnam½y (D)³ kMu
SeRsamGnam½yKYrEt³ SminRtUveRbIR)as;rYmKñanUv³
- eRbIral;eBlrYmePT - m¢úl
- eRbICamYyRKb;édKUTaMgGs;
- eRtommanCaeRscRKb;eBlevla - Lam
- eRbI[)anCab;CaRbcaM eTaHbICaGifiCnkMBugEtBüa)aleday»sfRbqaMgemeraK - m¢úlsak;Es,k
eGds_k¾eday b¤ k¾édKUTaMgBIrmanpÞúkemeraKeGds_dUcKñak¾eday . Ã
SminRtUvb:HmuxrbYsedaypÞal;
Spþl;RbwkSaGMBI³ - pÞúyeTAvij³ RtUveRbIeRsaméd nig fñaMsMlab;emeraK
- kareRbIeRsamGnam½y[)anRtwmRtUv SminRtUve)aHecalvtßúmutRsYcepþspþas
- CMnajkñúgkarcrcaCamYyédKU[eRbIR)as;eRsamGnam½y - pÞúyeTAvij³ RtUve)aHecalenAkñúgRbGb;suvtißPaB
SminRtUveRbIeRKOgejón
ÃedIm,IbgáarkarcmøgemeraKEdlsuaMnwg»sfRbqaMgemeraKeGds_ b¤ bgáarkarqøgbEnßmeTotnUv - minRtUveRbImú¢lsWruagM rYmKñaeT
RbePTemeraKdéTeTot 11 12

pþÜcepIþm[mankarpøas;bþÚr\riyabf ¬4¦ 3-RKb;RKgBüa)alCm¶WkameraK

(E)³ eCosvag
SrYmePTedaymin)aneRbIeRsamGnam½ykarBar S ebIsinCaédKUrYmePTNamñak;manCm¶WkameraK »kasqøgemeraKeGds_x<s;
S\riyabfRbQm dUcCa³ enAeBlrYmePT
- eRbIeRKOgRsvwgeRcInhYs
- eRbIeRKOgejón S Büa)alCm¶WkameraKGackat;bnßykarRbQmnwgkarqøgemeraKeGds_
S Gb;rMBIkarbgáarCm¶WkameraK
- karbMBan b¤rMelaPpøÚvePT

(F)³ EpnkarRKYsar S CMruj[RsIþmkTTYlesvaEfTaMBüa)alCm¶WkameraK edIm,IeFIVeraKvinicä½ynig

SsMrYl[RsIþ)anTTYlesvaEpnkarRKYsar Büa)alCm¶WkameraK)anTan;eBl
13 14

47
 4>karpþl;RbwkSanigeFIVetsþQamedaysG½RKcitþnigrkSakarsm¶at;

S karyl;dwgBIsßanPaBpÞúkemeraKeGds_CaktþasMxan;Nas;kñúgkarbgáarkarrIk
raldalénemeraKeGds_
S GñkqøgemeraKeGds_PaKeRcInmin)andwgBIsßanPaBrbs;xøÜneT
S karGacTTYl)annUvkarBüa)aleday»sfRbqaMgemeraKeGds_ eFIV[buKÁl
nigshKmn_TTYl)annUvplRbeyaCn_BIkareFIVetsþQamrkemeraKeGds_

15

skmHPaBTI2³ karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds__ sRmab;bgáarkarcmøgemeraKeGds_BImþayeTAkUn

» karpþl;RbwkSanigeFIVetsþQam KWCaGnþraKmn_d¾sMxan;mYysRmab;eCaKC½y
kñúgkarbgáarkarcmøgemeraKeGds_BImþayeTAkUn
» ®sIþmanépÞeBaHnigédKU RtÚvEtdwgGMBIsßanPaBpÞúkemeraKeGds_rbs;xøÜnCa
munsin munnwgTTYl)annUvesvaEfTaMbnþdéTeTot
karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_sMrab;
bgáarkarcmøgemeraKeGds_BImþayeTAkUn
karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_ KWCaGnþraKmn_bgáarkarcmøgemeraK
eGds_BImþayeTAkUnmYyEdlpþl;»kasdl;RsþImanépÞeBaH nigédKU)andwgBIsßanPaB
pÞúkemeraKeGds_ nigTTYl)annUvesvabgáarkarcmøgemeraKeGds_BImþayeTAkUn PMTCT
karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_ sMrab;bgáarkarcmøgemeraKeGds_BImþay
eTAkUn
S GackMNt;)annUvRsIþmanépÞeBaHnigédKUEdlmanpÞúkemeraKeGds__
S pþl;nUvkarcab;epþIm karEfTaM Büa)alnigKaMRTEdlmanlkçN³RKb;RCugeRCayénGñk
pÞúkemeraKeGds_
S CYyRsþInigédKUrbs;Kat;[)andwg nigpøas;bþÚr\riyabfEdlRbQmeTAnwgkarqøg
emeraKeGds_.
18

48
 karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_sMrab;
RsIþmanépÞeBaH
RsIþmanépÞeBaHEdlmin)andwgBIsßanPaBpÞúkemeraKeGds_rbs;xøÜn ³
S RtUv)ancat;TukfaRbQmnwgkarcmøgemeraKeGds_BImþayeTAkUn nig KYrEt
TTYl)annUvkarpþl;RbwkSa
S KYrEtdwgfa kareFIVetsþQamGaceFIV)anenAeBlEdlKat;mkBinitüépÞeBaH
S KYrEtRtUv)anrMlwkBIplRbeyaCn_énkardwgBIsßanPaBpÞúkemeraKeGds_rbs;
xøÜn
S RtUvdwgfa karEfTaMnigBüa)aldl;GñkpÞúkemeraKeGds_-Cm¶WeGds_ GaceFIV[
RsIþmanépÞeBaHpÞúkemeraKeGds_manCIvitkan;EtRbesIreLIg 19
skmHPaBTI3³ lMhat;³ KaMRTnigRbqaMg³ karpþl;RbwkSanigeFIVetsþQamedaysHR½KcitþnigrkSakarsm¶at;; sRmab;bgáarkarcmøgemeraKeGds_BImþayeTAkUn
» RKÚnwg[GñkBicarNaBIkarpþl;RbwkSanigeFIVetsþrkemeraKeGds_. etI
GñkKitfa karpþl;RbwkSanigeFIVetsþQamdl;buKÁl CaKMnitmYyl¥Edrb¤eT?
b¤mYyk¾vaCabBaða?
» RKÚnwgEcksikçakamCa2RkúmesIHKña. mYyRkúmnwgedIrtYCaGñkKaMRT
nigmYyRkúmeTot edIrtYCaGñkRbqaMgcMeBaHkarpþl;RbwkSanigeFIVetsþQam
» beBa©jmtiKaMRTKMnitrbs;RkúmGñk eTaHCaGñkKaMRTkIþb¤ GñkRbqaMgkIþ
cMeBaHkarpþl;RbwkSanigeFIVetsþQam
» RKÚsRmbsRmÜlnwgeFIVkarBiPakSacMeBaHmtirbs;RkúmTaMgBIr
» sUmBinitüemIl etIvamanPaBxusKñarvagKuNsm,tiþnigKuNvibtiþya:gdUc
emþcEdr ebIeyageTAelIlT§pletsþviC¢manb¤GviC¢man
49
karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_
edaysG½RKcitþnigrkSakarsm¶at; nigkarcUlrYmrbs;édKU
edIm,I[esvapþl;RbwkSanigeFIVetsþQammanRbsiT§PaBl¥tamEdlGaceFIV)an édKUTaMg
BIrRtUvEtcUlrYmTaMgGs;Kñanig³
S KYrEtTTYlkarpþl;RbwkSanigeFIVetsþQam nigdwgBIsßanPaBpÞúkemeraKeGds_rbs;
xøÜn
S KYrEtdwgfa manGnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUn nigGacTTYl
)annUvesvaTaMgenaH
S RtUvEtyl;BIsar³sMxan;énkarrYmePTEdlmansuvtißPaB TaMgenAeBlmanépÞeBaH
nigeBlbMe)AedayTwkedaHmþay
emeraKeGds_-Cm¶WeGds_b:HBal;dl;RKYsarTaMgRsug édKUTaMgBIrKYrEtRtUv)an
elIkTwkcitþRKb;»kasTaMgGs; kñúgkarmkTTYlesvapþl;RbwkSa
nigeFIVetsþQam edaysHRK½ citþ nigrkSakarsm¶at; 20
KuNsm,tþiénkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_eday
sG½RKcitþnigrkSakarsm¶at;sMrab;bgáarkarcmøgemeraKeGds_BImþayeTAkUn
karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds__ pþl;[RsþIEdlKHanpÞúk
emeraKeGds_)anTTYlnUv³
S B½t’mannigkarGb;rMGMBIemeraKeGds_-Cm¶WeGds_
S cMeNHdwgsIþBIsßanPaBpÞúkemeraKeGds_rbs;Kat;
S »kasEkERb\riyabfRbRBiwtþEdlRbkbedayeRKaHfñak;
S yuT§saRsþsMrab;EfrkSaxøÜn[enAEtKHanpÞúkemeraKeGds_Canic©.
22
 KuNsm,tþiénkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_eday
sG½RKcitþnigrkSakarsm¶at;sMrab;bgáarkarcmøgemeraKeGds_BImþayeTAkUn
karpþl;RbwkSanigeFIVetsþQamrkemeraKeGds__ GnuBaØat[RsþIEdlman
pÞúkemeraKeGds_)anTTYlnUv³
SB½t’mannigkarGb;rMGMBIemeraKeGds_-Cm¶WeGds_
ScMeNHdwgsIþBIsßanPaBpÞúkemeraKeGds_rbs;Kat;
STTYlB½t’mansIþBIkarbgáar eFIVy:agNakMu[cmøgemeraKeGds_eTAGñkdéT
SGnþraKmn_kat;bnßykarcmøgemeraKeGds_BImþayeTAkUn
23
KuNvibtiþénkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_edaysG½RK
citþnigrkSakarsm¶at;srM ab;bgáarkarcmøgemeraKeGds_BImþayeTAkUn
RsIþnigédKUGacCYbRbTHnUv³
S GarmHN¾minl¥enAeBlEdlRtUv)anykQameTABinitü
S manRbtikmHpøÚvcitþ dUcCa³ esakesA mankMhwg P½yxøac Gs;sgÇwm.l.
enAeBlEdlKat;dwgBIsßanPaBpÞúkemeraKeGds_rbs;xøÜn
S karRbQmnwgkarmak;gay nigerIseGIgBIsMNak;bþI smaCikRKYsar shKmn_
nieyaCik buKÁliksuxaPi)al.l.
24

skmHPaBTI4³ etIkarpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_enAesvaEfTaMépÞeBaHRbRBwtþeTAya:gdUcemþcxøH?
etIkarpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_enAesva
EfTaMépÞeBaHRbRBwtþeTAya:gdUcemþcxøH?
etIRtUvpþl;RbwkSadl;GñkNa SRKb;RsIþmanépÞeBaH nigédKUrbs;Kat;
xøH?
etIGñkNaCaGñkpþl;RbwkSa? SGñkpþl;RbwkSaEdl)anTTYlkarbNþúHbNþalrYc
enAeBlNa? SenAeBlmkBinitüépÞeBaHelIkdMbUg ebIsinCaGac
SenAeBleRkay²eTot
pþl;[ya:gdUcemþc? Spþl;RbwkSaCaRkumenAkñúgbnÞb;Gb;rMmþay
¬muneFIVetsþQam¦
Spþl;RbwkSadl;bIþRbBn§ ¬mun b¤eRkayeFIVetsþQam¦
Spþl;RbwkSaCalkçN³buKÁl ¬mun b¤eRkayeFVIetsþQam¦
enATIkEnøgNa? SenAkñúgbnÞb;Gb;rMmþay b¤
SenAkñúgbnÞb;pþl;RbwkSaCalkçN³ÉkCnénesvaEfTaMépÞeBaH
26

50
skmHPaBTI5³ BaküKnwøH³ eKalkarN_ENnaMsIþGMBIkareFIVetsþQamrkemeraKeGds_edaysH½RKcitþnigrkSakarsm¶at;;
» RKÚnwgR)ab;;Gñk[KitGMBIeKalkarN_sMxan;bMputsRmab; VCCT eKalkarN_ENnaMsMrab;karpþl;RbwkSanigeFVIetsþQam
rkemeraKeGds_edays½GRKcitþnigrkSakarsm¶at;
karpþl;RbwkSanigeFIVetsþQamRtUv³
S eFIVeLIgedaymankarsH½RKcitþ
S karrkSakarsm¶at;
GtifiCnRtUv³
S mankarRBmeRBog
S TTYl)annUvkarKaMRTeRkayeBleFIVetsþQam 28

skmHPaBTI6³ eFIVkarCaRkúm³ eKalkarN_ENnaMsIþGMBIkareFIVetsþQamrkemeraKeGds_edaysH½RKcitþnigrkSakarsm¶at;;

» eKalbMNgénlMhat;enH KWedIm,IsikSasIuCeRmABIeKalkarN_ENnaMsRmab;
VCCT 1>karsG½RKcitþ
» RKÚEcksikçakamCa4Rkúm³ RkúmTI1³ karsH½RKcitþ
S KHannrNamñak;RtUv)anbgMç[TTYlkarpþl;RbwkSanigeFIVetsþQamrkemeraK
RkúmTI2³ karrkSakarsm¶at;
RkúmTI2³ kic©RBmeRBogrbs;GtifiCn eGds_eT
RkúmTI3³ karKaMRTeRkayeFIVetsþQam S karpþl;RbwkSanigeFIVetsþQamRtUv)anpþl;CUndl;RKb;RsIþmanépÞeBaHTaMgGs;
» eFIVkarenAkñúgRkúmrbs;Gñk Kitdl;cMNucsMxan;²EdlTak;TgnwgRbFanbT eRBaHvaCaEpñkmYyénkarEfTaMépÞeBaH
rYcehIysresrkt;Rta S RsIþGaceRCIserIsmineFIVetsþQam)an
» sikçakammñak;kñúgcMeNamRkúmnImYy²nwgeLIgmkbgðajBIlT§plrbs;RkúmxøÜn
» BiPakSaelIRbFanbTbnÞab;BIeFIVkarbgðaj 30

51
 2> karrkSakarsm¶at; ¬1¦
S karrkSakarsm¶at;mansar³sMxan;Nas; sMrab;eFIV[GtifiCnman
TMnukcitþ
S kalNaebIKHanTMnukcitþeT RsþIGacnwgbdiesFkareFVIetsþQam
S karFana)annUvkarsm¶at; KWCaKnwøHsMxan;kñúgkarTTYleCaKC½y
sMrab;esvabgáarkarcmøgemeraKeGds_BImþayeTAkUn.
31
3> kic©RBmeRBog
buKÁlmñak;²mansiT§i³
S TTYlB½t’manc,as;las;nigRtwmRtUvGMBIkareFVIetsþQamrkemeraKeGds_muneBl
yl;RBmeFIVetsþQam dUecñHBYkeKniwgyl;c,as;BI³
- eKalbMNg nig KuNRbeyaCn_énkarpþl;RbwkSanigeFVIetsþQam
- eKalbMNg nig KuNRbeyaCn_énesvaepSg²eTotEdlKat;GacTTYl)an
kñúgkrNIEdllT§pletsþbBa¢ak; faviC¢man
- dMeNIrkarénkarpþl;RbwkSa nigeFVIetsþQam
S bdiesFkareFVIetsþQam
S TTYl)annUvkareKarBcMeBaHkarsMerccitþkñúgkareFVIetsþQamrbs;BYkKat;33
52
2> karrkSakarsm¶at; ¬2¦
S bnÞb;pþl;RbwkSaeRbIsMrab;pþl;RbwkSadl;bIþRbBn§ b¤CabuKlÁ RtUvEtmanlkçN³
ÉkCn
S B½t’manEdlGtifiCnpþl;[ Gñkpþl;RbwkSaRtUvrkSaTukCaerOgsm¶at;
S ral;kMNt;RtaevC¢saRsþnigbBa¢IeQHaH RtUvrkSaTukCasm¶at; nigRtUvrkSaTukenA
kEnøgEdlmansuvtßiPaB.
B½t’manrbs;GtifiCn ¬rab;bBa©ÚlTaMglT§pletsþQam¦Gac[buKÁlikEfTaM
déTeTotdwg)an edIm,IFanafa RsþI)anTTYlkarEfTaMtamEbbevC¢saRsþd¾Rtwm
RtUv. k¾b:uEnþkrNITaMgenHGaceFIV)an luHNaEtmankarGnuBaØatBIsamIxøÜnpg
32
Edr.
4> karpþl;karKaMRTeRkayeBleFVIetsþQam
lT§pletsþQamRtUvEtpþl;[GtifiCnenAkñúgbnÞb;mYydac;edayELk. ebIsinCaGac
karpþl;lT§plKYrEtpþl;[edayGñkpþl;RbwkSaEdl)anpþl;RbwkSamuneBleFVIetsþQam.
Gñkpþl;RbwkSaRtUvEt³
SFanaGHGagcMeBaHGñkCm¶Wfa ral;karpþl;RbwkSaniglT§pletsþQamnwgRtUv)anrkSaCa
karsm¶at;
Spþl;B½t’maneTAGñkCm¶WGMBIesvaBüa)al EfTaM nig KaMMRTEdlman nigeFIVkarbBa¢ÚnKat;eTA
rkesvaTaMgenaHkñúgkrNIcaM)ac;
Spþl;karKaMRTdl;GtifiCnedIm,I[Kat;h‘anR)ab;bIþ nigRKYsarKat;[dwgBIlT§pletsþrbs;
Kat;enAeBlEdlcaM)ac;. 34
skmHPaBTI8³ bMpusKMnitb¤El,gedIrtYY Ã ³eKalkarN_énkareFIVetsþQamrkemeraKeGds__
bMpusKMnit El,gedIrtYY
N RKÚ[sikçakamerobrab;[RtÚvtamlMdab; GMBIkareFIVetsþQameRkayBIkar N RKÚnwgsMu[sikçakamBIrnak;sH½RKcitþedIrtYCaGñkpþl;RbwkSa nigCaGtifiCn
pþl;RbwkSamunetsþ EdleTIbnwgTTYlkarRbwkSamuneBleFIVetsþQam
N Gñkpþl;RbwkSaRtÚveFIVetsþQameTAtamdMNak;kalnImYy²
Ã
eRCIserIsTRmg;skmHPaBNamYyEdlGñkcUlcitþb¤Kitfal¥bMput

nItiviFIénkareFIVetsþQamrkemeraKeGds_ elxkUdsMrab;esvabgáarkarcmøgemeraKeGds_BImþayeTAkUn
eRkayBIpþl;karRbwkSamuneFIVetsþQam Gñkpþl;RbwkSaénesvabgáarkarcmøg
emeraKeGds_BImþayeTAkUnKYrEt³³ S RsþIEdl)anTTYlkarpþl;RbwkSamuneBleFIVetsþQamnwgRtUvcuHelxkUd nigRtUv
1- TTYl)annUvkarRBmeRBogBIRsþImanépÞeBaHnigbþIrbs;Kat; ¬RbsinCabIþRtUv
eFIVetsþQampgEdr¦ )ancuHeQHaHkñúgbBa¢IénkmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn
2- Bak;eRsaméd ehIybUmQamdak;eTAkñúgTIbQam. S elxkUdénkmHviFbI gáarkarcmøgemeraKeGds_BImþayeTAkUnenHnwgRtUvbiTenAelI
3- edaHeRsamédecal
4- biTelxkUdrbs;GtifiCnenAelITIbQam nigkt;RtacUlkñúgesovePA b½NÑviPaKsMrab;P¢ab;CamYyTIbQamykeTAkan;mnÞIrBiesaFn_.
r)aykarN_ nUvelxkUd éf¶ Ex qñaM EdlGtifiCncUlrYm
5- bBa¢ÚnTIbQameTAkan;mnÞIrBiesaFn_edIm,IeFIVetsþQam
42 43
6- bBa¢ak;R)ab;GtifiCnGMBIeBlevlaEdlRtUvmkTTYllT§pl

54
 skmHPaBTI9³ etIlT§pletsþQamm mann½yya:gdUcemþc? etInwgmanGIVekIteT,IgxøHenAkñúgmnÞIrBiesaFn_?
kareFIVetsþQamenAmnIÞrBiesaFn__ kareFIeV tsþEbbFmHta¼qab;rh½s
elIIkTI1
» søayTI45 nwgBnül;GMBIdMNak;kaleFIVetsþQamEdlRtÚveFIVenAmnIÞr (+) (-)
BiesaFn_. kareFIVetsþEbbFmH
kareFVIettsþ
a¼qab; rh½s elIkTI2 b¤
ELISA lT§plGviC¢man
» RtÚvcMNaMfa lT§pletsþEdlviC¢man RtÚvRtÜtBinitümþgeTotCaelIkTIBIr (+) (-)

» RbsinCalT§plelIkTIBIrmindUcKñanwglT§plelIkTImYyeT lT§plviC¢man eFIVeT,IgvijeTAelI

nUvkareFI VetsþamedI
elImkTI1nigTI2
sMNakQamRtÚvykmkBinitüCafIHmþgeTotCamYynwgetsþrh½sBIrmux KMrUQ

» RbsinCalT§pletsþenAEtminRtÚvKñaeTot RtÚvNat;[mkmþgeTot lT§plénkareFVIetsþTaMgBIrelIkRtUv

KñaKW (+) b¤ (-)
lT§plEdlminRsbKña
lT§plmYy (+) lT§plmYy (-)
enAry³eBl15éf¶eRkayBIkareFIVetsþelIkTI1 edIm,IyksMNakQam
GtifiCneTABinitümþgeTot lT§plviCm¢ an b¤GviC¢man cat;TukfaCalT§plEdlminc,as;las;
eKalneya)ayCati VCCT (2002) eFIVetsþmþgeToteTAelIKMrUQamelIkTI2 45
HIV testing algorithm

etIlT§pletsþQamrkemeraKeGds_TaMgenHmanGtßn½yya:gdUcemþc? lT§pletsþEdlminc,as;lal;
RbsinebIlT§pletsþdMbUg viC¢man nig lT§plTI2 GviC¢man mnÞIrBiesaFn_nwgeFVI
lT§pletsþQamviC¢man³ etsþTaMgBIrenHeT,IgvijmþgeTot enAelIsMNakQamedImdEdl.
Smann½yfabuKÁlrUbenH KW )anqøgemeraKeGds_ lT§plénkareFIVetsþeT,Igvij³
SsMNakQamRtUv)aneFIVetsþCaelIkTI2edayetsþqab;rh½s¬b¤etsþ etsþTaMgBIrKW viC¢man mann½yfabuKÁlrUbenH )an qøgemeraKeGds_
ELISA¦edIm,IFanafalT§plenH KWBitCaRtwmRtUv etsþTaMgBIrKW GviC¢man
lT§pletsþQamGviC¢man³ Smann½yfabuKÁlrUbenH min)an qøgemeraKeGds_eT
Smann½yfabuKÁlrUbenH KWmin)an qøgemeraKeGds_enaHeT b¤ etsþmYyviC¢man nigetsþmYyGviC¢man
S)anqøgemeraKeGds_rYcehIy k¾b:uEnþsißtenAkñúgry³eBlcMh. GtifiCn Scat;TukfaCalT§plEdlminc,as;las;
KYrmkeFIVetsþQammþgeTotkñúgGMT,úgeBl3ExeRkay. SeKRtUvbUmykQamGtifiCnCaelIkTI2 ¬ya:gehac15éf¶eRkay¦ehIy
dMeNIrkarénkareFIVetsþnwgeFIVdUcmunmþgeTot edaycab;epþImBIcMNucdMbUg
46
mk. 47

55
 » skmHPaBTI10³³ kareFIVetsþQamenAelIkumarr
Bnül;GMBIkareFIVetsþQamenAelIkumar
» cMNaM;fa karviPaKrkemeraKeGds_ GaceFIVeraKvinicä½yBIkarqøgemeraK
eGds_)anrh½s RbsinCaetsþenaHGacrk)an nigkumarGacTTYlkareFIV
etsþ)an
søayTI49-51 etsþrkGgÁbdibkçR)aNemeraKeGds_
dl;TarknigkumarEdlRbQmnwgkarqøgemeraKeGds_
RKb;TarkEdlekItBImþayEdlmanpÞúkemeraKeGds_minEmnsuT§Et)anqøgemeraK
eGds_enaHeT b:uEnþ³
RbsinebI eFIVetsþrkemeraKeGds_rkGgÁbdibkçR)aNelITarkTaMgT,ayNaEdlekIt
BImþayEdlmanpÞúk emeraKeGds_lT§pl etsþnwgbgðajsBaØaviC¢man³
SsUm,IEtTarkrUbenHmin)anqøgemeraKeGds_BImþayk¾eday
SeRBaHGgÁbdibkçR)aNénemeraKeGds_rbs;;mþay)anqøgcUleTAkñúgxøÜnTark
tamry³suk
GgÁbdibkçR)aNemeraKeGds_rbs;mþayGacsßitenAkñúgxøÜnTarkrhUUtdl;18Ex
49

eKalneya)aysMrab;eFIVetsþQamelITarkEdlRbQmnwgkar
karviPaKrkvIruseGds_ (PCR) qøgemeraKeGds_
SBinitürkemeraKeGds_Bit TarkEdlRbQmnwgkarqøgemeraKeGds_ KYrEtBinitütamdanenAesvasuxPaB
SGacGnuvtþcMeBaHTarkEdlRbQmnwgkarqøgemeraKeGds_ cab;BITark sMrab;kumar OI/ART * EdlenACitbMputehIy³
manGayu6s)þah_ S kUnRtUveFIVetsþrkGgÁbdibkçR)aNénemeraKeGds_enAeBlEdlmanGayu
18Ex edaymankaryl;RBmBImþay
RbsinebI PCR GaceFIVeTA)an RtUveFIVetsþrk PCR enHenAs)þah_TI6
SRbsinebIetsþ PCRmanlT§pl viC¢man S TTYlkareFIVetsþedaykarviPaKrkvIruseGds_ PCR emeraKenAeBl
mann½yfaTark)anqøgemeraKeGds_ehIy EdlkumarenAmanGayutic kñúgkrNIEdlmanlT§PaBGaceFIVeTA)an
- eFVIeraKvinicäy
½ GMBIkarqøgemeraKeGds_[)anc,as;las;
SRbsinebIetsþ PCRmanlT§pl GviC¢man - kñúgkrNIlT§plviC¢man TarkmansiT§iTTYl)anesva ART
mann½yfaTarkmin)anqøgemeraKeGds_enaHeT - kñúgkrNIlT§plGviC¢man karbgáareraK Cotrimoxazole OI
ebIsinCaTarkEdlciBa©wmedayTwkedaHmþaymanlT§pletsþQamGviC¢man kareFIVetsþ PCR
RtUvbBaÄb;
RtUveFIVeT,IgsaCafHImþgeTotkñúgGMT,úgeBl3ExbnÞab;BIkarbMe)AedaHRtUv)anbBaÄb;TaMgRsug * ebIsinCaKHaneT RtUvbBa¢ÚneTAesvaBüa)alCm¶kW umar enAkñúgmnÞIreBTübEg¥kEdlenACitbMptu
50 51
edIm,IFanafaTarkenHmin)anqøgemeraKeGds_BImþaytamry³karbMe)AedaHeT.

56
cMNucKnwøH

m:UDulTI4>1³³ cMNucKnwøH
ƒ kabgáarbzménkarcmøgemeraKeGds_ KWCaviFId¾manRbsiTi§PaBkñúgkarkat;bnßykarcmøgemeraKeGds_BImþayeTAkUn
ƒ ®sIþmanépÞeBaHRKb;rUbnigédKU KYrEtTTYl)annUvB½t’manmuneBleFVIetsþ kareFIVetsþQamrkemeraKeGds_ nigkarpþl;
RbwkSaeRkayeBleFIVetsþ
ƒ kareFIVetsþQamdl;édKUnigkarpþl;RbwkSadl;;bIþRbBn§ RtÚv)anelIkTwkcitþ[eFVI
ƒ Gñkpþl;RbwkSanigbuKÁliksuxaPi)alTaMgGs;RtÚvrkSa[)annUvkarsm¶at;rbs;GtifiCn
ƒ kareFIVetsþrh½sGacTTYl)anlT§plenAéf¶EtmYy ehIynItiviFIenHRtÚv)anENnaM[eFIVenAesvaEfTaMépÞeBaH
ƒ kareFVIeraKvinicä½yGMBICMgWeGds_cMeBaHTarkmanPaBsúHúKsHaj Etvamansar³sMxan;sRmab;karRKb;RKgEpñkKøInik
ƒ kareFVIeraKvinicä½yGMBICMgWeGds_elITarktamsþg;dar RtÚvGnuvtþtamry³kareFIVetsþrkGgÁbdibkçR)aNenAxN³
eBlEdlTarkmanGayu18Ex
kareFVIeraKvinicä½yGaceFIV)anqab;CagenHH ebIsinCamanetsþþ PCR.

57
58
 4>2
karbgáarkarmankUnmintambMNgcMeBaH®sIþpÞúkemeraKeGds_

vtßúbMNg
enAcugbBa©b;énvKÁenH sikçakamTaMgGs;Gacnwg³
1> Bnül;GMBIsar³sMxan;énesvaEpnkarRKÜsar
2> erobrab;GMBImeFüa)ayEpnkarRKÜsarEdlsmRsbsRmab;®sIþpÞúkemeraKeGds_

  ry³eBl³ 30naTI

59
skmHPaBTI1³ karbgáarkarmanépÞeBaHmintambMNgenAelI®sIþpÞúkemeraKeGds_
karbgáarkarmanépÞeBaHmintambMNgenAelIRsþIpÞúk esvaEpnkarRKYsar
emeraKeGds_ SkarbgáarkarmanépÞeBaHmintambMNg nigEpnkarBnüarkMeNIt GacrYm
cMnYnRsIþpÞúkemeraKeGds_manépÞeBaHmintambMNg Gackat;bnßy)antamry³kar cMENkkat;bnßy
TTYl)annUv³ - GRtasøab;rbs;mata nigkumar
Sesvapþl;RbwkSasIþBIsuxPaBbnþBUCEdlmanKuNPaBx<s; - karcmøgemeraKeGds_BmI aþ yeTAkUn
SviFIBnüarkMeNItEdlmanRbsiT§iPaBnigsuvtißPaB - bBaðapøvÚ citþ
SkarTTYl)annUvB½t’mannigesvasMrab;RsIþnigédKUsIþBIEpnkarRKYsarEdlman
karTak;TgKñarvagesvaEfTaMépÞeBaH EpnkarRKYsar nigesvapþl;RbwkSanigeFIV KuNPaBx<s;mansar³sMxan;Nas;
etsþQam edaysH½RKcitþnigrkSakarsm¶at;mansar³sMxan;Nas; edaysarEt
manRsIþCaeRcInEdlmk TTYlesvaEfTaMépÞeBaHnigesvaEpnkarRKYsarmin)an Syuvv½y RsIþEdlminTan;erobkar nigRkumdéTeTot dUcCaRsIþCnCatiPaKtic
dwgBIsßanPaBpÞúkemeraKeGds_rbs;Kat; 6
RsþIrksIupøvÚ ePT .l. RtUvmansiTi§TTYl)annUvesvaTaMgGs;enaHesIH²Kña 7

skmHPaBTI2³ bMpusKMnit³ EpnkarRKÜsarsRmab;®sIþpÞúkemeraKeGds_

» RKÚnwg[sikçakameFIVkarCaKU edIm,IkMNt;rkviFIBnüarkMeNItEdlsmRsb » RKÚnwg[sikçakameqIøymþgmñak;GMBIviFBI nüarkMeNItnImYy² nig[bBa¢ak;fa
nigEdlminsmRsbsRmab;®sIþpÞúkemeraKeGds_ viFINamYyEdlRtÚvCamYynwgcMNgeCIgnImYy²
» RKÚsresrcMNgeCIgBIrenAelIkþarexon » sRmab;viFInImYy² etIGñkGacBnül;)anb£eTfa ehtuGIV)anCaviFIenaHsm
{viFIBnüarkMeNItEdlsmRsb}} {viFIBnüarkMeNItEdlminsmRsb} Rsb b¤minsmRsbsRmab;®sþIpÞúkemeraKeGds_

60
 meFüa)ayEpnkarRKYsar kareRbIeRsamGnam½yedIm,IbgáarkarqøgCafIGEfmeTot
eRsamGnam½y ¬sMrab;burs b¤RsIþ¦³ mantYnaTIBIr ebIsinCaeRbIR)as;va[)anRtwmRtUv nig
CaRbcaM
S bgáarkarmanépÞeBaH eRsamGnam½yKYrEteRbIeTaHbI³
S bgáarCm¶WkameraK nigkarqøgemeraKeGds_ b¤ karqøgCafIHEfmeTot S édKUTaMgBIrmanpÞúkemeraKeGds_ehIyk¾eday edIm,Ikat;bnßyeRKaHRbQm
RsIþpÞúkemeraKeGds_TaMgGs;KYrEtTTYlnUvkarpþlR; bwkSaGMBI³
S kareRbIeRsamGnam½y[)anRtwmRtUv
nwgkarcmøgemeraKeGds_fHeI pSgeTotEdlGac³
S CMnajcrcaCamYyédKUBIkareRbIeRsamGnam½y ™man\Ti§BlsahavxøaMgCagemeraKeGds_mun
S sar³sMxan;énkarGnuvtþn_karrYmePTEdlmansuvtißPaB ™suaMCamYynwg»sfRbqaMgemeraKeGds_
édKUKYrEtcUlrYmRKb;TidæPaBTaMgGs;énkarpþl;RbwkSaCalkçN³buKÁlkIþ S GñkCm¶WkMBugEteRbI»sfRbqaMgemeraKeGds_k¾eday
b¤CamYybIþRbBn§kIþ ebIsincaM)ac; 9 10

meFüa)ayEpnkarRKYsardéTeTot meFüa)ayEpnkar®KYsarEdlminRtUveRbIenAelI
RsIþpÞúkemeraKeGds_
meFüa)aydUcxageRkamenHsmRsbsMrab;RsIþpÞúkemeraKeGds_ nigRtUv)aneRbIbEnßm
BIelIkareRbIeRsamGnam½y³ kgdak;kñúgs,Ún
S fñaMRKab;BnüarkMeNIt ¬ebIsinminTan;eRbI»sfRbqaMgemeraKeGds_eT¦ S vabegIáneRKaHRbQmnwgkarrlakGagRtKak
kMNt;cN M aM³ »sfRbqaMgemeraKeGds_xøHbnßyRbsiTi§PaBfñaMRKab;BnüarkMeNIt. RsIþkMBugEt S eFIV[QamrdUv)at;bg;eRcIn
eRbI»sfRbqaMgemeraKeGds_Edlmincg;manépÞeBaHRtUveRbImeFüa)ayepSgeTot b¤eRbI
meFüa)ayBnüarkMeNItbEnßmepSgeTot S GacbegIánkarRbQmnwgkarcmøgemeraKeGds_
S fñaMcak;BnüarkMeNIt sarCatiKImIeRbIsMrab;smøab;emCIviteQHal
S kgdak;eRkamEs,kéd S GacbNþal[Rkhl;Rkhaynigrlakrn§TVarmas (allergy)
S meFüa)aybBaÄb;kMeNItkUn ¬karcgbMBg;TwkbgðÜremCIviteQHal b¤cgbMBg;éds,Ún ¦ S GacbegIáneRKaHRbQmnwgkarcmøgKñaeTAvijeTAmkrvagédKUTaMgBIr
11 12

61
cMNucKnwøH

m:UDulTI4>2³ cMNucKnwøH
ƒ karTTYl)annUvkarRbwkSaGMBIsuxPaBbnþBUC nigkarBnüarkMeNItEdlmansuvtiß-
PaB Gackat;bnßycMnYnépÞeBaHEdlmintambMNgenAelI®sIþpÞúkemeraKeGds_
ƒ eRsamGnam½yGaceRbIedIm,IbgáarkarmanépÞeBaHpg nig bnßyeRKaHRbQmnwg
karqøgemeraKeGds_nigCMgWkameraKpg
ƒ ®sIþpÞúkemeraKeGds_nigédKUrbs;Kat; KYrEtTTYl)annUvkarRbwkSasIþGMBIkareRbI
eRsamGnam½y[)anRtwmRtÚv
ƒ ®sIþpÞúkemeraKeGds_GaceRbImeFüa)ayBnüarkMeNItdéTeTotEdlsmRsbbEnßm
BIelIkareRbIeRsamGnam½y dUcCa fñaMRKab;sRmab;elbBnüarkMeNIt fñaMcak;Bnüar
kMeNIt karcgéds,Ún b¤bMBg;bgðÜremCIviteQHal
ƒ kgdak;kñúgs,ÚnnigCatiKImIsRmab;smøab;emCIviteQHal minRtÚveRbIenAelI®sIþpÞúk
emeraKeGds_eT

62
4>3
,
karbgáarkarcmøgemeraKeGds_BI®sIþpÞúkemeraKeGds_eTAkUnrbs;Kat;
(PMTCT)

esva PMTCT
4>3>1
karBüa)alnigkarbgáareday»sfRbqaMgemeraKeGds_ (ART/ARV)
karEfTaMenAeBlmanépÞeBaH eBlQWeBaHsRmalnigsRmal
4>3>2
karEfTaMeRkaysRmalnigkartamdanbnþ
4>3>33 karciBaw©mkUnkñúgbribTénemeraKeGds_
4>3>44 suvtißPaBenAkEnøgeFIVkar

63
64
4>3>1
esva (PMTCT)
karBüa)alnigkarbgáareday»sfRbqaMgemeraKeGds_

vtßúbMNg
enAcugbBa©b;énvKÁenH sikçakamTaMgGs;Gacnwg³
1> Bnül;GMBIehtuplEdlnaM[manesva PMTCT nigerobrab;GnþraKmn_BiesssRmab; PMTCT
2> BiPakSaGMBIRbsiT§iPaBénGnþraKmn_ PMTCT
3> kMNt;niymn½yénBakü ARVs nig ART nigBnül;GMBItYnaTIrbs; ART enAkñúgkarBüa)al
RKb;RKgCMgWeGds_
4> GFib,ayGMBIkarbgáarnigBüa)aleday»sfRbqaMgemeraKeGds_ enAelI®sIþmanépÞeBaHpÞúk
emeraKeGds_
5> Bnül;GMBIrbb»sfRbqaMgemeraKeGds_eRbIsRmab;bgáar EdlRtÚv)anENnaM[eRbIR)as;enAkm<úCa
6> Bnül;GMBIsar³sMxan;énkarRbkan;x¢ab;nUvkareRbIR)as;»sfRbqaMgemeraKeGds_sRmab;bgáar
nigBüa)al

  ry³eBl³ 2ema:g40naTI

65
skmHPaBTI1³ esvaa PMTCT cMNucsmÁal;³ ehtuGIV)anCaeyIgRtUvkaresva PMTCT ?
enAkm<úCa ebIKHanGnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUneT S enAkm<úCacMnYnkumarekItrs;Edl)an)a:n;RbmaNenAqñaM 2005mancMnYn 461/000Ã
kumarRbmaNCa3/000 nak;kñúg1qñaM GacqøgemeraKeGds_BImþayrbs;eK S eK)an)a:n;RbmaNfamanTarkeTIbnwgekItRbmaNBI 9/000-10/000nak;
RbQmmuxeTAnwgkarqøgemeraKeGds_BImþayrbs;BYkeKCaerogral;qñaM.
S ebIKHanGnþraKmn_NamYyeT GRtacmøgemeraKeGds_BImþayeTAkUnmanRbEhl30°
dUecñHTarkrhUtdl;Cag 3/000nak;GacqøgemeraKeGds_ BImþayrbs;BYkeK
cMnYnkumarqøgenH Gackat;bnßy)anRbEhl40° ¬RbEhl 1/800nak;kñúg1qñaM¦ Caerogral;qñaM
S mþayPaKeRcInmin)andwgBIsßanPaBpÞúkemeraKeGds_rbs;xøÜneT nigmanRsIþ
RbsinCa®sIþmanépÞeBaHpÞúkemeraKeGds_)anTTYlGnþraKmn_bgáarkar mYycMnYnmin)anTTYl b¤eRbIR)as;esva PMTCT eT.
cmøgemeraKeGds_BImþayeTAkUn.
esva PMTCT pþl;»kasya:gsMxan;kñúgkarkat;bnßy
nUvcMnYnkumarqøgemeraKeGds_fIG
7

karbgáarkarcmøgemeraKeGds_BImþayeTAkUn
eKalbMNgénesva PMTCT³ KWedIm,Ikat;bnßycMnYnqøgemeraKeGds_énkumar
EdlekItBImþayEdlmanpúÞúkemeraKeGds_.
eKalbMNgenHGacsMerc)antamry³
SkarrkeXIjRsIþmanépÞeBaHpÞúkemeraKeGds_ CaBiess RsIþEdlmindwgBIsßan
PaBpÞúkemeraKeGds_rbs;xøÜnBImunmk
SCYyRsIþ[TTYl)annUvesva PMTCT nigesvaEfTaMnigBüa)albnþ ¬CoC¦.
RKb;»kasTaMgGs; KYrEtrk[eXIjnUvGñkpÞúkemeraKeGds_edIm,I[
BYkeKRBmTaMgRKYsarrbs;BYkeK)anTTYlnUvesvaEfTaMnigKaMRT 8

66
 esva PMTCT ³ etIvaCaGIV? RbsiTi§PaBénGnþraKmn_kat;bnßykarcmøg
emeraKeGds_BImþayeTAkUn
GnþraKmn_sMxan;²sMrab;bgáarkarcmøgemeraKeGds_BImþayeTAkUnman³
GnþraKmn_rYmbBa©ÚlKñaGackat;bnßykarRbQmnwgkarcmøgemeraKeGds_BI
1> karpþl;RbwkSanigeFIVetsþQam ¬vKÁTI1 énm:UDulenH¦³ mþayeTAkUn ³
edIm,I[RsIþmanépÞeBaHman»kasdwgBIsßanPaBpÞúkemeraKeGds_rbs;xøÜn S)anrhUtdl; 40° kñúgcMeNamRsIþEdlbMe)AkUnedayedaH
Ã

2> karbgáar b¤karBüa)aleday»sfRbqaMgemeraKeGds_³ ¬dUecñHmanGRta= 15-25°¦>

edIm,Ikat;bnßybnÞúkemeraKeGds_nig kat;bnßykarcmøgBImþayeTAkUn S )anrhUtdl; 70° kñúgcMeNamRsIþEdlminbMe)AkUnedayedaH
Ã

3> GnuvtþkarsMralkUnEdlmansuvtßiPaB³ ¬dUecñHmanGRta= 5-15°¦

edIm,Ikat;bnßykarRbQmrbs;Tark enAeBlQWeBaHsMral nigsMral
4> GnuvtþkarciBaw©mkUnEdlmansuvtißPaBCag³ edIm,Ikat;bnßykarRbQmrbs; ÃkarfycuHBitR)akdGaRs½yeTAnwgktþamYycMnYn dUcCa GnþraKmn_lMGitén
TarkenAeBlbMe)A karbgáarkarcmøgemeraKeGds_BImþayeTAkUn nigbnÞúkemeraKeGds_rbs;mþay
9 10

lT§plénkUnEdlekItBImþaypÞúkemeraKeGds_
eRkayBI)anTTYlGnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUn
kñúgcMeNamkumar 100nak;; EdlekItBImþaypÞúk
emeraKeGds_* ehIyRtUv)anciBa©wmedayTwkedaHmþay
¬rhUtdl;2qñaM¦ eRkayBI)anTTYlGnþraKmn_bgáarkar
cmøgemeraKeGds_BImþayeTAkUn
kumarcMnYnBI 15-25nak; nwgqøgemeraKeGds_BImþay **
*TarkEdlRbQmnwgkarqøgemeraKeGds_
**TarkEdlqøgemraKeGds_
TarkEdlRbQmnwgkarqøgemeraKeGds_ b¤
TarkEdlqøgemeraKeGds_
TarkEdlRbQmnwgkarqøgemeraKeGds__ KWCaTarkEdlekItBImþaymanpÞúk
kumarcMnYnBI 75-85 emeraKeGds_
nak;nwgminqøgemeraK
eGds_eT
TarkEdlqøgemeraKeGds_ KWCaTarkekItBImþaypÞúkemeraKeGds_ Edl)anqøg
emeraKeGds_ enAeBlkMBugmanKP’ b¤eBlQWeBaHsMralnigsMral b¤tam
ry³karbMe)AkUnedayTwkedaHmþay
KYrcgcaMfa ³TarkRbQmnwgemeraKeGds_PaKeRcIn minqøgemeraKeGds_eT.
k¾bu:Enþ TarkTaMgenaHRtUvkartamdanya:gRbugRby½tñ edIm,IgayRsYlkñúgkar
11
rkeXIjbBaða)anTan;eBlevla. 12

67
skmHPaBTI2³ ARVs nig ART³ etIvaCaGIV?

etI ARV CaGIV? etI ART CaGIV?

»sfRbqaMgemeraKeGds_manskmHPaBl¥enAeBlEdleKeRbIva 3-4mux
S ARV or AntiRetroViral KWCa»sfEdlman cUlKña
skmHPaBRbqaMgemeraKeGds_ ART or Anti Retroviral Therapy
KWCakarBüa)aledayeRbI»sfRbqaMgemeraKeGds_ 3-4mux cUlKña
S»sfenHmanskmHPaBbg¥ak;karbMEbkxøÜnrbs;emeraKeGds_ karBüa)alenHeKGacehAmüa:geTotfa³
nigkat;bnßycMnYnemeraKeGds_enAkñúgxøÜnmnusS. HAART or Highly Active Anti Retroviral Therapy:
karBüa)aleday»sfRbqaMgemeraKeGds_skmHbpM tu
=karBüa)aleday»sfRbqaMgemeraKeGds_3muxcUlKñaya:gtic
15 16

skmHPaBTI3³ etII ARTeRbIsRmab;eFIVGIV? etIvamanRbsiTi§PaBRtwmkRmitNa??

» RKÚnwgsYrsikçakamfaetI; ART GaceFIVGIV)anxøH?
» etImanbBaðaGIVxøHTak;TgnwgkareRbI ARTEdlGñk)andwg?
etIARTeRbIsMrab;eFIVGIV?
S karBüa)aleday»sfRbqaMgemeraKeGds_ (ART) GacTb;min[
emeraKeGds_bMEbkxøÜn nigeFVI[³
-RbB½n§karBarragkayrbs;mnusS)anl¥RbesIreLIgvij nig
-eFIV[eraKsBaØaCm¶WeGds_)anFUrRsaleLIgvij.
S dUecñH (ART) Gac³
-begIánKuNPaBénCIvit)anl¥RbesIreLIgvij edaykat;bnßyCm¶WTak;Tgnwg
emeraKeGds_ ¬Cm¶W»kasniymtictYc¦
-BnüarCIvitGñkCm¶eW Gds_ nigkat;bnßykarsøab;EdlTak;TgnwgCm¶WeGds_
-bgáarkarcmøgemeraKeds_BImþayeTAkUn.
18

68
 etI ART minGaceFIVGIVxøH? etI ART bNþal[manbBaðaGIVxøH?
bBaðaEdlTak;TgeTAnwgkareRbI»sfRbqaMgemeraKeGds_³
karBüa)aleday»sfRbqaMgemeraKeGds_minGacBüa)al GñkCm¶WeGds_[Ca
)aneT Srbb»sfmanPaBsHKú sHajBi)akelb
• vaRKan;EtTb;min[emeraKeGds_bMEbkxøÜn)an EtenAeBlEdleRbIvaEt S»sfenHmanplb:HBal;bnÞab;bnSM EdlGackan;EteFIV[Cm¶WmanPaBF¶n;F¶r
b:eu NÑaH
• ebIsinbBaÄb;karBüa)al emeraKeGds_nwgeFIVkarbMEbkxøÜnCafIHeLIgvijya:g karRbkan;x¢ab;nUvkareRbIR)as;»sf³
rh½s SRtUvEt[)anxøaMgbMput edIm,ITTYlplBIkarBüa)al[)ankMritGtibrima
karBüa)aleday»sfRbqaMgemeraKeGds_minGackMcat;emeraKeGds_)anTaMg SRtUvEteRbIrhUtGs;mYyCIvit
RsugeT
• GñkCm¶WEdlBüa)aleday»sfRbqaMgemeraKeGds_enAEtGaccmøgemeraK karminRbkan;x¢ab;nUvkareRbIR)as;»sf
eGds_ eTA[édKUesñharbs;xøÜn. dUecñHGñkCm¶WRtUvEteRbIeRsamGnam½y
edIm,IbgáarkarcmøgenH. SeFIV[emeraKeGds_suaMeTAnwg»sfehIy emeraKenHGacnwgRtUv)ancmøg
19 20
eTAGñkdéTeTot.
skmHPaBTI4³ bMpusKMnit³ karBüa)alnigkarbgáareday»sfRbqaMgemeraKeGds_
» RKÚnwgesIñ[GñkKitGMBI karBüa)aleday»sfRbqaMgemeraKeGds_ ART
1> etIGIVeTACa ARV sRmab;bgáar? etIeKeRbIvasRmab;eFIVGIV? ART ³ KWCakarBüa)alCm¶WeGds_eday»sfRbqaMgemeraKeGds_Edlman
2> etIARVsRmab;bgáarxusKñaya:gdUcemþcBI ART? ry³eBlyUr rhUtGs;mYyCIvit.
kareRbI ART enAeBlmanépÞeBaH eBlQWeBaHsMralnigsMral
» Gñknwgman»kasnwgbgðaj RBmTaMgBiPakSaelIcemøIyrbs;Gñk eBlbMe)AkUnedayTwkedaHmþay nigbnÞab;mkeRbIrhUtGs;mYyCIvitGac³
SeFVI[suxPaBmþaykan;EtRbesIr edayeFIV[Kat;GacEfrkSakUnrbs;Kat;
nig RKYsarrbs;Kat;)anRbesIrCagmun
SbnßynUveRKaHRbQmnwgkarcmøgemeraKeGds_eTATark)an
edaykat;bnßy nUvbnÞúkvIrusEdlenAkñúgQamrbs;mþay
RsIþmanépÞeBaHpÞúkemeraKeGds_
nigGñkEdlRRtUvBüa)aleday»sfRbqaMgemeraKeGds_edIm,IsuxPaBrbs;Kat;
KYrEtmkTTYlkarBüa)alenH. 22

69
 karBüa)albgáareday»sfRbqaMgemeraKeGds_
karBüa)albgáar KWCakareRbIR)as;»sfRbqaMgemeraKeGds_ kñúgry³eBlxøI
edIm,Ikat;bnßykarcmøgemeraKeGds_BImþayeTAkUn.
karBüa)albgáareday»sfRbqaMgnwgemeraKeGds_enH ³
SminGacBüa)almþayEdlmanpÞúkemeraKeGds_)aneT
SminGackarBarkarcmøgemeraKeGds_dl;Tark enAeBlbMe)AedaH)aneLIy
SminGackarBarkarcmøgemeraKeGds_dl;Tark)anyUrGEgVg)aneLIy.
RsIþmanépÞeBaHpÞúkemeraKeGsds_ EdlminTan;RKb;lkç½x½NÐkñúgkarBüa)al
eday»sfRbqaMgemeraKeGds_ ART eT KYrEt)anTTYlnUv»sfRbqaMg
emeraKeGds_ ARV sMrab;bgáarkarcmøgdl;kUnrbs;Kat;.
23
etIRsIþNaxøHEdlKYrTTYlkarBüa)albgáareday»sf
RbqaMgemeraKeGds_ ARV ?
RsþImanépÞeBaHpÞúkemeraKeGds_Edl³
S sßitkñúgdMNak;kalTI1/ TI2/ b¤ TI3 éncMNat;fñak;Cm¶WeGds_rbs;GgÁkar
suxPaBBiPBelak
S b¤ Edlmanekasika CD4 eRcInCag 250kñúg 1mm3 Qam
S minTan;RKb;l½kçx½NÐTTYlnUvkarBüa)aleday»sfRbqaMgemeraKeGds_KYr
TTYl)an nUvkarBüa)albgáareday»sfRbqaMgemeraKeGds_ edIm,IkarBar
kUnrbs;Kat;.
RsIþmanépÞeBaHpÞúkemeraKeGds_ EdlminTan;sißtkñúgdMNak;kaleGds_F¶n;F¶r
KYrTTYl)an nUvkarBüa)albgáareday»sfRbqaMgemeraKeGds_ (ARV)edIm,I
karBarkUnrbs;Kat;. 25
70
etIRsIþNaxøHEdlRKb;l½kçx½NÐGacTTYl)annUvkar
Büa)aleday»sfRbqaMgemeraKeGds_ (ART)?
RsþImanépÞeBaHpÞúkemeraKeGds_Edl³
S sßitkñúgdMNak;kalTI4éncMNat;fñak;Cm¶WeGds_rbs;GgÁkarsuxPaBBiPB
elak b¤
S cMnYnekasika CD4 ticCagb¤esHI 250kñúg 1mm3 Qam
KYrTTYl)annUvkarBüa)aleday»sfRbqaMgemeraKeGds_ ART *
RsIþmanépÞeBaHpÞúkemeraKeGsds_ EdlsißtkñúgdMNak;kaleGds_F¶n;F¶r
RtUvBüa)aleday»sfRbqaMgemeraKeGds_ ART edIm,IsuxPaBxøÜn
nigedIm,I;bgáarkarcmøgemeraKeGds_eTAkUnrbs;Kat;.
* eKalkarN_ENnaMCatisMrab;kmHviFIbgáarkarcmøgemeraKGds_BImþayeTAkUn -2005 24
etI»sfRbqaMgemeraKeGds_KYrcab;epþImeRbIenAeBlNa
cMeBaHRsþImanépÞeBaHpÞúkemeraKeGds_?
ART³ karBüa)aleday»sfRbqaMgemeraKeGds_
S RtUvcab;epþImBüa)alPøam²ebIGaceFVI)an CaBiessebIsinCaRsþIenaH
Føak;xøÜnQWF¶n;F¶r
S RtUvBnüareBlpþl;»sfdl;RsIþrhUtdl;cUlRtImasTI2énépÞeBaH
nigRbsinebIRsþIenaH minmanCm¶WF¶n;F¶reT
ARV Prophylaxis³ karBüa)albgáareday»sfRbqaMgemeraK
eGds_RtUvcab;epþImeRbIenAs)þah_TI28énGayuépÞeBaH b¤GaceRbIPøam
bnÞab;BIdwgfaRsIþmanépÞeBaHelIsBI28s)þah_ehIy. 26
smÁal;³ Bnül;BaküénGkSrkat;;
»sfRbqMagemeraKeGds_ etIrbb»sfGVIxøHEdlKYrykmkeRbI?
» NVP eNvIra:BIn Nevirapine ART³
» AZT hSIúdUvuyDIn Zidovudine SeK[rbb»sfCalkçN³sþg;dar Ã

» 3TC LamIvuyDIn Lamivudine

ARV sMrab;bgáar³
» Hb eGm:UkøÚb‘Ín Haemoglobin
S munqñaM 2006: pþl;eNvIra:BIn (NVP) mYykMriteTAmþaynigTark
enHsRmab;sÞg;emIl faetImþaymanQameRcInb:uNÑa. RbsinCa HbenHTab enaH S cab;BIqñaM 2006: bþÚreTAeRbI AZT nig NVP nig 3TC
mann½yfamþayesøksøaMgehIy. Kat;GacemIleTAeXIjmanesøksøaMg Gs;kmøaMg BIeRBaHrbb»sfenHmanRbsiTi§PaBCag
nigdkdegIðmexSay.
27

smÁal;³ rbb»sfRbqMagemeraKeGds_ mþayEdlkMBugeRbI ART³ rbb»sf

RbsinCamþay)anTTYl NVPenAeBlQWeBaHsRmal RtÚvpþl; 3TCnig AZT mþS ayRtU vTTYl³
eRkayeBlsRmaldl;Kat; edaysarEtRbQmnwgkarsuaMrbs;emeraK
eGds_eTAnwg»sf NVP¬sUmGanB½t’manCamUldæan¦.
RbsinCamþaymkyWteBkmin)anTTYl NVPenAeBlsRmaleT
mincaM)ac;pþl; 3TC nig AZT eRkayeBlsRmaldl;Kat;eT
edaysarEtvaminTak;TgnwgPaBsuaMrbs;emeraKeTAnwg»sf
NVP¬søayTI30¦.
AZT ª 3TC ª NVP
¬kMritsþg;dar¦³ebIsinCamþayminmanesøksøaMg¬Hb> 9g/dl¦
S D4T ª 3TC ª NVP ¬kMritsþg;dar¦³ ebIsinCamþaymanesøksøaMg
¬ Hb< 9g/dl ¦
bnþeRbIcab;BImanépÞeBaHrhUtdl;eBlQWeBaHsMralTarkRtUvTTYl³
S NVP mYykMritbnÞab;BIsMralkñúgkMLúgeBl72em:ag
S AZT (4mg/kg) 2dgkñúg1éf¶ ry³eBl7éf¶*
*RbsinebImþay)anTTYl AZT ticCag 4 s)þah_kñúgkMLuúgeBlmanépÞeBaH
TarknwgTTYl AZTry³eBl4s)þah_ 28

71
 ARV sMrab;bgáar³ rbb»sf ARV sMrab;bgáardl;TarkEdlmþaypÞúkemeraKeGds_min)an
eKalkarN_ENnaMCatisMrab;kmHviFbI gáarkarcmøgemeraKeGds_BImþayeTAkUn qñaM2005 TTYl ARV esaH
dMNak;kalKIønikTI1 2 b¤3 rbs;GgÁkarsuxPaBBiPBelak b¤ CD4 eRcInCag 250kñúg 1mm3
b¤esva PMTCT q¶ayminGacTTYl)annUvesva OI/ART)an S enAeBlmanépÞeBaH b¤sMral nig
mþayRtUvTTYl³
S AZT(300mg) 2dgkñúg1éf¶ cab;BI 28s)þah_énépÞeBaH
S mkdl;mnIÞreBTüEdlmanesva PMTCTkñúgkMLúgeBl2em:agénkarsMral
S AZT(300mg) enAeBlQWeBaHsMral [erogral;3em:agmþgrhUtdl;sMral
S NVP(200mg) mYykMriteBlkMBugQWeBaHsMral TarkRtUvTTYl³
S AZT(300mg) nig 3TC(150mg) 2dgkñúg1éf¶ ry³eBl7éf¶ bnÞab;BIsMral S NVP(2mg/kg) mYykMritKt;bnÞab;BIsMral[)anqab;rh½stamEdlGac
TarkRtUvTTYl³ eFIV)an ¬minRtUv[hYsBI72em:ageRkaysMraleT¦
S NVP(2mg/kg) mYydUsKt;bnÞab;BIsMralkñúgÃkMLúgeBl72em:agà S AZT(4mg/kg) 2dgkñúg1éf¶ ry³eBl4s)þah_
S AZT(4mg/kg) 2dgkñúg1éf¶ ry³eBl7éf¶
à RbsinebImþay)anTTYl AZT ticCag 4s)þah_ kñúgkML úgeBlmanépÞeBaH
mþayEdlmin)anTTYl»sfRbqaMgemeraKeGds_esaH enAeBlEdlTarkekIt
TarknwgTTYl AZTry³eBl4s)þah_ min)ac;RBYy)armÖBIkarsuaMrbs;emeraKeGds_CamYynwg NVP eT
à RbsinebImþaysMralkUnticCag2em:ageRkayeRbI NVP TarkRtUvTTYl NVP Pøam
29 30
eRkayBIekIt.

kñúgsßanPaBBiess PaBBulén»sfTak;TgeTAnwgkarBüa)aleday
ARTeBlmanépÞeBaH
RsþImanépÞeBaHpÞúkemeraKeGds_EdlkMBugBüa)aledayfñaMrebg³ SesøksøaMg (AZT)
S GacTTYlkarBüa)al ARTb¤bgáareday ARV)an Splb:HBal;dl;épÞeBaH
S RtUv[ ART rYmnwgkartamdankarBüa)albEnßmCacaM)ac;. - kUnekItminRKb;TMgn;
RsþIEdlkMBugBüa)aleday ART EteRkaymkmanépÞeBaH³ - sMralminRKb;Ex
S KYrbnþBüa)aleday ART - kUnekItsøab;
S RbsinCanagkMBugeRbIrbb ART Edlman Efavirenz RtUvbþÚrfñaM plb:HBal; (outcomes)EdlekItmaneLIgTaMgGs;enH Tak;TgCamYynwg
enHeTACa NVP vij BIeRBaHvaGaceFVI[b:HBal;dl;TarkkñúgépÞ. PaBF¶n;F¶rénCm¶WeGds_rbs;mþay. eCaKC½yénkarBüa)aleday ART Gac
kat;bnßynUveRKaHRbQm)an.
31 32

72
skmHPaBTI5³ BiPakSa³³ karRbkan;x¢ab;nUvkareRbI»sf ARV [)anRtwmRtÚv
» RKÚnwgesIñsikçakam[KitGMBIBakü{karRbkan;x¢ab;} etIvamann½yEbbNa? karRbkan;x¢ab;nUvkareRbI ARV ¬1¦
etIvamansar³sMxan;ya:gdUcemþcxøH?
karRbkan;x¢ab;nUvkareRbI ARV mann½yfa RtUvelbfñaMTaMgGs;
» RKÚnwgdwknaMkarBiPakSasIþGMBIkarRbkan;x¢ab;nUvkareRbI»sf[)anRtwmRtÚv StamevC¢bBa¢a
nig GMBIsar³sMxan;rbs;va S [)aneTogTat;tameBlevla
S [RtUvtamkMrit
karRbkan;x¢ab;nUvkarBüa)al CaktþaKnøwH edIm,ITTYleCaKC½ykñúgkarBüa)aleday
»sfRbqaMgemeraKeGds_ ARTnigkarbgáareday ARV
ebIsinCakarelbfñaMmankarxkxanminRtwmRtUv GacbNþal[³
ScMnYnemeraKeGds_ekIneLIgenAkñúgQam nig
SvivtþeTArkCm¶WeGds_
SbegáInnUvkarRbQmnwgkarcmøgemeraKeGds_
SbegáInkarRbQmnwgPaBsuaMrbs;emeraKeGds_CamYynwg»sf 34

karRbkan;xa¢ b;nUvkareRbI ARV ¬2¦ karRbkan;x¢ab;nUvkareRbI»sf ARV

S karRbkan;xa¢ b;nUvkareRbI ARV KWCakarsMxan;Nas; ehIyKb,IelIkTwkcitGþ tifCi n
Kitdl;bBaðaenH muneBlcab;epþmI ARV nigRtUvBRgwgkarRbkan;xa¢ b;nvU karBüa)al enH
CaBiess cMeBaHbuKÁl RKYsar nigenAshKmn_.
S Gñkpþl;esvaKYrEtBiPakSaGMBIplb:HBal;én»sfRbqaMgemeraKeGds_EdlKat;)an dwg nig
BIsar³sMxan;énkarRbkan;xa¢ b;nvU kareRbI»sf ARV edIm,ICYyRsþI³
- [dwgCamunnUvplb:HBal;
- dwgBIerbobRKb;RKgplb:HBal;bnþicbnþÜcEdlGacekItmaneLIg
- minbBaÄb;karBüa)aleday\tehtupl
S bnÞab;BcI ab;epþmI Büa)al ART mk RsþIKYrEtmkCYbnwgRKUeBTü[)anjwkjab; edIm,ITTYl
)annUvkarKaMRTTak;TgnwgkarRbkan;xa¢ b;nUvkareRbIR)as;»sf[)anRtwmRtUv nig eTogTat;
nigedIm,IeFVkI arvaytémønigRKb;RKgplb:HBal;rbs;»sfenaH. 35
kñúgkMLúgeBlmanépÞeBaHnigeRkayeBlsMral
karRbkan;x¢ab;nUvkareRbI»sf ARVGacCakarBi)akNas;sMrab;RsþImanépÞ
eBaHnigRsIþ eRkaysMraledaysarEt³
S karcaj;kUnEdlGaceFIVITukçceg¥arkan;EtxøaMgenAeBleRbI»sfRbqaMgemeraK
eGds_
S karRBYy)armÖ fakar[»sfRbqaMgemeraKeGds_GacbgáeRKaHfñak;dl;Tark
S karpøas;bþÚrragkayeRkaysMral KYbpSMnwgeRsþsnigtMrUvkarEfTaMdl;TarkEdl
eTIbnwgekIt.
pþl;karKaMRTbEnßmdl;GtifiCnedIm,I[Kat;)anRbkan;x¢ab;nUvkareRbI»sfRbqaMgemeraK
eGds_)anRtwmRtUvnigeTogTat; TaMgenAeBlmunnigeRkaysMral. eFIVdUecñHRsIþnwgmin
bBaÄb;karBüa)almuneBlkMNt; eTaHbICamanplb:HBal;bnþicbnþÜcBI»sf k¾eday. 36

73
skmHPaBTI6 ³ lMhat;³ ARV sRmab;bgáardl;kumar³³ KNnabrimaN
N
» enAkñúglMhat;enH GñkRtÚvKitbrimaNénsIur:Ub NVP nig AZT KNnaBItMrUvkarkMrit»sfsIur:Ub NVP nig AZT sMrab;Tark
edIm,Ipþl;[TarkEdlmanTm¶n;xus²Kña Tark TMgn;eBlekIt kMrit NVP (ml)
0.2ml/kg
kMrit AZT (ml) 0.4ml/kg
» kRmit»sfEdlRtÚvkar manbgðajenAkñúgsøay 1kMritKt; 2dg¼1éf¶
1 2250 Rk 0> 5 ml 1>0 ml
» cUrBinitüTm¶n;rbs;TarknImYy². bnÞab;mk[sikçakamKitfa etIkUn 2 2>5 KRk 0> 5 ml 1>0 ml
mñak;²RtÚvTTYl)ansIur:Ubb:unHan?
3 2>7 KRk 0> 5 ml 1>1 ml
4 3010Rk 0> 6 ml 1>2 ml
5 3240Rk 0> 7 ml 1>3 ml 38

karENnaMsMrab;mþay ¬1¦ karENnaMsMrab;mþay ¬2¦

S RtUvcak;sIur:UbeTAkñúgdbs¥atKHanemeraK edIm,I[mþayykeTApÞH
- RtUvdak; 20m>l sIur:Ub AZT sMrab;1s)þah_
- RtUv1db sIur:Ub AZT sMrab;4s)þah_
S ebIsinCadbminmanKMrbdMNk;eT RtUv[sWruaMgcMNuH 1m>l eTAmþay
S eRbIb‘ícEdlminecHrlb; sresrelIsWruaMg edIm,IbgðajmþayBIbrimaN
»sfEdlRtUvpþl;[kUn
S mþayRtUvlagsWruaMgeRkayeBleRbImþg² eday)aj;lagCaeRcIndgCamYy
nwgTwkqin¥
S ebIdbmanKMrbdMNk;ehIy mincaM)ac;lagvaeT
39
S kMrit³ 0>4m>l kñúg1KILÚRkam sMrab;kUnTMgn; 2>5KILÚ= 1m>l sIur:Ub
S [2kMritkñúg1éf¶ [12ema:gmþg
S Tuk»sfkñúgdbs¶Üts¥at kMu[RtUvBnWøéf¶
S ebIsinCaTarkk¥Ütkñúgrvag10naTIeRkayBIpwk»sf RtUvpþl;[kUn1kMriteTot
S RtUvR)akdfa kUnpwkmþgEtmYykMriteT
S ebIsinCaePøc[»sfelIsBI6em:agmin)ac;[kMritenaHeT
S minRtUvEck»sfenHeTA[TarkNaepSgeT eRBaHebIeRbI»sfminRtwmRtUvnaM[
manemeraKeGds_manPaBsuaMeTAnwg»sf
40

74
cMNucKnwøH

m:U:DulTI4>3>1³³ cMNucKnwøH
ƒ karTTYl)annUvesva PMTCT Gackat;bnßycMnYnkumarqøgemeraKeGds_fHI
ƒ ebIKHanGnþraKmn_eT eRKaHRbQmnwgkarcmøgemeraKeGds_BImþayeTAkUnmanBI25-40°.
kareFIVGnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUnrYmKña Gackat;bnßyGaRtaqøgrhUtdl;eTA40°
cMeBaHmþayEdlbMe)AkUnedayedaH
ƒ GnþraKmn_sMxan;²énkarbgáarkarcmøgemeraKeGds_BImþayeTAkUn man³
1> karpþl;RbwkSanigeFIVetsþQam ¬vKÁTImYyénm:UDulenH¦
2> karbgáarnigBüa)aleday»sfRbqaMgemeraKeGds_
3> karGnuvtþn_karsRmalEdlmansuvtißPaB
4> karGnuvtþn_karciBaw©mkUnEdlmansuvtißPaB
ƒ ART KWCakarBüa)almþayEdlmanpÞúkemeraKeGds_. vaGackat;bnßyeRKaHRbQmnwgkarcmøgemeraKeGds_BImþayeTAkUn
ƒ ARV Ca»sfsRmab;bgáarminGacBüa)almþay)aneT EtGackat;bnßyeRKaHcmøgemeraKeGds_BImþayeTAkUn)an
ƒ karRbkan;x¢ab;nUvkareRbI»sfARV KWCaktþaKnwøHsRmab;eCaKC½yénkarbgáarnigBüa)aleday»sfRbqaMgemeraKeGds_

75
]bsm<½n§³ B½t’manCamUldæan
mþayTTYlkarBüa)al ART ³ rbb»sf rbb»sfsMrab;bgáarRbqaMgemeraKeGds_
rbb»sf munsMral ry³eBlQWeBaHsMral eRkaysMralPøam² eRkaysMral rbb»sf munsMral ry³eBlQWeBaHsMral eRkaysMralPøam² eRkaysMral
ART mþay³ mþay³ mþay³ Tark³ Zidovudine mþay³ mþay³ mþay³ Tark³
¬mþay¦ ART ART ART NVP
(AZT) nig AZT (300mg) AZT (300mg) AZT (300mg) NVP
Nevirapine (2mg/kg)
(2mg/kg) BIrdgkñúg1éf¶cab;BI 1RKab;enAeBlQW nig [TarkpwkPøam
(NVP) nig eBaHsMralnigerog 3TC (150mg)
[TarkpwkPøam Lamivudine 28s)þah_énépÞeBaH elbBIrdgkñúg1éf¶ eRkaysMral
3TC b¤ ral;3 ema:gmþgrhUt
eRkaysMral dl;sMral nig NVP sMrab; ry³eBl7 AZT
pþl;[PøambnÞab;BIdw éf¶eRkaysMral (4mg/kg)
gfamanépÞeBaH (200mg) Etmþg Kt;
AZT enAeBlQWeBaH sMral [TarkpwkBIrdgkñú
(4mg/kg) eRkayBI 28 s)þah_ g1éf¶ ry³eBl7
[TarkpwkBIrdg eLIgeTA. éf¶
kñúg1éf¶
ry³eBl7 éf¶* *RbsinebImaþ y)anTTYl AZT < 4s)þah_ kñg
ú kMLgú eBlmanépÞeBaH TarknwgTTYl AZTry³eBl 4s)þah_
*RbsinebImaþ y)anTTYl AZT ticCag 4s)þah_kñúgkMLúgeBlmanépÞeBaH TarknwgTTYl AZTry³eBl 4s)þah_

segçb³ kareRbI»sfBüa)alRbqaMgemeraKeGds_sMrab;RsþI ¬1¦

»sfbgáarRbqaMgemeraKeGds_sMrab;Tark
RsþImanépÞeBaH
RsþImanépÞeBaHEdlkñúgeBlfHI² eraKvinicä½ybBa¢ak;famanpÞúkemeraK pþl;RbwkSa nigcab;epþImeRbI»sf
rbb»sf munsMral ry³eBlQWeBaHsMral eRkaysMralPøam eRkaysMral eGds_ GacTTYl)annUvkarBüa)aleday»sfRbqaMgemeraKeGds_ Büa)alRbqaMgemeraKeGds_PøamebI
GaceFVI)an
AZT nig/b¤ NVP mþay³ mþay³ mþay³ Tark³
sMrab;Tark NVP RsþImanépÞeBaHEdlkñúgeBlfHI² eraKvinicä½ybBa¢ak;famanpÞúkemeraK pþl;»sfbgáarRbqaMgemeraKeGds_
KHan KHan KHan (2mg/kg) eGds_ minGacTTYl)annUvkarBüa)aleday»sfRbqaMgemeraK cab;BI 28s)þah_énépÞeBaH
(eBlEdlmþaymin [TarkpwkPøam eGds_
)anTTYlnUv»sf eRkaysMral RsþImanépÞeBaHpÞúkemeraKeGds_ Edlmin)anTTYlkarBüa)aleday
bgáarRbqaMgemeraK AZT »sf RbqaMgemeraKeGds_ b¤ »sfbgáarRbqaMgemeraKeGds_enA pþl; NVP nig AZT eTATark.
(4mg/kg)
eGds_enAeBlmanépÞ [TarkpwkBIrdg eBlmanépÞeBaH b¤ enAeBlQWeBaHsMral ehIy)anmkdl;mnÞIr
eBaH) kñúg1éf¶ry³eBl eBTüEdlmanesva PMTCTkñúgry³eBl2em:agbnÞab;BIsMral.
4 s)þah_ RsþImanpÞúkemeraKeGds_ EdleTIbnwgrkeXIjeraKvinicä½yfH²I pþl; NVP nig AZT eTATark.
enAeBlsMral. pþl;RbwkSa nig elIkTwkciitþ[eFVIetsþ
QamrkemeraKeGds_.

76
B½t’manGMBI»sf
segçb³ kareRbI»sfBüa)alRbqaMgemeraKeGds_sMrab;RsþI ¬2¦
RsþImanépÞeBaH
RsþIpÞúkemeraKeGds_EdlkMBugEtBüa)aleday»sfRbqaMg
emeraKeGds_ ehIyeRkaymkmanépÞeBaH.
RsþIKHanépÞeBaH
RsþImanpÞúkemeraKeGds_EdleTIbnwgeFIVeraKvinicä½yfH²I
GacTTYl)annUvkarBüa)aleday»sfRbqaMgemeraKeGds_
ehIyGacmanépÞeBaHenAeBleRkay.
bnþeRbI»sfBüa)alRbqaMgemeraKeGds_
edaypøas;bþÚrrbbfñaM ¬]TahrN_BI EFVeTA
NVP¦
pþl;karRbwkSa nig cab;epþImeRbI»sfBüa)al
RbqaMgemeraKeGds_ edayeRbI NVP.
eCosvageRbI EFV
B½t’mansþIBI»sf- Zidovudine (AZT)
SmankarbWtRsUbykl¥bnÞab;BIelb
STarkGacRTaMRT)an TaMgmunsMralnigeRkaysMral
SGacelb)anCamYyGahar b¤ edayKHanGahar)an
plvi)akbnÞab;bnSM ³¬CaTUeTAekItmaneRkayeRbIBI 3-6s)þah_¦
Sceg¥ar
Svilmux CaBiessenAeBlegIbQr
SesøksøaMg*¬rYmCamYynwgPaBGs;kMlaMg Bi)akdkdegIðm sm,úrsøaMg¦.
FmHtaplvi)akTaMgenH nwg)at;eTAvijeRkayQb;elbfñaM.
*PaBesøksøagM enHKWbNþalmkBIkarb:HBal;eTAelIxYrq¥gw xñg nig minGacBüa)al)anedayfñaCM atiEdk nig folate )an.

karBicarNaelIkarpþl;»sf AZT B½t’mansIþBI»sf – Lamivudine (3TC)

1> buKÁliksuxaPi)alRtUvEtTTYlkarbNþúHbNþalBIkareRbIR)as;»sf
S mankarbWtRsUbl¥bnÞab;BIelb
S AZT
S Iron and Folate supplements

2> buKÁlikmnÞIrBiesaFn_enAkEnøgEdlmanesva PMTCTRtUvTTYlemIletsþ Hb S GaceRbIedaysuvtißPaBCamYy»sfepSgeTotEdleRbIsMrab;Büa)al

3> RsþImanépÞeBaHpÞúkemeraKeGds_RtUv eraKsBaØaTak;TgnwgCm¶WeGds_
S BinitüemIletsþ Hb munnwgcab;epþImeRbI AZT S Gacelb)anCamYyGahar b¤ min)ac;manGahark¾)an
SmkBinitütamdanbnþerogral;2s)þah_mþg sMrab;ExTImYy nig
mYyExmþgrhUtdl;eBlsMral rYmCamYynwgkartamdanetsþ Hb pg
Syl;BIsar³sMxan;énkareRbIR)as;»sfeTogTat;nigRtwmRtUv nigman plvi)akbnÞab;bnSM
bMNgGnuvtþtamkarBüa)al S kRm[manplvi)akbnÞab;bnSM
S)anelIkTwkcitþ[mksMralkUnenAmnIÞreBTüEdlmanesva PMTCT .

77
B½t’manGMBI»sf ¬t¦
B½t’mansIþBI»sf - Nevirapine (NVP) ehtuGIV)anCabBaðaPaBsuaMnwg»sfmancMeBaHEt
ehIyminmanelI AZT
NVP

S mankarbWtRsUbl¥bnÞab;BIelb S AZT GacRtUv)anpþl;dl;RsIþrhUtdl;RbEhl 3Ex enAeBleRbIvasMrab;bgáarenA

S manry³eBlyUr EdlRbsiT§iPaBCaGMeNaypldl;kUn eBlmanépÞeBaH
S Gacelb)anCamYyGaharb¤ min)ac;manGahark¾)an S ARTRtUv[ry³eBlEvgEdlmanya:gehacNas;»sfbImuxrYmKña edIm,Ikat;bnßy
kareRbI NevirapineEtmYykMrit kMrmanekIteLIgnUvplrMxanbnÞab;bnSMNas; PaBsuaMrbs;emeraKeGds_CamYynwgfñaM
plrMxanbnÞab;bnSMGacekItmanenAeBleRbIva SPaBsuaMeTAnwg AZT ³
kñúglkçN³Büa)alEdlmanry³eBlyUr SeFVI[mankarERbRbYlTaMgcMnnY nigkarvivtþn_rbs;vIrusyWt
- rmas;knÞÜlRkhm S vamineFVI[manPaBsuaMTaMgGs;eT dUcCa³
- BuleføIm ¬ceg¥ar Bisamin)an Es,kelOg QWeBaH Gs;kMlaMg ekþAxøÜn - AZT GacmanGMeNayplEdr eTaHbICamankarpøas;bþÚrnUvPaBsuaMxøHk¾eday
plb:HBal;TaMgenHCYnkalmanlkçN³F¶n;F¶rEdltMrUveGaybþÚrfñaM. SPaBsuaMeTAnwg NVP
karepIþmBüa)alCm¶WeGds_ edayeRbI NVPEdlmankMritTab - RtUvkarEtmYykMriteT eFVI[vIruseGds_mankarERbRbYly:agqab;rh½s
¬200m>Rk¼1éf¶¦kñúgry³eBl2GaTitü dMbUgkat;bnßynUveRKaHRbQm - manPaBsuaMTaMgGs;Etmþg
nwgplvi)akF¶n;F¶r. - manlT§plpÞúyBI EFV
»sfRbqaMgemeraKeGds_RkumTI1³ plrMxanbnÞab;bnSM
plvi)akenHEtgEtekIteLIgenAExdMbUgénkarBüa)aleday»sfRbqaMgemeraKeGds_
plrMxanbnþicbnþÜcEdlekItmanCaFmHta³
Sceg¥ar rak QWk,al ht; QWeBaH eKgminlk;
plrMxanF¶n;F¶r³
S 3TC: kMr[manplrMxanF¶n;F¶rNas;
S D4T: peripheral neuropathy: s<wkb¤ cak;eqob²enA éd b¤ eCIg
S NVP: rmas;knÞÜlRkhm BuleføIm ¬Es,kelOg ceg¥ar QWeBaH Gs;kMlaMg
ekþAxøÜn ¦
S AZT: esøksøaMgxøaMg (Gs;kMlaMg ht; søaMg)
S EFV: rmas;knÞÜlRkhmxøaMg BuleføIm vegVgvgVan;b¤eRkomRkMkñúgcitþmindwg
mUlehtu. hameRbIcMeBaHRsþImanépÞeBaH
¬eFVI[b:HBal;dl;karlUtlas;rbs;TarkkñúgépÞ¦
RsþImanépÞeBaHEdlkMBugBüa)aleday»sfRbqaMgemeraKeGds_ehIymanecjnUveraKsBaØa RKUeBTüenA
esva OI/ARTKYrEtBinitüeLIgvij edIm,IeFVIkarvaytMél faetIeraKsBaØaenaHbNaþlmkBIkareRbI »sf
RbqaMgemeraKeGds_ b¤ »sfBüa)alCm¶W»kasniym b¤ bNþalmkBImanépÞeBaH.

78
CMgW»kasniymmYycMnYn nig karbgáarCMgW»kasniym
Pneumocystis carinii Pneumonia (PCP)
SKWCaCm¶WsYtF¶n;F¶rKMramkMEhgdl;CIvit bNþalmkBIemeraKpSiteQHaH
Pneumocystis Carinii ¬eKehAmüa:geTotfa Pneumocystis
Jirovecii¦.
SvaeFIVeGayb:3HBal;F¶n;F¶rdl;GñkCm¶WeGds_Edlman CD4 Tab ¬ticCag
200 ¼mm ¦Edl min)aneRbI»sfbgáarCm¶W PCP
SvabgðajeLIgedaymank¥ks¶Ütbnþicmþg² ekþAxøÜn nig ht;xøaMgeBlxMRbwg
SCm¶WenHmineqøIytbeTAnwgkarBüa)aledayeRbIGg;TIb‘Íy:UTIkeT
SeKBüa)alCm¶WenHedayeRbI kURTIm:uksasul kMritx<s;ry³eBl 3GaTitü
rYmCamYy Steroide ebIsinCa GñkCm¶WeGds_mansPaBF¶n;F¶rxøaMg.
SkarBüa)alnwgTTYleCaKC½y)an luHRtaEteKarBtamkarbgáarTI2
edIm,IeCosvagnUvkarlab;eLIgvij.
Cm¶WrlakeRsamxYrbgáedayemeraK Cryptocoque
SKWCaCm¶WbgáeLIgedayemeraKpSitEdlKMramkMEhgdl;CIvitrbs;GñkCm¶W
eGds_jwkjab;CageKbMput.
S vaekItenAelIGñkCm¶WeGds_Edlmankarvivtþn_eTAmux
CaTUeTA CD4< 50 ¼mm3 Qam.
SRbEhl90°énkrNICm¶WqøgedaysaremeraK Cryptocoque enH
EsþgecjCaCm¶Wrlak eRsamxYrk,al/ rYmCamYynwgQWk,alCab;CaRbcaM
ekIneLIgCalMdab; QWeRcInéf¶ eRcIn GaTitü b¤eRcInCagenHeTAeTot/ mank¥Üt
nig CYnmansHartI CYn)at;sHartI.
SeKBüa)alCm¶WenHeday Amphotericin B cak;tamsrés kñúgry³eBl
2-3 s)þah_ rYmCa mYynwg Fluconazole RKab;kñúgry³eBl8s)þah_.
SkarBüa)alTTYl)aneCaKC½yluHRtaEteKarBtamkarbgáarTI2edIm,I
eCosvagnUvkarlab;eLIgvij.
smÁal;³ CMgW Pneumocystis carinii eKehAmüa:geTotfa Pneumocystis jirovecii
79
karbgáarCm¶W PCP
SkarbgáarTI1³ RtUvpþl;[GñkpÞúkemeraKeGds_TaMgGs; Edlman³
- Cm¶WeGds__vivtþeTAmux ¬dMNak;kalTI3 2/ 3 b¤ 4 rbs;GgÁkarsuxPaBBiPBelak¦
- ekasika CD4 ticCag 200¼mm Qam
SkarbgáarTI2³ RtUvpþl;[GñkCm¶WEdlkMBugEtBüa)alCm¶W PCP
SkarbgáarKWkarpþl; cotrimozaxol 960 mg kñúg1éf¶. cotrimozaxol
GacbgáarpgEdrnUvCm¶W qøgEdlbgáeLIgeday Bacteria xøH² nig
toxoplasmosis
SkarbgáarRtUveFIVrhUtGs;1CIvit
b¤rhUtdl;GñkCm¶We3Gds_Edl)anTTYl»sfRbqaMgemeraKeGds_ man
CD4>200 ¼mm Qamkñúgry³eBl6Exya:gtic
SCm¶W PCP nwgminGacekItman)aneT
ebIsinCaGñkCm¶W)anTTYlkarBüa)albgáarRtwmRtUv.
karbgáarCm¶W PCP
SkarbgáarTI1³ RtUvpþl;[GñkpÞúkemeraKeGds_TaMgGs; Edlman³
c Cm¶WeGds__vivtþeTAmux ¬dMNak;kalTI3 2/ 3 b¤ 4 rbs;GgÁkarsuxPaBBiPBelak¦
c
ekasika CD4 ticCag 200¼mm Qam
SkarbgáarTI2³ RtUvpþl;[GñkCm¶WEdlkMBugEtBüa)alCm¶W PCP
SkarbgáarKWkarpþl; cotrimozaxol 960 mg kñúg1éf¶. cotrimozaxol
GacbgáarpgEdrnUvCm¶W qøgEdlbgáeLIgeday Bacteria xøH² nig
toxoplasmosis
SkarbgáarRtUveFIVrhUtGs;1CIvit b¤rhUtdl;Gñk3Cm¶WeGds_Edl)anTTYl»sf
RbqaMgemeraKeGds_ man CD4>200 ¼mm Qamkñúgry³eBl6Exya:g
tic
SCm¶W PCP nwgminGacekItman)aneT ebIsinCaGñkCm¶W)anTTYlkarBüa)al
bgáarRtwmRtUv.
CMgW»kasniymmYycMnYn nig karbgáarCMgW»kasniym ¬t¦
Cm¶Wrebg (TB)
SCm¶WrebgCaCm¶W»kasniymEdlekItmanjwkjab; nig CamUlehtucMbgénkar
søab;rbs;GñkpÞúkemeraKeGds_ TaMgenAelIBiPBelak nig enARbeTskm<úCa.
SemeraKeGds_minTak;TgTAnwgGRtax<s;énCm¶WrebgeLIy.k¾b:uEnþ karfycuH
nUvPaBsuaMEdlbNþalmkBIemeraKeGds_ eFIV[GñkCm¶WEdlmanpÞúkemeraK
eGds_RbQmmuxya:gxøaMgeTArkkarvivtþn_CaCm¶WrebgskmH.
SCm¶WrebgGacekItmanRKb;dMNak;kalénCm¶WeGds_. b:uEnþkarecjeraKsBaØa
KøInikmanPaBERbRbYl nig qøúHbBa¢agM BIkMritcuHexSayénRbB½n§PaBsuaM.
SkarBüa)aldUcKñanwgkarBüa)alrbs;GñkEdlminmanpÞúkemeraKeGds_Edr.
b:uEnþ GRtaénplrMxan bnÞab;bnSM karlab;eLIgvij karqøgCm¶WeLIgvij nig
karsøab; mankMritx<s;CagGñkEdlminmanpÞúkemeraKeGds_.
karecjeraKsBaØaKøInik ¬2¦
S Cm¶WrebgeRkAsYt EtgCYbRbTHjwkjab;elIGñkCm¶WeGds_CaBiess enAeBl S karBüa)al³ tRmUv[man»sfeRcInmuxsMrab;ry³eBlBüa)alyUr
Edl CD$ Føak;cuHTab.
S sNæanCm¶WrebgeRkAsYtEdlCYbRbTHjwkjab;CageKKWCaCm¶WrebgkUnkNþúr
- kUnkNþúrenAsgxagsrésTwkrég³mankUnkNþúr nigekþAxøÜn nigmanRskTMgn;
- kUnkNþúrenAeBaH³ QWeBaH ekþAxøÜnRskTMgn; nig eBlxøHmanrak
S TMrg;epSgeTot rYmman³ TwkkñúgeRsamsYt nig rlakeRsamxYrk,al b¤
k_Gacb:HBal;rhUt dl;xYrk,al ebHdUg q¥wgxñg b¤qw¥gdéTeTot nig snøak;
S CaTUeTAeKeFVIeraKvinic©½yedaysniñdæan BIeRBaHvamankarBi)aknwgrk AFBs .
karecjeraKsBaØaKøInik ¬1¦
SCm¶WrebgsYt (PTB) EsþgecjedaymanekþAxøÜnelIsBI 3s)þah_ rYmnigk¥k
nig cuHTMgn; rsab;rsl; EbkejIseBlyb; )aymin)an.
SeraKvinic©½yBwgEp¥keTAelIkarravrknUv Acid Fast bacill(AFB)
enAkñúgkMhak
enHKWCa Smear-positive rbs;Cm¶WrebgsYt
¬cUrcaMfa cMeBaHGñkCm¶WeGds_ krNIén Smear-negative
rbs;Cm¶WrebgsYtmancMnYnekIneLIg¦.
karBüa)alCm¶Wrebg
FmHta»sf 4muxsMrab;ry³eBl2Ex ehIybnþmkeTot KW»sf2mux
sMrab;ry³eBl 4Ex.
- rbb»sfenHKWeRbIdUcKñasMrab;Büa)alGñkpÞúkemeraKeGds_nigGñkKHanpÞúk
emeraKeGds_
- vaGacekItmannUvPaBRbqaMgKñarvag»sfBüa)alCm¶Wrebg nig»sf ARV
- ebIsinCaGñkCm¶WkMBugTTYlkarBüa)alCm¶Wrebg Gacp¥ak ART b¤k¾bþÚr»sf ARV *
*EFVGaceRbI)anCamYynwgkarBüa)alCm¶Wrebg karBüa)alRsþImanépÞeBaH
ehIymanCm¶WrebgmankarBi)akkñúgkarpþl;nUvkarENnaMBiesssMrab;eFVI ART
80
CMgW»kasniymmYycMnYn nig karbgáarCMgW»kasniym ¬t¦
sBaØanigeraKsBaØaEdlekItmanjwkjab;elIkumarpÞúkemeraKeGds_ karpþl;kURTIm:uksasuldl;kumarpÞúkemeraKeGds_edIm,Ibgáar
kURTIm:uksasuleRbIbgáarCm¶W»kasniymedIm,IRbqaMgnwg³
eraKsBaØaTaMgenHGaceXIjmancMeBaHkumarEdlminqøgemeraKeGds_Edr³ SCm¶Wrlaksac;sYt ¬PCP¦
SmanTm¶n;Tab nigminsUvmankarlUtlas; SCm¶WxYrk,aleday Cerebral Toxoplasmosis
SmanCm¶WGMe)AGMEbkCaerOy² SCm¶WqøgedayBYk)ak;etrIepSg²
SrakCaRbcaM Cm¶Wrlaksac;sYt ¬PCP¦
SmanCm¶Wrebg SCm¶Wrlaksac;sYténemeraKeGds_bNþalmkBI Pneumocystis Carinii
eraKsBaØaEdlminsUveXIjmancMeBaHkumarFmHta³ SCamUlehtuénkarsøab;rbs;kumarEdlpÞúkemeraKeGds_ EdlbgðajCaeraK
sBaØa k¥k RKun nigdkdegðImjab;ehIyú xIø²
SCm¶Wrlaksac;sYt ¬PCP¦ SminGacBüa)aledayBYkGg;TIb‘Íy:UTIkEdlFøab;eRbICaFmHta)aneLIy
SCm¶WpSitkñúgmat; Cm¶WxYrk,aleday Cerebral Toxoplasmosis
SehImkUnkNþúr SCaCm¶WxYrk,albNþalmkBI Toxoplasma Gondii
SehImRkeBj)a:rUTIt SmaneraKsBaØaRbkac; nigsBaØaCm¶WxYrk,alsMxan;²déTeTot

karpþl;kURTIm:uksasuldl;kumarpÞúkemeraKeGds_edIm,Ibgáar
kMriténkURTIm:usasul cab;epIþm bBaÄb;enAeBlNa
RKab; = 480mg karbgáardMbUg
sIru :U = 240 mg/5ml 1-kumarRbQmmanGayu6Ex 1-ebIsinCalT§pl¬-¦
[mþgkñúgmYyéf¶ 2-Gayu12Ex ebIsin
2-kumarpÞúkemeraKeGds_
KHaneraKsBaØa
5-9kg ½ RKab; b¤ 5ml man CD4<15% 3-ebI CD4>15% 2dg
10-14kg 1RKab; b¤ 10ml kñúgcenøaHeBl6Exmþg
15-24kg 1½RKab; b¤ 15ml
>25kg 2RKab; b¤ 20ml karbgáarbnÞab;³ bnÞab;BIeFIVeraKvinicä½yeXIjman
PCP RtUv[Gs;mYyCIvit

81
82
4>3>2
karEfTaMenAeBlmanépÞeBaH eBlQWeBaHsRmalnigsRmal
karEfTaMeRkaysRmal nigkartamdanEfTaMbnþ

vtßúbMNg
enAcugbBa©b;énvKÁenH sikçakamTaMgGs;Gacnwg³
1> BiPakSakarRKb;RKg®sIþpÞúkemeraKeGds_enAeBlmanépÞeBaH
2> GFib,ayGMBInItiviFIénkarbBa¢Ún®sIþeTAesvaepSg²
3> Bnül;GMBIkarRKb;RKg®sIþpÞúkemeraKeGds_enAeBlQWeBaHsRmalnigsRmal
4> BiPakSaGMBIkarRKb;RKg®sIþEdlmindwgBIsßanPaBpÞúkemeraKeGds_enAeBlQWeBaHsRmal nig
sRmal
5> GFib,ayGMBIsmasPaKsMxan;²énkarEfTaMPøam²dl;TarkEdleTIbnwgekIt
6>
erobrab;nigGFib,ayGMBIsmasPaKsMxan;²énkarEfTaMeRkayeBlsRmaldl;mþaynigkUnrbs;Kat;

  ry³eBl³ 3ema:g20naTII

83
skmHPaBTI1³ BaküKnwøH³ GnþraKmn_bgáarkarcmøgemeraKeGds_BImþayeTAkUnnigkarEfTaMépÞeBaHH
» RKÚnwgesIñu[sikçakameFIVkarCaKUnigerobrab;GMBIsar³sMxan;énB½t‘manEdl karbRBa¢abesvaEfTaMépÞeBaH
®sIþmanépÞeBaHKYrTTYl)anenAfñak;Gb;rMmþayenAÉesvaEfTaMépÞeBaH
S esvaEfTaMépÞeBaH KWCaRbPBEfTaMsuxPaBmYyd¾sMxan; nigpþl;nvU KuN
RbeyaCn_énsuxPaBdl;mþaynigRKYsarrbs;Kat; .
S RKb;RsþImanépÞeBaH gayRbQmnwgkarqøgemeraKeGds_Nas;
S kardak;rYmbBa©Úlesva PMTCT cUleTAkñúgesvaEfTaMépÞeBaHGacpþl;
RbeyaCn_dl;RsþImanépÞeBaHRBmTaMgkUnrbs;Kat;[TTYl)annUvesvaEfTaM
suxPaBkan;EtRbesIreLIg
S RsþImansuxPaBl¥GacEfrkSakUnrbs;Kat;)any:agRbesIr.

smasPaKénkarbgáarkarcmøgemeraKeGds_BI karRKb;RKgRsþImanépÞeBaHpÞúkemeraKeGds_enA
mþayeTAkUnenAEpññkEfTaMépÞeBaH esvaEfTaMépÞeBaH
SebIsindwgfaRsþImñak;;manpÞúkemeraKeGds_ RtUvbBa¢ÚnRsIþenaHeTArkesvaBüa)alCm¶W
RKb;RsþImanépÞeBaHTaMgGs;Edl)anmkTTYlesvaEfTaMépÞeBaH KYrEtTTYl)annUv³ »kasniym nigBüa)aleday»sfRbqaMgemeraKeGds_ (OI-ARV) edIm,I
S B½t’mannigkarGb;rMsuxPaB vaytémøBIPaBGacTTYl)annUvkarBüa)al ART enH[)anqab;ebIGaceFVI)an
S karGb;rMsþIGMBIsuvtßiPaBénkarrYmePTnigemeraKeGds_-Cm¶WeGds_ SebIsinCaRsIRþ Kb;l½kçx½NÐnwgTTYl)an»sfRbqaMgemeraKeGds_/ esva (OI/ART)
S karpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_-rYmTaMgédKU RtUvpþl;karBüa)aldl;RsIþ rYmCamYynwgkartamdankareRbIR)as;»sfpg nigpSar
S GnþraKmn_edIm,Ikat;bnßykarcmøgemeraKeGds_BImþayeTAkUn RbsinebIcaM)ac; P¢ab;CamYyesvaEfTaMMbnþdéTeTot
S karpþl;RbwkSasþIBIkarciBa©wmkUn SebIsinCaminTan;RKb;l½kçx½NÐnwgTTYl)ankarBüa)aleT esva OI/ART b¤GtIt
S kareFVIeraKvinic½äynigBüa)alCm¶WkameraK mnÞIreBTüRsuk RtUvpþl;CUn»sf ARV edIm,Ibgáardl;RsIþmanépÞeBaH cab;BI
eBlEdlépÞeBaHmanGayu28s)þah_eLIgeTA nigpSarP¢ab;CamYynwgesvaEfTaMbnþ
S B½t’mansIþBIEpnkarRKYsar déTeTot
S KMnitpþÜcepIþmsIþBImatuPaBKHaneRKaHfñak;rYmTaMgkarBüa)alCm¶Wrebg nigCm¶W SRKb;RsþImanépÞeBaHpÞúkemeraKeGds_TaMgGs; RtUv)anENnaM[eTAsMralkUnenA
RKuncaj; ¬enAtMbn;ratt,at ¦pg . 8
kEnøgEdlmanesva PMTCT 9

84
skmHPaBTI2³ krNIsikSa³³ karpþl;esvaa PMTCTdl;®sIþmanépÞeBaHH
» eKalbMNgénskmHPaBenH KWedIm,IrMlwk krNIsikSaelI®sIþmanépÞeBaHH
eLIgvijGMBIkarRKb;RKgEfTaMépÞeBaH
kñúgbribTén®sIþpÞúkemeraKeGds_ {NaNa} Gayu22qñaMmanépÞeBaHCaelIkTI1.
» RKÚnwgEckRkdasftcmøgénkrNIsikSa[eTA nag)anmkesvaEfTaMépÞeBaHenAeBlEdlKP’manGayu24GaTitü.
GñksRmab;Gan PaKK 1
» GñksH½RKcitþmñak;RtÚveLIgGankrNIsikSamYy bnÞab;BIsþab;karGb;rMenAbnÞb;Gb;rMmþaymk nag)anseRmccitþTTYlkarpþl;RbwkSa
PaKmþg² bnÞab;mksikçakamTaMgGs;CaGñk nigeFIVetsþQamrkemeraKeGds_.
eqIøysMNYr
» RtÚvBiPakSanUvsMNYrnImYy² s 1 etIGñkpþl;RbwkSaRtÚvcat;;viFankarya:g dUcemþcxøH?
» cUrGñkKitfa etImanEdlCYbbTBiesaFn_ PaKK 2 {NaNa} )anRtLb;mkTTYlkarpþl;RbwkSaeRkayetsþenAéf¶bnÞab;. nagmanpÞúkemeraKeGds_.
RsedogKñaEdrb¤eT enAkEnøgeFIVkarrbs;Gñk?
» etIviFankarN_énkarRKb;RKg)aneFIVdUcKñanwg s22 etIviFankarGIVEdlKYreFIV edIm,IRKb;RKgEfTaM®sIþenAeBlmanépÞeBaHkñúgeBlbc©úb,nñenH?
krNIsikSaEdrb¤eT? PaKK 3 { NaNa} )aneTATTYlesva OI/AR. ekasika CD4rbs;nagman350¼mm3
s 3 etI {NaNa} KYrTTYl)annUvkarENnaMGIVxøH?
skmHPaBTI3³ lMhat;³ nItiviFIbBa¢ÚnnigTRmg;EbbbTT skmHPaBTI4³ krNIsikSa³³ karRKb;RKg®sIþpÞúkemeraKeGds__
» eKalbMNgénlMhat;enH KWedIm,IGnuvtþbMeBj³ » eKalbMNgénlMhat;enHKWedIm,IBinitüeLIgvijBIkarRKb;RKg®sIþpÞúkemeraK
1- Rkdaskt;Rtakarpþl;RbwkSa eGds_enAeBlsRmal
2- katsRmab;Nat;CYb
3- katsRmab;bBa¢Ún ¬ VCCT, PMTCT nig rebg¦ » karBiPakSaRtÚveyagtamkrNIsikSaEdl)anEckCUn
4- TRmg;EbbbTmnIÞrBiesaFn_
¬manenAkñúg]bsm<½n§énm:UDulenH¦ » GñksH½RKcitþnwgGanRbeyaKnImYy²nigsMNYrnImYy²
» RKÚnwgEckRkdasftcmøgénTRmg;EbbbTnigkateTAGñk.GñkRtÚveFIVkarCa » RKÚnwgsYreTARkúm[eqIøynwgsMNYrnig[cUlrYmkñúgkarBiPakSa
RkúmEdlmanKñaBI4-5 nak; edIm,IbMeBjTRmg;TaMgenaH
85
krNIsikSa³³ enAGKarsmÖB
EpñksmÖB ³ krNIsikSa³1
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RbqaMgemeraKeGds_. nagniyayfa nagQWeBaHkan;EtxøaMgeLIg² nigQWImgþ ²manry³eBlRbEhl4naTI.Gñk)anBinitümat;s,ÚnnigeFVIkarsniñdæanfa
ya:gehacNas;k¾Cag2em:ageTotEdreTIb {NaNa} sRmalkUn. Gñkpþl;fñaM NVP1kRmiteTA[nagenAeBlkMBugQWeBaH.
etIGñkRtÚveRbIeRsamédEdrb¤eT enAeBlBinitüGñkCMgWEdlmanpÞúkemeraKeGds_? tameKalkarN_bgáarCaskl etItRmÚv[GñkeRbIeRsamédsRmab;Binti ü
s 1>1 RKb;®sIþEdlmksRmal dUc²KñaEdrb¤eT KitTaMgeBlkMBugQWeBaHsRmalnigsRmal edayminKitGMBIsßanPaBpÞúkemeraKeGds_rbs;®sIþ?
s 1>2 etIenATIkEnøgeFVIkarrbs;GñkmanpÁt;pÁg;eRsaméd)anRKb;RKan;Edrb¤eT? etIeRsamédTaMgenaHmanTMhMepSg²RsbeTAnwgTMhMédEdrb¤eT?
s 1>3 etIeyIgGacdwgGMBITMnak;TMngrvagkarcmøgemeraKeGds_BImþayeTAkUnnigkarBinitümat;s,Únya:gdUcemþcxøH cMeBaH®sþImanépÞeBaHpÞúkemeraKeGds_ ?
PaK2 {NaNa})anEbkeRsamTwkeBaHePøaHGs;ry³eBlCag4ema:gmkehIy. nagGs;kmøaMgCaxøaMg. bnÞab;BIkarBinitütamry³ Partogramrbs;nag
RKÚeBTü)anseRmccitþeRbIOxytocin edIm,I[nagqab;)ansRmalkUn.
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CaGñkCUtsMgYtnigEfTaMTarkbnþ. bnÞab;mksukk¾Føak;ecj.
s 3>1 cUrrab;sMelokbMBak;karBarEdlsmRsbsRmb;eRbIenAEpñksRmal.
s 3>2 sUmRtiHriHBicarNaGMBIkare)aHecalvtßúßmutRsÜcenAEpñksRmalEdl)aneRbIrYcehIy. etIenAmnIÞreBTürbs;GñkmanRbGb;suvtißPaBb¤FugsRmab;Tukdak;vtßú
TaMgenHEdrb¤eT>?
s 3>3 etIenAmnIÞreBTürbs;GñkmaneKalkarN_sIþGMBIkare)aHecalsRmamEdrb¤eT? etIGñkRtÚve)aHecalsuknigsmÖar³déTeTotya:gdUcemþc?
PaK4 {NaNa} KWCa®sIþTI8ehIyEdlGñk)ansRmalkUn[kñúgry³eBl24ema:gknøgeTAenH. GñkRtÚvRtLb;eTApÞHnigCYbCMuRKÜsar. k¾bu:Enþ GñkEdlRtÚvbnþevn
BIGñkminTan;mkdl;. Gñk)anniyayesIñeTAkan;RbFanrbs;Gñk[CYyrkGñkNamñak;;mkCMnYsGñk.
s 4>1 etIGñkmanGarmHN_ya:gNaEdr enAeBlEdlRbFanrbs;GñkfaGñkGaceTApÞH)an?
s 4>2 enAkEnøgeFVIkarrbs;Gñk etImanGñkNaEdlGacCYYyGñkkñúgkarrkbuKÁlikmkCMnYskargarGñkEdrb¤eT RbsinCamankarcaM)ac;?
86
skmHPaBTI5³ rMlwkeLIgvij³ karRKb;RKg®sþIpÞúkemeraKeGds_enAeBlQWeBaHsRmall
» søayTI14-20 EdlrMlwkGMBInItiviFIsRmab;RKb;RKgdl;®sIþenAeBl
QWeBaHsRmal
karbgáarCasklenAeBlQWeBaHsMralnigsMral¬1¦
S biTmuxrbYsenAelIEs,k b¤muxrbYscMh * edaybg;s¥itEdlminRCabTwk
S Bak;eRsamédenAeBlEdleFVIkarb:HBal;nwgQam b¤sarFaturavrbs;srIragÁ
SBak;Gav)øasÞikEdlminRCabTwkenAeBleFIVkarsMral
SRbsinebImanQamxÞatRbLak;elIEs,k RtUvRbjab;lagnwgTwknigsab‘U.
RbsinCaxÞatcUlEPñk RtUvlagEPñkCamYynwgTwkEtb:ueNaÑH.
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suvtßiPaB edayGnuvtþeTAtameKalkarN_énmUldæan
* GñkmanCm¶WesIEs,k minKYreFVIkarenAEpñksmÖBeLIy
karcmøgemeraKeGds_enAeBlQWeBaHsMralnigsMral
S eRKaHRbQmnwgkarcmøgemeraKeGds_BImþayeTAkUnenAeBlQWeBaHsMral nig
sMral manRbEhl15PaKry
S karcmøgenHekIteLIg)anenAeBlEdlTarkb:HpÞal;nwgQamnigsarFaturav
rbs;mþay
S karRbQmnwgkarcmøgemeraKeGds_BImaþ yeTAkUnkñúgkMLúgeBlQWeBaHsMral
nig sMral Gackat;bnßy)aneday³
SGnuvtþCaRbcaMnUvkarbgáarCaskl
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14
karbgáarCasklenAeBlQWeBaHsMralnigsMral ¬2¦
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¬elx21 RbEvg4 s>m¦ enAeBledrsaeLIgvij
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15 16
87
 GnuvtþkarsMralkUnEdlmansuvtißPaB viFIsMralkUn
S eRbI»sf ARV edIm,Ibgáarb¤Büa)alenAeBlQWeBaHsMraledayeyag karsMralkUnedayvHkat; Gackat;bnßyeRKaHRbQmnwgkarcmøgemeraK
eTAtamBiFIsar eGds_BImþayeTAkUn ebIsinCa³
S kat;bnßykarBinitümat;s,Ún[)ankMritGb,brma S bnÞúkemeraKrbs;mþayx<s;
S eCosvagkarTuk[RsIþQWeBaHsMralyUr S )aneFIVmuneBlQWeBaHsMral
S eCosvagkarbMEbkeRsamTwkePøaHCaRbcaM k¾b:uEnþmankarRbQmnwgeRKaHfñak;EdlTak;TgeTAnwgkardak;fñaMsNMþ nigkarvH
kat;
S eCosvagkareFIV[b:HTgiÁcxøaMgenAeBlsMral
kMNt;cMNaM³ enAkmú<úCabc©úb,nñ karsMralkUnedayvHkat;min)anENnaM[eFIVCa
S kat;bnßyeRKaHRbQmnwgkarFøak;QameRkaysMral[)ankMritGb,brma
S pþl;Qam[RsIþEtenAeBlNacaM)ac; nigeRbIEtQamNaEdl)anBinitü sþg;daeT. eKeFIVEtkñúgkrNIEdlmanbBaðaxagsmÖBEtb:ueNÑaH.
rkemeraKeGds_rcY b:eu NÑaH 17
18

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sMral ¬1¦ sMral ¬2¦
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sñammkCamYy S mankarBi)akkñúgkarpþl;RbwkSa edaysarEtRsIþkMBugEtQWeBaHxøaMg
RsIþTaMgenaHnwg)at;bg;»kasTTYlesva PMTCT
karRbQmnwgkarcmøgemeraKeGds_BmI þayeTAkUnenAeBlQWeBaHsMralnig elIkTwkcitþ[RsIþTTYlesvapþl;RbwkSanigeFIVetsþQameRkaysMral[)anqab;tamEdl
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sMralmanRbEhl 15° 19 ¬kñúgkMLúgeBl72ema:geRkaysMral¦ ebIsinCamþaymanpÞúkemeraKeGds_. 20

88
 » skmHPaBTI6³ BaküKnøwH³ karEfTaMPøam²dl;TarkeTIbnwgekIt
RKÚnwgesIñ[GñkKitGMBItRmÚvkarEdlRtÚveFIVCabnÞan; bnÞab;BIsRmalkUnrYc
» etIdMbUgGñkRtÚveFIVGIV enAeBlEdlTarkekItecjmk etIRtÚvbgáardUcemþcxøH
enAeBleFIVkargarenaH
» sresrcemøIyTaMgenHenAelIkþarexon
» etIbnÞab;mkRtÚveFIVGIVeTotnigRtÚvbgáarya:gdUcemþcxøH?
» sresrbEnßmcMNucnanaenAkñúgbBaI¢EdlmanenAelIkþarexon
» bnþeFIVdUecñHrhUtdl;Gs;eyabl;
skmHPaBTI7³ bMpusKMnit³ smasPaKénkarEfTaMeRkaysRmall
» RKÚnwgesIñ[GñkeFIVkarCaKU edIm,IbeBa©jKMniterobrab;nUvGIV²TaMgGs;Edl
KYrbBa¢ÚlkñúgkarEfTaMdl;®sIþpÞúkemeraKeGds_eRkayeBlsRmal
» søayTI27 segçbkarRKb;RKg®sIþEdlmindwgBIsßanPaBpúúÞkemeraKeGds_
rbs;xøÜn
89
karEfTaMPøam²dl;TarkeTIbnwgekIt
S rkSa[)annUvkarbgáarCaskl enAeBlEfTaMTark
S Bak;eRsamédnigEv:ntakarBarEPñk enAeBlb:HBal;TarkEdleTIbnwigekIt
S ekobTgsuk[)anqab;eRkayeBlekIt. minRtUvc,ÚtrWtTgsukeT. RKbTg
suk nwig és,muneBlkat; edIm,IeCosvagkarxÞatQam
S CUtmat;nigRcmuHrbs;Tarkedayés,enAeBlEdlk,alvaekItecjmkput
S kuMTMlab;bWtesøsHTarkCaRbcaM. eRbIRbdab;bWtesøsHTark ebIsinCaTark
manQøk;TwkePøaH ( amniotique fluide)
S sMgYtTarkniwgkEnSgs¥at
S bBa¢ak;CamYymþay[)anc,as;BICMerIsénkarciBa©wmkUnrbs;Kat;
S pþl;vItamIn K 1mg cak;sac;dMunigbnþk;fñaMEPñkR)ak;nIRtatcUlkñúgEPñkkUn
karEfTaMeRkaysMral
eTaHbICaRsIþmansßanPaBpÞúkemeraKeGds_ya:gNak¾eday muneBlecjBImnIÞr
eBTüRtUvpþl;RbwkSadl;RsIþGMBI³
1> karciBaw©mkUn
2> GaharUbtßmÖ
3> karcak;fñaMbgáarCm¶W7mux
4> EpnkarRKYsar nigpþl;B½t’mansmRsbGMBIrebobTTYl)annUvesvaEfTaMbnþ
eBlevla nig TIkEnøgedIm,ITTYlesvaTaMgenaH.
mþaypÞkú emeraKeGds_RtUvkarkarEfTaMtamdannigKaMRTbnþ EdlRtUv)ansMrb
sMrYl tamry³bNþajbBa¢ÚnrvagesvanImYy²enAkñúgmnIÞreBTü nigenAtam
shKmn_ 25
 karEfTaMeRkaysMraldl;RsIþpÞúkemeraKeGds_nigkUnrbs;Kat;
enAmuneBlcakecjBImnÞIreBTü mþayRtUvTTYlB½t’mandUcxageRkam³
1> karBüa)albgáareday»sfRbqaMgemeraKeGds_sMrab;mþaynigkUn
2> karciBa©wmEfTaMTarkEdleTIbnwigekIt
3> karcak;fñaMbgáarCm¶W7muxdl;Tark
4> karGb;rMTUeTA
5> EpnkarRKYsar ¬sUmGanvKÁTI2énm:UDulenH¦
6> sBaØanigeraKsBaØaénkarkøayeraKeRkaysMral
7> karBüa)al EfTaM nig KaMRTbnþ dl;RsIþpÞúkemeraKeGds_ nigkUnrbs;Kat;
8> bnþkarKaMRTpøÚvcitþ 26
RsIþEdlmindwgBIsßanPaBpÞúkemeraKeGds_nigkUnrbs;Kat;
RsIþEdlmindwgBIsßanPaBpÞúkemeraKeGds_ RtUvEt³
S TTYl)annUvkarEfTaMdUcKñanwgRsIþpÞúkemeraKeGds_Edr
S TTYl)annUvB½t’mannigkarGb;rMGMBIemeraKeGds_-Cm¶WeGds_ nigkarpþl;RbwkSa
nigeFIVetsþQamBIGñkpþl;RbwkSaenAEpñksmÖB b¤GKareRkaysMral
S )anelIkTwkcitþkñúgkarTTYl)annUvesvapþl;RbwkSanigeFIVetsþQamCamYyédKU
enAkñúgkMLúgeBl 72em::ageRkaysMraledIm,I[³
- kUn)anTTYlkarbgáareday»sfRbqaMgemeraKeGds_ ebIsinCamþay
manpÞúkemeraKeGds_
- mþay)anTTYlkarpþl;RbwkSasIþBIkarciBaw©mkUnrbs;Kat; nigkUnrbs;Kat;
RtUvEtTTYl)annUvkarcak;fñaMbgáarCm¶W7muxdUcTarkdéTeTotEdr.
27

skmHPaBTI8³ eFIVkarCaRkúm³ smasPaKénkarEfTaMeRkaysRmall

» eKalbMNgénskmHPaBenH KWedIm,IBinitülMGitGMBIsmasPaKénkar
EfTaM®sIþ
» sikçakamRtÚv)anEckCa4Rkúm nigEckRbFanbTdUcteTA³
RkúmTI1³ ARVsRmab;bgáardl;mþaynigTark
RkúmTI2³ karciBaw©mTarknigkarcak;fñaMbgáar
RkúúmTI3³ Gb;rMsuxPaBTUeTAsRmab;mþay
RkúmTI4³ karKaMRTpøÚvcitþ
» eFIVkarBiPakSaenAkñúgRkúm edIm,IsresrcMNucsMxan;²énRbFanbTrbs;Gñk
» RkúmnImYy²RtÚvcat;tMNagmñak;edIm,IeLIgmkbgðajkic©karrbs;RkúmxøÜn

90
 ehtuGIV)anCamþayRtUvelb AZT nig 3TC bnÞab;BIsMral?
1> »sfbgáarRbqaMgemeraKeGds_
S »sfRbqaMgemeraKeGds_ Nevirapine (NVP) manRbsiT§PaBBak;kNþalén
sMrab;RsþIpÞúkemeraKeGds__ Edl)aneRbI»sf ARVsMrab;bgáar³ ry³eBlBI25-30ema:g
S RtUvR)akdfamþay)anTTYl³ S enHmann½yfaenAeBlQWeBaHsMral kar[»sf NVP 1 dUs vaGacsßitenAkñúg
xøÜnmþayCaeRcInéf¶¬3-7éf¶¦
AZT (300mg) + 3TC (150mg) elb2dgkñúg1éf¶ ry³eBl7éf¶bnÞab;
S manPsþútagbgðajfa emeraKeGds_GacvivtþxøÜn[suManwig»sf NVP enAkMLúgeBl
BIsrM al enH
S Bnül;Kat;GMBIsar³sMxan;énkarelbfñaM[)anRtwmRtUv S emeraKeGds_sauMniwgfñaMGac³
S CH\T§iBlGaRkk;eTAdl;mþayenAeBlBüa)aleday»sfRbqaMgemeraKeGds_
ebIsinCaRsþIkBM ugTTYlkarBüa)al ART RtUvrMlwkKat;[³ ART enAeBlGnaKt
S bnþeRbIrbb»sfBüa)alrbs;Kat;teTAeTot S raldalPaBsMuaenH eTAdl;kUn nig bþIrbs;Kat;
S RtLb;eTAesvaBüa)alCm¶W»kasniymnigBüa)aleday»sfRbqaMgemeraK S karelb AZT nig 3TC rYmpSMKñary³eBl7éf¶eRkayeBlsMral Gackat;bnßykuM
eGds_ OI-ART tamkarkMNt;rbs;RKUeBTü edIm,IeFIVkartamdanbnþ [emeraKeGds_ qab;suaMnwigfñaMeBkkñúgkMLuúgeBlEdl NVP sßitenAkñúgxøÜnrbs;
mþayenAeLIy. 30
nigTTYl»sfbEnßmeTot. 29

kareRbI»sfRbqaMgemeraKeGds_ ARV ehtuGVIcaM)ac;[ AZT eTATarkeRkayekIt?

sMrab;bgáardl;Tark SRtUvpþl; AZT dl;TarkeRkayeBlekIt sMrab;ry³eBl7éf¶ edIm,I[R)akdfa
»sf ARV sMrab;bgáar³ emeraKeGds_Edl)ancUleTAkñúgQamrbs;kUnenARtImascugeRkay
S TarkRtUvTTYl NVP 1kMrit kñúgkMLúgeBl72em:ageRkaysMral enAeBlQW eBaHsMral b¤eBlsMral minGacbgákarcmøgdl;Tark)an
S RtUvR)akdfakUn)anTTYl AZT sMrabr;y³eBl7éf¶
Ã
SRtUvpþl; AZT dl;TarkeRkayeBlekItry³eBl28éf¶ ebIsinCamþayeRbI»sf
¬b¤28éf¶¦eRkaysMral ARV b¤ ART min)anRKb;4s)þah_muneBlsMralkUneT BIeRBaHeRKaHRbQm
S RtUvR)akdfa mþay)anyl;BeI KalbMNgénkar[»sf AZT eTAkUn nwgkarcmøgemeraKeGds_eTAkUnmansPaBx<s;
nigdwgBIrebob[fñaMeTAkUn
à RbsinebImþay)anTTYlkarbgáar ARVb¤Büa)al ART eday»sf BüayamsÞabsÞg;CMenOnigkaryl;dwgrbs;mþayGMBI»sf nigkarBüa)al
RbqaMgemeraKeGds_ muneBlsMralticCag4s)þah_. muneBlBnül;Kat;BIkareRbI AZT
31
32

91
 2> karciBaw©mTarkeTIbnwgekIt
eRkayeBlsMral nigmuneBlecjBImnIÞreBTü Gñkpþl;RbwkSaRtUvFanafa
mþaypÞúkemeraKeGds_ ³
S )anTTYlkarpþl;RbwkSaGMBICMerIsepSg²BIkarciBaw©mkUn
S GacsMerccitþeRCIserIsviFIciBaw©mkUnEdlmansuvtißPaBCag
S )anTTYlkarbeRgonBIrebobciBaw©mkUn nigRtUv)ansegátfaKat;Gac
eFIV)an
S )anTTYlB½t’manGMBIesvaepSgeTotEdlRtUvTTYl nigGñkEdlRtUv
TMnak;TMngCamYyedIm,I)anTTYlesvaenaHebIsinCaKat;RtUvkar
S RtUv)anbBa©ÚneTARkumEfTaMGñkCm¶WeGds_tampÞH b¤RkumKaMRTdl;Gñk
pÞúkemeraKeGds_ ebIsinCaKat;mancitþcg;cUlrYm
4> karGb;rMTUeTA
ENnaMmþayGMBI³
S karEfTaMefñrTVar nigedaHrbs;Kat;
S viFankarN_EdlKat;RtUveFIVCamYysMPar³qøg dUcCa³ RkNat;RbLak;Qam
b¤sMLIGnam½y
S sar³sMxan;éncMNIGaharRKb;RKan;sMrab;mþay kareFIVlMhat;R)aN karsMrak
Gnam½yl¥.l.
S \Ti§BlGaRkk;éneRKOgRsvwg karCk;)arI karesBeRKOgejón .l.
S sBaØanigeraKsBaØaénCm¶WkameraK sar³sMxan;énkarBüa)alCm¶WkameraK 35
)anTan;eBl nigTIkEnøgEdlRtUvTTYlesvaTaMgenaH
karcak;fñaMbgáarCm¶W7mux
S RtUvpþl;karcak;fñaMbgáardl;TarkRbQmnwgemeraKeGds_ dUcTarkdéT
eTotEdr edayepIþmcak; BCGÃ nig HepB(0) PøameRkayeBlekIt
S enAeBlTarkGayu)an6s)þah_ RtUvykTarkeTAmNÐlsuxPaBedIm,ITTYl
DTP nig HepB(1) nig Polio (1)
S kalbrieqäTenH KWdUcKñanwgTarkdéTeTotEdr
à minRtUvpþl; BCG dl;TarkEdlmaneraKsBaØaemeraKeGds_eT
33
34
yuT§saRsþénGaharUbtßmÖsMrab;mþaypÞúkemeraKeGds_
pwksarCatirav[)anjwkjab;; dUcCaa ³
STwkEdlmanCatiRbUetGuInnigpþl;famBlx<s; ¬]³ TwksENþk¦
sMrab;eBlmanRKunekþAnigGs;kMlaMg
SpwkTwkEpøeQIlayKña ebIsinCamankark¥Ütceg¥ar b¤rak
SeRbIR)as;bMBg;bWtebIsinCaQWmat;
STwks‘ub.l.
briePaKGahartictYc nig GaharsMrn;[)anjwkjab;; ³
SkñúgenaHmanGaharTn;²EdlKat;cUlcitþ
SbegáInkarbriePaKGahar[)an500KILUÚkaLÚrIkñúgmYyéf¶ ebIsinCabMe)AkUnedayTwkedaH
SeCosvagkarbriePaKmðÚbqa ebIsinCamanrak b¤eBaHevonbWtRsUbmin)anl¥
SbriePaKbbrxab; ebIsinCamanQWmat; k¥Üt ceg¥ar b¤ rak
SbriePaKeck ebIsinCamanCm¶Wrak
enAtamtMbn;mYycMnYn manGgÁkareFIVkarkñúgshKmn_xøH 36
GacCYypÁt;pÁg;Gahardl;RsIþ)an.
92
 5> EpnkarRKYsar 6> karkøayeraKeRkaysMral
S manbBa¢ak;enAkñúgm:UDulTI4 vKÁTI2 Gñkpþl;RbwkSaRtUvBinitürksBaØanigeraKsBaØaéneraKqøg nigpþl;B½t’manGMBITI
kEnøgEdlRtUvTTYlkarBüa)aleraKsBaØaTaMgenaH dUcCa³
S enamRkhay
S RKunekþA
S LÚsIu ¬ Lochia¦FMku iøns¥úy
S k¥kmankMhak dkdegIðmjab;xIø²
S sñammuxrbYsenAeBaH b¤enATVar eLIgRkhm QWcab;xøaMg nigmanhUrxÞúH
S EpñkxageRkaméneBaHeLIgrwgxøaMg
37
38

7> karBüa)al EfTaM nigKaMRT kartamdanbnþedayesva OI-ART

S RsIþpÞúkemeraKeGds_EdlkMBugBüa)aleday»sfRbqaMgemeraKeGds_ ART
KYrEtRtUv)antamdanbnþBIkarBüa)alrbs;Kat;eRkayeBlsMraledayesva
Büa)alCm¶W»kasniymnigBüa)aleday»sfRbqaMgemeraKeGds_ OI-ART
mþaypÞúkemeraKeGds_EdlTTYlkarbgáareday»sfRbqaMgemeraKeGds_
ARV RtUvRtLb;mkTTYlesva OI-ART vijedIm,ItamdanCm¶Wrbs;Kat; eTaHbI
CaKat;minmaneraKsBaØak¾eday k¾ekasika CD4rbs;Kat;GacFøak;cuHdl;cMNuc
EdlKat;RtUvTTYl ART Edr
SRsIþpÞúkemeraKeGds_KYrTTYl)annUvesvaEfTaMbnþeRkaysMral
39
S karbgáarnigRKb;RKgCm¶W»kasniym
S karBüa)alnigtamdanCm¶Wrebg
S karbgáarnigBüa)alCm¶WRKuncaj; enAkñúgtMbn;qøg
S kartamdankarBüa)aleday»sfRbqaMgemeraKeGds_
S vaytémøBIl½kçx½NÐTTYl)annUv ARTCafIH
S EfTaMnigKaMRTedayRkumEfTaMGñkCm¶WeGds_tampÞH RkumGñkpÞúkemeraK
eGds_ nigRkumEfTaMKaMRTdéTeTotEdlenAtamshKmn_
S mNÐlmitþCYymitþ
40

93
 kartamdankumarenAmNÐlsuxPaB kartamdankumarenAesvaCm¶WeGds_kumar ¬1¦
kumarRbQmnwgemeraKeGds_TaMgGs;RtUvbBa¢ÚneTAesvaCm¶WeGds_kumaredIm,Itamdan
kartamdankumarenAmNÐlsuxPaBrYmman³ cab;6s)aþh_énCIvit rhUtdl;Gayu18Ex
S karcak;fñaMbgáarCm¶W7mux kartamdanman³
S vaytémøBIGaharUbtßmÖ S BinitürkemIlsBaØanigeraKsBaØaénCm¶WeGds_
- taragtamdankarlUtlas;énkumar S BinitüemIlBIkarlUtlas;nigkarvivtþn_
- rMlwkBIkarciBaw©mkUn S Büa)alCm¶W»kasniym (PCP)
- tMrUvkarbþÚrviFIciBaw©mkUn S RsavRCavrkemeraKrebg nigBüa)al
S BinitüsuxPaB S bgáarnigBüa)alCm¶WRKuncaj;
- eraKsBaØanigcegáameraKsBaØaénCm¶W CUcCaCm¶WeGds_CaedIm S RKb;RKgCm¶W rYmmanCm¶W»kasniym
- karbBa¢ÚneTAesvaCm¶WeGds_kumar ebIcaM)ac; S eFIVetsþQamenAeBlkumarmanGayu18Ex
S karbBa¢ÚneTAesvaKaMRTenAtamshKmn_ ebIsinCaRsIþmanbMNg S pþl; ART ebIsinCaRKb;l½kçx½NÐEdlRtUvpþl;[ Ã

42
41 * eKalkarN_ENnaMCatisIþBk
I arBüa)aleday»sfRbqaMgemeraKeGds_enAelIkumar

kartamdankumarenAesvaCm¶WeGds_kumar ¬2¦ kartamdankumarenAesvaCm¶WeGds_kumar ¬3¦

karBüa)albgáarCm¶W»kasniym³
kURTIm:uksasulsMrab;bgáar RtUvpþl;[kumarcab;BIGayu6s)þah_
rhUtdl;³
SrkeXIjfakumarKHanpÞúkemeraKeGds_
SkumarKHaneraKsBaØa enAeBlmanGayu12Ex
kareFIVetsþQam³
RKb;kumarRbQmTaMgGs;RtUveFIVetsþQamrkemeraKeGds_enAeBl
EdlkumarmanGayu18Ex edaymankaryl;RBmBImþay
b¤GaNaBüa)al
esvaBüa)alCm¶WeGds_kumar³
S RtUvpSarP¢ab;CamYyRkumEfTaMGñkCm¶WeGds_tampÞHnigRkumKaMRTGñkpÞúk
emeraKeGds_ edIm,I
StamdankumarRbQmenAtamshKmn_ ¬edaymanyl;RBmBIRKYsar¦
SkMNt;)an nigbBa¢ÚnkumarRbQmEdlmin)andwgBImunenAkñúgshKmn_
eTATTYlesvaEfTaM nigeFIVetsþQam
43
S pþl;B½t’manGMBIesvaKaMRTepSgeTot dUcCamNÐlmitþCYymitþtUc² 44

94
 karKaMRTpøÚvcitþ CMerIskñúgkarKaMRTpøÚvcitþ
karKaMRTpøÚvcitþdl;mþayeRkaysMralmansar³sMxan;Nas; BIeRBaH³ S pþl;karRbwkSaeRkaysMraledaybuKÁlik PMTCT
S mþayxøHeTIbEtdwgBIsßanPaBpÞúkemeraKeGds_rbs;xøÚnfIH² ehIyKat; S bBa¢ÚneTAGgÁkarEdlmanenAtamshKmn_
SRkumEfTaMtampÞH
minTan;;GacsMrbxøÜn)anPøam²eT SRkumKaMRTGñkpÞúkemeraKeGds_
S mþayxøHpSarP¢ab;CIviteTAnwglMenAsßanEdlKat;rs;enA dUecñHkarKaMRTBI SGgÁkarsasna
SGgÁkarenAtamshKmn_epSgeTot
RkumEfTaMGñkpÞúkemeraKeGds_-Cm¶WeGds_ nigBIshKmn_mansar³ S mNÐlmitþCYymitþ EdlTTYl)antamry³esva OI-ART
sMxan;xMøagNas;
GgÁkarxøHGacCYy]btßmÖdl;tMrUvkarBiessxøH² dUcCa³ pÞH meFüa)ay
S bc©úb,nñenH nagmankUn dUecñHnagkan;EtBi)akcitþedaysarEt eFIVdMeNIr mðÚbGahar nigkarRbkbmuxrbredIm,IbegIánR)ak;cMNUl
46
45
nagKitBIkUnrbs;nag

95
cMNucKnwøH
m:UDulTI4>3>2³³ cMNucKnwøH
S karsRmalEdlmansuvtißPaBmandUcCa kareCosvagnUvviFIsRmalNa
Edlbgá[man karb::HTgiÁc nigGnuvtþCanic©nUvkarbgáarCaskl
S karpþl;RbwkSasIþGMBIkarciBaw©mkumar KYrepIþmeFIVenAeBl®sIþmkBinitüépÞeBaH
nigbnþrhUtdl;eBlQWeBaHsRmalnigeRkaysRmal
S karEfTaMeRkaysRmalnigtamdandl;mþaynigkUn RtÚvmansmasPaK
dUcteTA³
1> karpþl;»sfARVsRmab;bgáardl;mþaynigTark
2> karciBaw©mkUnEdleTIbnwgekIt
3> karcak;fñaMbgáardl;Tark
4> karGb;rMsuxPaBTUeTA
5> EpnkarRKÜsar
6> sBaØanigeraKsBaØaénkarkøayeraKeRkaysRmal
7> karBüa)alEfTaMnigKaMRTdl;mþaypÞúkemeraKeGds_nigkUnrbs;Kat;
8> karKaMRTpøÚvcitþCabnþ

96
]bsm<½n§
skmHPaBTI3³ RkdasbBaI¢sRmab;pþl;RbwkSa³³ TMB½rTI1

97
RkdasbBaI¢sRmab;pþl;RbwkSa³³ TMB½rTI2

98
katNat;CYb

99
katbBa¢Ún ¬sRmab;esvaa VCCT PMTCTnigrebg¦¦

100
TRmg;sRmab;mnIÞrBiesaFn_

101
102
4>3>3
karciBaw©mkUnkñúgbribTénemeraKeGds_-CMgWeGds_

vtßúbMNg
enAcugbBa©b;énvKÁenH sikçakamTaMgGs;Gacnwg³
1> Bnül;GMBIeKalkarN_ENnaM sIþGMBIkarciBaw©mkUnenAkñúgbribTénemeraKeGds_
2> Bnül;GMBIeKalbMNgnigkarpþl;RbwkSa sIþGMBIkarciBaw©mkUnsRmab;esva PMTCT
3> BiPakSaGMBICeRmIssMxan;bMputénkarciBaw©mkUnEdlmanenAkm<úCa nigBnül;GMBIKuNsm,tiþ
nigKuNvibtiþrbs;va
4> BiPakSaGMBIkarCab;Bak;B½n§énCeRmIsénkarciBaw©mkUnepSg²eTAnwgkarR)ab;GMBIsßanPaBpÞúk
emeraKeGds_eTAGñkdéT

  ry³eBl³ 3ema:g

103
skmHPaBTI1³ bMpusKMnit³ TsSn³CamUldæankñúgkarciBaw©mkUn
» RKÚnwgesIñ[GñkKitGMBIkarciBaw©mkUnkúñúgn½yTUeTA nigkarciBaw©mkUnEdlman
TMnak;TMngCamYy®sIþmanépÞeBaHpÞúkemeraKeGds_
» KitBIeKalbMNgénkarciBa©wmkUn GMBIiviFIciBaw©mkUnxus²Kña GMBIsar³sMxan;
énkarqøgemeraKeGds_ EdlmanTMnak;TMngTAnwwgkarGnuvtþn_kñúgkarciBaw©m
kUn
104
yuT§saRsþsklsMrab;ciBaw©mTarknigkumartUc² Ã
ƒ kgVHGaharUbtßmÖTTYlxusRtUvedaypÞal;b¤edayRbeyalcMeBaHkarsøab;Cag
50°énkumarGayueRkam5qñaM kñúgcMeNamkumarsøab; 10>9lannak;enATUTaMg
BiPBelak
ƒ kñúgcMeNamkumarEdlsøab; mankumarCag1lannak;GayueRkam1qñaM
ƒ yuT§saRsþsklsMrab;ciBaw©mTarknigkumartUc² )anerobcMedayGgÁkar
suxPaBBiPBelak nigGgÁkarshRbCaCatimUlniFiedIm,Ikumar edIm,IeFVI[
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à sUmGanB½t’manlMGitkñúg]bsm<½n§EdlmanenAkñúgm:UDulenH 7
plb:HBal;énkarciBaw©mkUn
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ƒ cMeBaHmþaypÞúkemeraKeGds_ k¾mankarRbQmnwgkarcmøgemeraKeGds_
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8
skmHPaBTI2³ karelgEl,g³³ GnuvtþkarciBaw©mkUnnigkarcmøgemeraKeGds__
» eKalbMNgénlMhat;enHKWKitGMBIkarRbQmnwgkarcmøgemeraKeGds_
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» RKÚnwg[GñkxitekAGIeTAmçag rYcehIyQrCargVg;cMkNþalbnÞb;
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eraKeGds_ enAeBlciBaw©mkUnedayedaH
» GñkEdleqIøyRtÚv²eTAQrenAcMkNþalrgVg;
» GñknwgRtÚv)ansYrpgEdrGMBIviFIEdlGackat;bnßykarcmøgenH ebIGñkeqIøyRtÚv
nwgRtÚv)an[mkcUlrYmkñúgRkúmFMvij
» GñkRtÚveFIVdUecñaHrhUtTal;EtGs;sMNYr
» BinitüemIl faetIRkúmEdlenAxagkñúgGaceTAcUlrYmCamYyRkúmFMmþgeTot)an
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105
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karciBa©wmkUnedayTwkedaHmþay
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karcmøgemeraKeGds_BImþaycenøaHBI 5-15°
karciBaw©mkUnedayTwkedaHeKaemSACMnYsTwkedaHmþay
S Gacbgá[manCm¶Wrak Cm¶WpøÚvdegIðm nigkgVHGaharUbtßmÖ ebIsinCaGaharmin
)anerobcM[mansuvtißPaBnigRtwmRtUveT k¾b:uEnþvaminRbQmnwgkarcmøg
emeraKeGds_BImþayeTAkUneT
10
etIbBaðaénkarcmøgemeraKeGds_tamry³
karbMe)AedaHmanTMhMb:uNÑa?
S eRbva:Lg;énGñkqøgemeraKeGds_enAkm<úCa manRbEhl 2°. kñúgcMeNam
RsIþ1000nak; manRsþI®bEhl20nak;manpÞúkemeraKeGds_
S karRbQmnwgkarcmøgemeraKeGds_tamry³karbMe)AedaHmanRbEhl15°
kñúgcMeNamRsIþpÞúkemeraKeGds__ cMnYn20nak;; CamYynwgkUn20nak;³
S manTarkRbEhl4nak;nwgqøgemeraKeGds_BImþayenAeBlmanépÞeBaH
eBlQWeBaHsMral nigsMral
S manTarkRbEhl3nak;nwgqøgenAeBlbMe)AedayedaHmþay
11
 ktþaRbQmnwgkarcmøgemeraKeGds_enAeBlbMe)AkUnedayedaHmþay karciBaw©mkUnedayedaHmþay karbgáaredayeRbI»sf
ARV nig karBüa)aleday ART
karRbQmnwgkarcmøgemeraKeGds_tamry³karbMe)AkUnedayedaHmþay
ekIneLIgenAeBlEdl³
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S edaysarEteTIbnwgqøgfIH ¬enARtImascugeRkayénkarmanépÞeBaH b¤enA eBlbMe)AedaHeT
eBlbMe)AkUnedayedaHmþay¦
S edaysarEtCm¶WeGds_vivtþeTAmux S karBüa)aleday ART pþl;karkarBardl;TarkBIkarcmøgemeraK
S bMe)AkUnedayedaHmþayry³eBlyUr eGds_CaerogrhUt kñúgkMLúgeBlkMBugbMe)AkUnedayedaHmþay eday
S ciBaw©mkUnedayGaharcMruH eFIV[bnÞúkemeraKeGds_rbs;mþayenATab
S rlakedaH b¤eRbHcugedaH
S kUnmanpSitkñúgmat; b¤dMe)Amat; 12 13

eRKaHRbQménkarciBaw©mkUnedayGaharcMruH
S kUnEdlciBa©wmedayedaHmþay minRtUvpþl;Gaharb¤ePsC¢³epSgeTot
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14

106
skmHPaBTI3³ karBiPakSa³³ eKalneya)ayCatisþIGMBIkarciBa©wmkUn
» søayTI16-17 erobrab;GMBIkarENnaMrbs;GgÁkarsuxPaBBiPBelak sIþGMBIkarciBaw©mkUn
» søayTI18 GFib,ayGMBIeKalkarN_ENnaMCati sIþGMBIkarciBaw©mkUnsRmab;®sIþpÞúkemeraKeGds_
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karBar elIkkMBs; nigKaMRT” S bnþbMe)AedaHkUnrhUtdl;kumarmanGayu2qñaM
S cab;epIþmpþl;GaharbEnßmEdlmantulüPaBGaharUbtßmÖdl;kUn enAeBlEdl
kUnmanGayu6ExeLIgeTA
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)aneroberogeLIgeday UNAIDS, WHO, UNICEF, 1997 kñúgeBlbMe)AedaH nigGnuvtþsuvtißPaBénkarrYmePT edIm,Ikat;bnßykarRbQmnwg
16 17
karcmøg nigRbQmnwgkarqøgemeraKeGds_enH.
karciBa©wmkUn karENnaMsMrab;RsIþEdlman niymn½y
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S karbMe)AkUnedayTwkedaHmþayKYrEtbBaÄb;[)anqab; ehIymþayRtUv
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nigmansuvtißPaB Cak;)an
S mþaypÞúkemeraKeGds_TaMgGs;KYrTTYlkarpþl;RbwkSasIþBIkarciBaw©m
mansuvtißPaB(Safe): RKYsarGacTTYl)annUvTwks¥atsMrab;layTwkedaHeKaemSA
nigsMrab; lagsMGatsMPar³epSg² ehIynigGacTTYl)annUvesvaEfTaMsuxPaBEdl 19
kUn 18 enACitpÞH
sikçakamKYrGan{ 10dMNak;kaledIm,ITTYleCaKC½ykñúgkarciBaw©mkUnedayTwkedaHmþay (WHO, UNICEF) enAkñúg]bsm<½n§énm:UDulenH
107
skmHPaBTI4³ karpþl;RbwkSasIþGMBIkarciBa©wmkUn
» cMNaM³ mþayKWCamnusSEtmñak;Kt;EdlCaGñkseRmccitþkñúgkareRCIserIs
viFIciBaw©mkUn
karpþl;RbwkSasIþBIkarciBa©wmkUn
karpþl;RbwkSaRtUvEtdak;bBa©lÚ nUvB½t’mannigkarGb;rMdUcCa³
S eRKaHfñak;énkarqøgemeraKeGds_BImþayeTAkUntamry³karbMe)AkUn
edayedaHmþay
S sar³sMxan;énkarciBaw©mkUn edIm,I[kumarmansuxPaBl¥/ TTYl)annUv
GaharUbtßmÖRKb;RKan; karFMFat;nigkarlUtlas;)anl¥
S viFIcBi a©wmkUnepSg² KuNsm,tþinigKuNvibtþiénviFITaMgenaH
karpþl;RbwkSaRtUvKitdl;karGnuvtþn_ CMenO nig TMenomTMlab;
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22
108
eKalbMNgénkarpþl;RbwkSasIþBIkarciBa©wmkUn
elIkkMBs;karGnuvtþn_viFIciBa©wmkUnEdlRbkbedaysuvtßiPaBnigedIm,I
kat;bnßy³
S eRKaHRbQmnwgkarcmøgemeraKeGds_BImþayeTAkUn
S GRtasøab;nigGRtaQWrbs;kumarEdlbNþalmkBIkgVHGaharUbtßmÖ
nigCm¶Wqøg
S karRbQmnwgkarmak;gayEdlmaneTAelImþaynigRkumRKYsarrbs;Kat;
GnuvtþkarciBaw©mkUn[)anRtwmRtUvtamkarENnaMGackat;bnßykarcmøgemeraK
eGds_BImþayeTAkUn nigkat;bnßykarsøab;rbs;kUnEdlbNþalmkBICm¶Wraknig
Cm¶Wqøg 21
karsMerccitþBIkarciBaw©mkUn
mþayEdlmanpÞúkemeraKeGds_³
S mansiTi§eRCIserIsviFIciBaw©mkUnEdlxøÜneBjcitþ
S RtUvTTYlkarpþl;RbwkSaedIm,IeFIVkarsMerccitþeRCIserIsviFIciBaw©mkUn
Gñkpþl;RbwkSa³
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S RtUveFIVCamKÁúeTsk_dl;mþayEdlpÞúkemeraKeGds_ kñúgkareRCIserIsviFI
ciBaw©mkUn[)anRtwmRtUvtamsßanPaBrs;enArbs;Kat;
23
skmHPaBTI5³ etIkarpþl;RbwkSasIþGMBIkarciBaw©mkUnRtÚveFIVeLIgenAeBlNanigpþl;RbwkSaedayGñkNa??
kMNt;smÁal;³ etIkarpþl;RbwkSasIþBIkarciBa©wmkUnRtUveFIVeLIgenAeBlNa?
» karpþl;RbwkSasIþGMBIkarciBa©wmkUnRtÚveFIV[)aneRcIndgtaMgBImanépÞeBaH SmuneBlsMral
rhUtdl;eRkaysRmal Spþl;B½t’man nig karGb;rM edIm,ICYy[mþayeRCIserIsviFIciBa©wmkUn
» KWCakarsMxan;Nas;EdlmþayRtÚvmanTMnku citeþ lICeRmIsrbs;xnÜø nigRbsinCa
rbs;Kat;
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Spþl;karENnaMnigKaMRTmþay kñúgkarGnuvtþn_viFIciBa©wmkUnEdlKat;
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25

etIGñkNaCaGñkpþlR; bwkSaBIkarciBa©wmkUn? karKaMRTenAtamshKmn_

RKb;buKÁliksuxaPi)alEdl)anbNþúHbNþalBIkmHviFbI gáarkarcmøgemeraKeGds_
BImþayeTAkUn enAesvaEfTaMépÞeBaH sMralnigeRkaysMral mantYnaTIya:gsMxan;
kñúgkar ³
Spþl;B½t’manGMBIviFIciBa©wmkUndl;RsþImanépÞeBaHEdlpÞúkemeraKeGds_ nig
Spþl;karENnaMnigKaMRTdl;RsIþ TaMgkñúgGMLúgeBlmanépÞeBaH nigeRkayeBl
sMral.
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nig tamdanTarknigkumarEdlRbQmcab;BIGayu6s)þah_eLIgeTA.
26
S karGb;rMenAtamshKmn_ nigskmHPaBcl½tGacCYyCMruj[lT§plénkar
pþl;RbwkSaBIkarciBa©wmkUnenAtammNÐlsuxPaBkan;EtRbesIreLIg
S RkumEfTaMtampÞH RkumKaMRTGñkpÞúkemeraKeGds_-GñkCm¶WeGds_ nigGgÁkar
nana mantYnaTIya:gsMxan;kñúgkarCYyKaMRTRsþIenAtampÞH
Gñkpþl;RbwkSaénesva PMTCT RtUv[R)akdfa RsþIpÞúkemeraKeGds_nwgTTYl
)annUvkarKaMRTBIshKmn_ebIsinCaman edaymankaryl;RBmBIsamIxøÜnpg.
27

109
skmHPaBTI6³ BaküKnwøH³ viFIciBaw©mkUn
» RKÚnwgerobrab;R)ab;GñkBIktþamYycMnYnEdlRtÚvelIkykmkBicarNa viFIciBa©wmkUn ktþaTaMgLayEdlRtUvBicarNa
enAeBleFIVkareRbóbeFobBICeRmIsénkarciBaw©mkUnepSg²Kña bEnßmBIelIeRKaHRbQmnwgkarcmøgemeraKeGds_eTAkUn enAeBleRCIserIsviFI
ciBa©wmkUn ktþaEdlRtUvBicarNaman³
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SkarcMNay
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SelIkkmøaMgcitþ
SktþasgÁm nigvb,Fm’ 29

skmHPaBTI7³ kargarCaRkúm³ CeRmIsviFIciBa©wmkUn

» eKalbMNgénskmHPaBenHKWedIm,IBinitüBICeRmIsénviFIciBaw©mkUnxus²Kña » KitGMBICeRmIsénkarciBaw©mkUn nigsresrGMBIKuNsm,tiþnigKuNvibtþirbs;
RBmTaMgKuNsm,tiþnigKuNvibtiþrbs;va
» RKÚnwgEcksikçakamCa4Rkúm nig[RkúmnImYy²nUvRbFanbTdUcteTAenH³ viFInImYy² nigcMNucepSg²eTotEdlGñkrkeXIjtamEdlGaceFIV)an
RkúmTI1³: søayTI32-38 » RkúmnImYy²nwgeLIgmksegçbKMnitrbs;RkúmxøÜn
karciBaw©mkUnedayTwkedaHmþayEtmYymuxKt;nigkarpþac;edaHPøam²
RkúmTI2³ søayTI39-45 » sresrcemIøyBIeRkamRbFanbTenAelIkþarexon[)ansmRsb
» eRkayBIRkúmnImYy²eFIVkarbgðajBIkic©karrbs;xøÜnrYcehIy GñkRtÚvBiPakSa
karciBaw©mkUnedayTwkedaHeKaemSACMnYsTwkedaHmþay
RkúmTI3³ søayTI46-48
karciBaw©mkUnedayTwkedaHkemþA ¬TwkedaHrWtBIedaHmþay¦ elICeRmIsénkarciBaw©mkUnnImYy² edayepþateTAelIKuNsm,tiþ nig
KuNvibtiþénCeRmIsnImYy² nigriHrkviFIkat;bnßyeRKaHRbQmTaMgenaH

110
kareRCIserIsviFIciBa©wmkUn³ ry³eBl6ExdMbUgénCIvit
1> karciBaw©mkUnedayedaHmþayEtmYymuxKt; nigkarpþac;edaHPøam²
CaCMerIsmYyEdlRtUv)anENnaMsMrab;mþayEdlpÞúkemeraKeGds_enA
kñúgRbeTskm<úCa
2> karciBaw©medayTwkedaHeKaemSACMnYsTwkedaHmþay
3> karcMGinTwkedaHmþay
RKb;kumarTaMgGs;RtUvkarGaharbEnßmRKb;RKan; cab;BIGayu6ExeLIgeTA
KuNsm,tþiénTwkedaHmþay
TwkedaHmþay³
S pþl;RKb;CIvCati nigTwkRKb;RKan;dl;tMrUvkarrbs;Tark
S gayRsYlkñúgkarrMlay
S manGgÁbdibkçR)aNkarBarragkay nigkarBarTarkBICm¶WmYycMnYn
BiessCm¶W rakrUs nig Cm¶WrlakpøÚvdegðIm
S mincaM)ac;cMNay manTwkedaHCanic© nigmincaM)ac;mankarerobcMBiess
GVIeLIy
33
karciBaw©mkUnedayTwkedaHmþayEtmYyKt; nigkarqab;pþac;edaH
karciBaw©mkUnedayTwkedaHmþayEtmYymuxKt; mann½yfa[Tarke)AedaHmþay
EtmYymuxb:ueNÑaH
SKHanePsC¢³ b¤GaharbEnßmeT ¬sUm,IEtTwkk¾mincaM)ac;Edr¦
S»sf b¤ vItamInCMnYybEnßmmYycMnYnGacpþl;[)an RbsinCacaM)ac;
karqab;pþac;edaH mann½yfa RtUvbBaÄb;karbMe)AkUnedayedaH[)anqab;
enAeBlEdlmanGaharCMnYsTwkedaHmþaysmRsbehIy ³
enAeBlTarkmanGayu RKb;6Exb¤ticCag
* smRsbmann½yfa³GacTTYlyk)an GaceFIV)an GacéllkrkTij)an
32
31 mannirnþrPaB nigmansuvtßiPaB {søayTI8}
KuNsm,tþiénkarciBaw©mkUnedayTwkedaHmþay
TwkedaHmþay³
S begIánPaBsñiT§sñalrvagmþaynigkUn
S CYykñúgkarBnüarkMeNIt
S karBarsuxPaBmþay
S kMriténkarcmøgemeraKeGds_BImaþyeTAkUnmankMritTabCagkarciBaw©mkUn
edayGaharcMruH
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S RtUv)aneKniymGnuvtþ dUecñHeKnwgminsYrfaehtuGIV)anCabMe)AkUnedayedaH
34
111
 KuNvibtþiénkarciBawm© kUnedayTwkedaHmþay karqab;pþac;edaH
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GaharCMnYsRKb;RKan;
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2-3s)þah_
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nigeFIVya:gNa[edaHenAmansuxPaBl¥
SkarbMe)AkUnmankarlM)akRbsinebImþayRtUveTARbkbkargar b¤enAeBlEdl - KaMRTpøvÚ citþ
mþayQW - KaMRTGaharUbtßmÖdl;kumar
*see WHO IYCF Counselling training course, session 19 35 36

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SGnuvtþkarRbmUlsMram[mansuvtßiPaB edaydak;kñúgfg;Cab;;l¥minFøayecj Twk b¤kñúgFug b¤
dutkñúgLsuvtßiPaB b¤ kb;. 12
Decontamination
SkarkMcat;emeraK (Decontamination)³ KWCadMNak;kaldMbUgkñúgkareFIV[]bkrN_
eRbIR)as;mansuvtßiPaB. RtUvRtaM]bkrN_eRbIR)as;kñúgTwkEdlmanCatikørIn0>5°
ry³eBl10naTI . dMNak;kalenHsMxan;Nas; eRBaHva GacsMlab;emeraKrlakeføIm
RbePTebnigemeraKeGds_)an
SkarlagsMGat (Cleaning) karlagsMGatsMPar³[)ans¥atCamYysab‘UnigTwkekþA
KWCadMNak;kalmYyd¾sMxan;munnwgQaneTAdl;kareRbICatiKImI b¤ es¶arrMgab;emeraK³
- bMpøaj[Gs;nUvGtisuxumR)aNEdlmanbrimaNx<s;
- yksarFatukxVk;karBaremeraKecj[Gs;dUcCa FUlIdI CatiGMbil nig
sarFatuepSg²eTot
SkarrMgab;emeraK (Desinfection) CaviFIkMcat;GtisuxumR)aNmYycMnYnFM
edayeRbIR)as;CatiKImI.
k¾b:uEnþviFIenHminGacbMpøajGs;ral;sNæanénemeraKeT ¬]³ s<½rén)ak;etrI¦13

SkarrMgab;emeraK (Sterilization) kMeTcGs;nUvral;GtisuxumR)aN;Etmþg

123
 karbgáarCaskl³ karbgáarCaskl³ r)aMgkarBar
kareRbIR)as;vtßúmtu RsYc[mansuvtßiPaB
SeCosvagkarRKbKMrbm©úledayédTaMgBIr S eRbIR)as;eRsamédenAeBlb:HpÞal;CamYysarFaturavénragkay Es,krbYs
SRbsinebIcaM)ac;RtUvRKbm¢úleTAkñúgKMrbvij RtUveRbIEtédmçagtamviFIsÁÚb (Scoop) b¤RsTab;Pñasrbs;GñkCMgW
- dak;KMrbm¢úlenAelIépÞrabesHIehIyrwg bnÞab;mkRtUvdkédecj
- eRbIédmçagkan;sIuruaMgEdlmanP¢ab;m¢úl ehIyeRbIm¢úlenaHedatcUlkñúgKMrbm¢úl S eRbIR)as;m:as;karBar Ev:ntakarBarEPñk GavkarBar ¬GavEvgeFVIGMBICati
- enAeBlEdlm¢úlcUlkñúgKMrbm¢úls‘ubrYcehIy RtUveRbIédmçageTotrujKMrbm¢úl )øasÞik¦ nig Es,keCIgkEvgC½r edIm,IkarBarQamb¤ sarFaturavénragkay
- bBa¢Úl[kibeTAnwgdgm¢úl EdlxÞatb:H
SeRbIR)as;m¢úlsIuruaMg nig kUnkaMbitsMrab;vHkat;fIHCanic© ehIyeRbIrbs;TaMgenHsMrab;
EtGñkCm¶Wmñak;Etb:ueNÑaH S eRbIRkNat;¼bg;s¥its¥atEdlminRCabTwkRKbb¤bitelI muxrbYs b¤Es,k
Se)aHecalm¢úl¬sMrab;cak;eRkamEs,knigsMrab;edr¦ nigvtßúmutRsYcdéTeTot rlat;;
¬kaMbitvHkat; Lam ¦eTAkñúgRbGb;suvtßiPaB S eRbIR)as;nUvFnFansmRsmnigmanRbsiT§iPaB³ eRbIR)as;sMPar³karBar
SRtUvykRbGb;suvtißPaBTaMgenaHeTAdutbMpøajecalkñúgL b¤kb;ecal ehIyminRtUv CaGaTiPaBsMrab;eFIVkarbgáItkUn nigsMrab;edrrbYs.
ykmkeRbIR)as;mþgeToteT. 15
14

karRKb;RKgbrisßankargar
SbegáItnigGnuvtþ nUveKalneya)aynignitiviFI sMrab;raykarN_nigBüa)al
bgáardl;GñkEdlRbQmnwgemeraKeGds_
SEfTaMnigkarBardl;buKÁlikRKb;Can;fñak;[)ansmRsb
SGnuvtþviFankarKaMRT EdlGacCYykat;bnßynUv Stress PaBÉeka nig Burn out
STTYldwgB¤nigeqIøytbeTAnwgtMrUvkarrbs;buKÁliksuxaPi)alEdlqøgemeraK
eGds_
Spþl;nUvsMPar³nigkarpÁt;pÁg;EdlcaM)ac;sMrab;GnuvtþkarbgáarCaskl³ sMelok
bMBak; nigsMPar³sMrab;karBar plitplsMlab;emeraKEdlsmRsb
nigRbGb;suvtßiPaB
SRtUvFana[)annUvkarbMpøajecalral;RbGb;suvtßiPaB nigsMPar³TaMgGs;Edl
eRbIR)as;rYc[)anRtwmRtUv
16
karGb;rMCaRbcaMBIkarbgáarCm¶Wqøg
SENnaMbuKÁlikTaMgGs; rYmTaMg GñkGb;rMsuxPaBdl;GñkrYmkargar Gñkpþl;
RbwkSa nig GñksMGat [)anyl;dwgBIeKalkarN_énkarbgáarCaskl
SFanafa ral;buKÁlikTaMgGs;EdleFVIkarRbQmnwgQamnigsarFaturavén
ragkayCaRbcaM ¬evC¢¢bNÐit qHb Kilanubdæak nig Kilanubdæayika nigGñk
sMGat¦ TTYl)ankarbNþúHbNþaltaMgBIdMbUg nigCabnþGMBIkareRbIR)as;
sMPar³ nigeRKÓgbrikçarTaMgGs;[mansuvtißPaB
StMrUv[GñkRKb;RKgeFVIkarcuHBinitüCaeTogTat; nigeFVIkarvaytémøelIkar
Gnuvtþn_ edaysuvtßiPaB nigpÁt;pÁg;nUvkarxVHxatCacaM)ac;.
17

124
skmHPaBTI3³ BaküKnwøH³ niymn½yénBaküü PEP
» RKÚnwgsYrGñkBIGIVEdlGñk)andwg b¤)anyl;GMBIkarBüa)albgáareRkay etI PEP CaGVI?
RbQmnwgkarqøgemeraKeGds_ b¤ PEP
PEP ³
S KWCakarBüa)aledayeRbI»sfRbqaMgemeraKemeraKeGds_
S RtUv)anpþl;[EtcMeBaHGñkEdlKHanpÞúkemeraKeGds_Etb:ueNÑaH
S pþl;[bnÞab;BImaneRKaHfñak;kñúgkargarEdlRbQmnwgkarqøg
emeraKeGds_
S KWedIm,IbgáarkarqøgemeraKeGds_dl;buKÁliksuxaPi)al
20

skmHPaBTI4³ bMpusKMnit³ RbePTkargarEdlgayRbQmeTAnwgkarqøgemeraKeGds__

» RKÚsYrsikçakam [rkRbePTeRKaHfñak;énkargarRbQmnwgkarqøg etIRbePTénkargarGVIxøHEdlgayRbQmmuxeTAnwgkarqøgemeraKeGds¾?
emeraKeGds_EdlGacekItmaneLIg RbePTénkarRbQm ]TahrN_
» BüayameFIVkar)a:n;sHanBIkRmitRbQmeRkayeRKaHfñak; ¬]³ Tab mFüm manrbYsesIEs,k karmutm¢úl¼rbYsedaykUnkaMbitvHkat;
b¤x<s;¦ nigktþaepSg²eTotEdlGaceFIV[karRbQmmankRmitkan;Etx<s;
karb:HBal;CamYyPñas QamxÞatcUlEPñk
» bnÞab;mkcUrrkemIlfa etIsarFaturavénragkayRbePTNaxøHEdlmanpÞúk
emeraKeGds_ Es,kEdlmanrbYs QamxÞateTAb:HnwgEs,kEdldac;rEhk b¤man
rbYs b¤Es,kEdlmanrlak
» sresrcemøIyenAelIkþarexon nigKUsCataragEdlmanRbePTéneRKaHfñak;
eRKaHfñak;TaMgenH RbQmmuxeTAnwgkarqøgCm¶WrlakeføImRbePTeb
nigkRmiténkarRbQm nigRbePTes RBmTaMgemeraKeGds_pgEdr. 22

125
 etIeRKaHRbQmnwgkarqøgmankMritF¶n;F¶rRtwmNa? rbYsedaymutm¢úl
RbePTénkarRbQm karRbQmmuxnwg karBnül; eRKaHRbQmnwgkarqøgemeraKeGds_tamry³rbYsedaymutm¢úlmankMritx<s;
karqøgemeraKeGds_ RbsinebI³
karmutm¢úlesIEs,k 0.3% 3nak;¼1000 SrbYsmuteRCAedaym¢úlmanRbehag
éneRKaHfñak; SmanQamRbLak;Cab;m¢úl
elIPñas 0.09% 9nak;¼10/000 Sm¢úlenaHCam¢úlcak;kñúgsrésQam
éneRKaHfñak; SGñkEdlCaRbPBedImsißtkñúgdMNak;kalcugeRkayénCm¶WeGds_ ¬BIeRBaH
Es,kEdlmanrbYs <0.09° < 9nak;¼10/000 GRtaemeraKeGds_enAkñúgQamrbs;GñkEdlCaRbPBedImmankMritx<s;¦
éneRKaHfñak; 23 24

etIsarFaturavénragkayNaxøHEdlGaccmøgeraK? etI PEP manRbsiT§iPaBy:agdUcemþc?

eRKaHfñak;x<s; ³ RbsinebIelb)anRtwmRtUvPEPGackat;bnßyeRKaHRbQmnwgkarcmøgemeraK
SQam eGds_)anRbEhl2¼3
eRKaHfñak;mFüm ³ ¬GacmaneRKaHfñak;x<s;ebIsinmanlayQam¦ enaHmann½yfaa ³
SxYrq¥wgxñg TwkePøaH TwkeRsamebHdUg TwkeRsameBaH TwkeRsamsYt SRbsinebImin)anGnuvtþ PEP eT karRbQmnwgkarqøgemeraKeGds_Gacman
Twkkñúgsnøak;q¥wg 3krNI kñúgcMeNamGñkmutrbYs1000krNI
KHaneRKaHfñak;; ³ ¬maneRKaHfñak;luHRtaEtmanbrimaNQamRKb;RKan;¦ SdUecñHebI)anGnuvtþPEPkarRbQmnwgkarqøgemeraKeGds_Gackat;bnßy
STwksMe)ar Twkmat; TwkEPñk eBaJIs Twkrég TwkRkBH Twkenam lamk mkenARtwm 1krNIkñúgcMeNamGñkmutrbYs1000krNI
25 26

126
skmHPaBTI5 ³ etIIcaM)ac;RtÚveFVIGVIxøH bnÞab;BImankrNIRbQmnwgkarqøgemeraKeGds_kñúgkargarr
» søayTI27-37 erobrab;GMBIdMNak;kalepSg²EdlRtÚveFIVbnÞab;BI
mankarRbQmnwgeRKaHfñak;kñúgkargar
» eKalbMNgéndMeNIrkarenH KWedIm,IFanafa enAeBlNaEdlRtÚveFIVkar
Büa)albgáarPEP . RtÚvpþl;CUndl;buKÁliksuxaPi)alEdlrgeRKaHPøam²
k¾b:uEnþminRtÚvBüa)al PEPEdlminsmRsbenaHeT.
karRKb;RKgkrNIRbQmnwgkarqøgemeraKeGds_kñúgkargar
SbnÞab;BImankarRbQmnwgkarqøgemeraKeGds_ buKÁliksuxaPi)alEpñkEfTaM
suxPaBRtUveTArkesva OI-ART PøamebIsinCaGac.
SRbsinebIGñkpþl;esva OI-ART minGacTTYl)anPøam²eT RtUveTArk
esvaseRgÁaHbnÞan;énmnÞIreBTübEg¥kEdlenACitenaH[)anqab;CaTIbMput
SEpñkseRgÁaHbnÞan;énmnIÞreBTüRtÚvmanPar³kic©bNþúHbNþalbuKÁlikrbs;xøÜn
GMBIeKalkarN_ENnaMGMBI PEP nigman»sfRbqaMgemeraKeGds_RKb;RKan;
sMrab;;bgáarpgEdr. 28
127
cMNucsMxan;²man³³
» kMNt;[)anfaetI eRKaHRbQmenaHvaF¶n;F¶rrhUtdl;RtÚvBüa)alPEPEdr
b¤eT?
» kMNt;[)anfaetIRbPBCnbgámanpÞúkemeraKeGds_Edrb¤eT ?
» kMNt;faetIbuKÁliksuxaPi)alEdlrgeRKaHmanpÞúkemeraKeGds_Edrb¤eT?
etIIeyIgRtUveFVIGVIxøH
bnÞab;BImankarRbQmnwgemeraKeGds_kñúgkargar?
1> eFIVkarEfTaMCabzm elIkEnøgEdlmanmuxrbYs
2> )a:n;RbmaNBIsPaBénkarRbQm
k¦- etIkarRbQmnwgkarqøgemeraKeGds_enaH manlkçN³ya:gdUcemþc?
x¦- etIeRKaHfñak;enaHekIteLIgyUrb:uNÑaehIy?
K¦- etIGkñ EdlCaRbPBéneRKaHfñak;enaH manpÞkú emeraKeGds_Edrb¤eT?
3> )a:n;RbmaNBIsPaBrbs;buKÁlikEfTaMsuxPaB
4> kMNt;faetI RtUvpþl; PEP dl;buKÁlikEdlmaneRKaHfñak;Edrb¤eT?
5> eFIVkartamdanbnþ nigpþl;karRbwkSadl;GñkrgeRKaH
6> erobcMr)aykarN_ 29
 1> karEfTaMCabzmelIkEnøgEdlmanmuxrbYs
kEnøgmuxrbYsnigEs,k ³
SlagsMGatmuxrbYsedaysab‘UnigTwkry³eBl3naTI
PñasEdlRbQm ³
SRtUvlagsMGatCamYynwgTwks¥at bgðÚr[)an10naTI
karRc)ac;muxrbYs[ecjQammin)anENnaM[GnuvtþeT
30
2>x> etIeRKaHfñak;ekIteLIgmanry³eBlyUrb:uNÑaehIy?
ebIsinCakal³eTs³huc[³ karBüa)albgáareRkayRbQmnwgeRKaHfñak;
PEP KYrcab;epþImpþl;[kñúgcenøaHeBl4em:ageRkayBIkarmutrbYs
S PEP KYrcab;epþImeFIVeGay)anqab; kan;EtRbesIr edIm,I[karbgáarman
RbsiT§iPaBx<s;
SkarBüa)al PEP Edlcab;epIþmkñúgry³eBl36ema:g eRkayeRKaHfñak;
)anbgðaj fa)ankat;bnßyeRKaHRbQmnwgkarqøgemeraKeGds_
SminRtUvBnüareBlBüa)aleT enAeBlkMBugrg;caMlT§pletsþQamb¤bMeBj
EbbbTÉksarkIþ. 32
128
2>k>etIkarRbQmnwgemeraKeGds_enaHmanlkçN³ya:gdUcemþc?
RbePT nigbrimaNénsarFaturav b¤ Calika
S Qam
S sarFaturavEdlemIleTAmanlayQam
S sarFaturav b¤ekasikaEdlGacbgáeraKdéT²eTot
RbePT nigPaBF¶n;F¶rénkarRbQmnwgkarqøgemeraKeGds_³
S karRbQmnwgeRKaHfñak;enAeBlmutm¢úlelIEs,k
- CMerAénmuxrbYs?
- RbePTm¢úlEdlmut ¬RbehagnigmanmuxFM?¦
- eXIjmanQamCab;nwgm¢úlb¤KHan?
- m¢úlEdlcak;srésQam
S PñasEdlRbQmnwgeRKaHfñak;
S Es,kmanrbYsEdlRbQmnwgeRKaHfñak; brimaNQamEdlb:HBal;eRcInb¤tic?
S Es,kEdlKHanrbYs-minmaneRKaHfñak;eT
RtUvbBa¢ak;[)anc,as;fa buKÁlikEdlRbQmtictYc mintMrUv[eFIV PEP eT. 31
2>K>etIRbPBénCnEdlbgáeRKaHfñak;manpÞúkemeraKeGds_Edrb¤eT?¬1¦
S kMNt;sßanPaBpÞúkemeraKeGds_rbs;buKÁlEdlbgáeRKaHfñak; tamry³kareFVIetsþrh½s
rkGgÁbdibkçR)aN ³
kMNt;sMKal;³ munnwgeFIVetsþQam GñkRtUvEt³
- )anTTYlkarRBmeRBogCamunsin
- rkSakarsm¶at;[)an
- eKarBsiT§Ri sbc,ab;rbs;GtifiCnkñúgkarbdiesFeFVIetsþQam
- RbsinCaGac RtUveFVIetsþrkemeraK + rlakeføImRbePT B nig C
nigGgÁbdibkçR)aNRbePT C (HBsAg, HCV)
S RbsinebIbuKÁlEdlbgáeRKaHfñak; bdiesFkareFVIetsþb¤minGaceFVIetsþ)anRtUvvaytémøBI ³
SsBaØaKøInikNamYyEdlsgS½yfaCasBaØarbs;Cm¶WeGds_
SRbvtþiénkarRbRBwtþirbs;eKEdlRbQmnwgkarqøgemeraKeGds_
S RbsinebIGñkEdlTTYleRKaHfñak;min)andwgc,as;las;BIkarRbQmmuxRtUvvaytémøBI ³
- eRbvaLg;énkarqøgemeraKeGds_ ¬rlakeføImRbePT B nig C ¦enAkñúgshKmn_
edIm,IeFVIkar):an;sHanGMBIlT§PaBEdlGacRbQmnwgkarqøgemeraKeGds_BIGñkCm¶W 33
minRtUveFVIetsþelIm¢úlEdlRbLak;Qam sMrab;rkemeraKEdlrs;enAkñúgQameT..
 2>K>etIRbPBCnEdlbgáeRKaHfñak;manpÞúkemeraKeGds_Edrb¤eT?¬2¦ 3>kar):an;RbmaNelIbuKÁlikEfTaM³ B½t’manCamUldæan
RbPBCnEdlbgáeRKaHfñak;KHanpÞúkemeraKeGds_³
buKÁliksuxaPi)almmincaM)ac; ³ RtUvykB½t’manEdlTak;TgGMBI ³
SeFVIetsþQamrkemeraKeGds_eT Skarcak;fñaMbgáareCm¶WrlakeføImRbePTeb nigsßanPaBeqøIytbénv:ak;saMg
SeFIVkarBüa)albgáar PEPeT SkareRbIR)as;fñaMnaeBlbc©úb,nñ
StamdanbnþeT SsßanPaBevC¢saRsþnaeBlbc©úb,nñ b¤BImunmk b¤ sßanPaBepSg²eTot
Etral;r)aykarN_énrbYsRtÚvEtbMeBj.
RbPBCnEdlbgáeRKaHfñak;manpÞúkemeraKeGds_³ ]TahrN_³ manépÞeBaH bMe)AkUnedayedaH Cm¶WeføIm tMrgenam CaedIm
):an;RbmaNelIGñkEdlCaRbPBcmøgenaH ¬eKalbMNgedIm,IBicarNa b¤eRCIserIsrbbBüa)al PEP
SdMNak;kalénCm¶WeGds_
Srab;cMnYnekasika CD4 RtUv ³
SRbvtþiénkarBüa)al ART enAeBlbc©úb,nñ nigBIGtItkal SkMMNt;lT§pletsþQamTukCaeKal edayemIl serostatus
S¬bnúÞúkemeraK /karsuaMrbs;emeraKeGds_eTAnwg»sf ARV rbs;GñkRbQmenAeBl EdlmaneRKaHfñak;
SeFIV HBsAg + HCV antibody tests RbsinCamanlT§PaB
B½t’manenH KWRtUv)aneRbIR)as;edIm,IeFVIkarsMerccitþkñúgkarBüa)al PEP[)ansm
34 35
RsbbMptu .
3>kar):an;RbmaNelIbuKÁlikEfTaM³ etsþrkemeraKeGds_ 4>kMNt;BIkarBüa)al PEP
S kareFVIetsþQamrkemeraKeGds_RtUvEteFVIkñúgbnÞb;mYyEdlGaclak;karsm¶at;
dl;GtifiCn)an kñúgl½kçx½NÐc,as;las;énkargarEdlRbQmnwgkarqøgemeraKeGds_
S RbsinebIbuKÁlikEfTaM cg;eFIVetsþQamenAkEnøg VCCT RtUveKarBkar RbPBCn³ GviC¢man RbPBCn³ viC¢man
sMerccitþrbs;Kat;
buKÁliksuxaPi)al³ min)ac;Büa)alPEPeT
S RbsinebIcaM)ac;RtUvpþl;karBüa)al PEPRtUvpþl;CUnPøamedaymin)ac;rg;caM GviC¢man Büa)al PEP Ã

lT§pletsþQamrkemeraKeGds_eLIy.
S RbsinebIlT§pletsþQaménbuKÁlikEfTaM mansBaØaviC¢man buKÁliksuxaPi)al³ min)ac;Büa)alPEPeT min)ac;Büa)alPEPeT
bBa¢ÚnbuKÁliksuxaPi)al bBa¢ÚnbuKÁliksuxaPi)al
- RtUvbBaÄb;karBüa)al PEP Pøam Ã
viC¢man eTAesva OI/ART eTAesva OI/ART
- RtUvbBa¢ÚnKat;eTATTYlkarpþlR; bwkSaeyabl; nigBüa)aleday»sfRbqaMg
emeraKeGds_
ÃkñúgsßanPaBenH karBüa)al PEP minpþl;plRbeyaCn_dl;buKÁlikEfTaMeT ehIyGaceFVI[mankar36 *pþl;»;sfRbqaMgemeraKeGds__ 4éf¶ sMrab;ry³eBlcab;epþImdMbUg
37
kekIteLIgénPaBsuaMngw fñaMEfmeTotpg.

129
skmHPaBTII ³ krNIsikSaa ³ kargarRbQmnwgkarqøgemeraKeGds_enAGKarsRmall

» eKalbMNgénlMhat;enHKWedIm,IsegçbnwgKitGMBIkarRKb;RKgkrNIeRkay krNIsikSaa
RbQmnwgeRKaHfñak; supaNa eFIVkarenAEpñksmÖBrhUtdl;yb;eRCA. nag)andkm¢úlesr:UmecjBIéd
» sikçakamRtÚvEbgEckCa4Rkúm nigEck[RkúmnImYy²nUvkrNIsikSa rbs;GñkCMgW. Caécdnünag)anmutRmamédnwgm¢úlenAeBlEdldkvaecj.
nigsMNYr sMNYr³
» RKÚTukeBl[GñkKitry³eBl20naTI edIm,IeqIøynwgsMNYr 1>eRkayBIeFIVkargarRbQmnwgkarqøgemeraKeGds_ etImundMbUgbg¥s;supaNaKYr
» GñksH½RKcitþmñak;²énRkúmnImYy² RtÚv)anesIñ[eqIøysMNYrdMbUg. eFIVGIVxøH?
» RKÚnwgesIñ[RkúmepSgeToteLIgeqIøymþg1Rkúm² rhUtdl;RKb;Rkúm 2>etInagKYreFIVGIVbnÞab;mkeTot? sUmerobrab;GMBIviFIEdlnagRtÚveFIVCabnþbnÞab;.
edIm,IraybBaI¢GMBIdMNak;kalEdlRtÚvGnuvtþtam

130
skmHPaBTI7³ emeron³³ rbb»sfBüa)alPEP
» søayTI43-46 erobrab;lMGitGMBIkartamdanbnþ nigkareFIVr)aykarN_ rbb»sfBüa)al PEP
GMBIdMeNIrkareRkayBITTYleRKaHfñak; -cMeBaHrbYsedaykarmutm¢úl nig sac;Pañ s-Es,kEdlR)akdfaRbQmmux
nwgkarqøg RtUvpþl;³
» cMNaM³ karRbkan;x¢ab;nUvkarBüa)alPEPsRmab;ry³eBl28éf¶man ƒAZT* (300 mg) + 3TC (150 mg) eRbIerogral;12 em:ag kñúgry³eBl4
sar³sMxan;Nas; k¾b:uEnþvaminEmnCakargayRsÜleT. RtÚvykcitþTukdak; s)þah_
KaMRTdl;buKÁliksuxaPi)alenAkñúgry³eBlenH. -cMeBaHmuxrbYseRCAedaysarmutm¢úlEdlmanRbehagkñúg ³
ƒAZT* (300mg) + 3TC (150mg) + Kaletra (133/33mg):
[mþgcMnYnbIRKab; eRbIerogral;12 em:ag kñúgry³eBl4s)þah_
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layCamYynwgfñaMRKab; 3TC
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131
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•raykarN_BkI armut

132
cMNucKnwøH

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133
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  ry³eBl 2ema:g

135
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136
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15
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16
17

138
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EfTaM
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139
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Rbtibtiþ 36

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38

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147
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149
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150
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153
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158
 kartamdan karvaytémø
kartamdanRtYtBinitü KWGaRs½yelIkarRbmUlTinñn½yCaRbcaM nigkareFIV karvaytémøenH Gacvas;EvgnUvkarpøas;bþÚrnanaTak;TgeTAnwgkarcmøgemeraK
r)aykarN_ dUcCa³ eGds_BImþayeTAkUn EdlbNþalmkBIesvabgáarkarcmøgemeraKeGds_BImþay
S esovePAbBaI¢kt;Rta eTAkUn.
S r)aykarN_RbcaMEx eKvas;sÞg;suc©nkredayRsg;B½t’manEdl)anpþl;[BImUldæan edIm,I³
S r)aykarN_fñak;extþ SqøúHbBa¢aMgBIeKaledA eKalbMNg nigskmHPaBGnþraKmn_nanakñúgkarkat;
S r)aykarN_fñak;Cati bnßykarcmøgemeraKeGds_BImþayeTAkUnenATUTaMgRbeTs
B½t’manTaMgenH RtUv)aneRbIsMrab;³ SeFIVkar):an;RbmaNBIRbsiTi§PaBénkmHviFI EdleqIøytbeTAnwgkarbgáarkar
S ):an;RbmaNkarGnuvtþn_esvabgáarkarcmøgemeraKeGds_BImþayeTAkUn cmøgemeraKeGds_BImþayeTAkUn
S ravrknigEklMGnUvbBaða SeqIøytbeTAnwgsuc©nkrsklelak EdlmaneKaledAbgáarkarcmøgemeraK
S eRbIR)as;FnFanEdlmanRsab;[kan;EtmanRbsiT§iPaB. 19
eGds_BImþayeTAkUn.
20

tYnaTIrbs;buKÁliksuxaPi)alkñúgkarRbmUlTinñn½y suc©nkr (Indicator) ¬1¦

kartamdanRtYtBinitü nig vaytémømansar³RbeyaCn_EtkñúgkrNIEdlTinñn½y
manCab;Bak;B½n§ RtwmRtUv nig eBjeljbuKÁliksuxaPi)alRtUvEtR)akdfa xøÜn³
Syl;c,as;BITinñny ½ EdlRtUvRbmUl
Skt;RtaTinñn½yCaerogral;eBl
Skt;RtaTinñn½yTaMgGs;
Skt;RtaTinñn½ytamrebobEtmYyCaerogral;eBl
karpþl;B½t’manRtLb;sIþBIRbB½n§r)aykarN_EdlkMBugEtdMeNIrkar nigkareFIV[
RbB½n§r)aykarN_enaHkan;EtRbesIreLIgmansar³sMxan;Nas;.
21
suc©nkrCatisrM ab;kmHviFIbgáarkarcmøgemeraKeGds_BImþayeTAkUn³
SRtUv)anerobcMeLIgedIm,ItamdanBIsmiTi§plnana kñúgkic©GnþraKmn_
bgáarkarcmøgemeraKeGds_BImþayeTAkUn
SRtUv)anKNnaCaRbcaMBIr)aykarN_extþnigr)aykarN_fñak;Cati
søayBIrxageRkamenHnwgbgðajBIsuc©nkrCatisMrab;eRbIR)as;enAfñak;
mCÄwm.
22

159
 suc©nkr (Indicator) ¬2¦
1> ° énRsukRbtibtiþEdlmankBa©b;skmHPaBGb,brmaénesvabgáarkarcmøg
emeraKeGds_BImþayeTAkUn ya:gehacNas;mYy
vas;GRtaRKbdNþb;TUTaMgRbeTs
2> ° énRsIþEdlmkBinitüépÞeBaHelIkTImYy)anTTYlesvapþl;RbwkSanigeFIV
etsþQam
vas;GRtacUlrYmeFIVetsþQaménRsIþmanépÞeBaHenAtammNÐlcMNuc
3> ° énRsIþEdl)anmkTTYlkarpþl;RbwkSaeRkayetsþQam
vas;GRtamkTTYllT§pletsþénRsIþmanépÞeBaHenAtammNÐlcMNuc
4> ° énbursEdl)anTTYlRbwkSaeRkayetsþQam tamry³kmHvFi bI gáarkar
cmøgemeraKeGds_BImþayeTAkUn
23
vas;karcUlrYmrbs;burs
skmHPaBTI7³ karviPaKTinñn½y
» eKalbMNgénlMhat;enHKWedIm,IBinitüemIlsMNMuTinñn½ynigedIm,IviPaKtam
lkçN³samBaØmYy
» RKÚnwgEckGñkCaRkúmtUcnigEckRkdasTinñn½yénesvaPMTCT Edl
RbmUl)anBIEpñkEfTaMépÞeBaHkñúgry³eBl6Ex
» BinitüemIlTinñn½y[)anm:t;ct;nigbnÞab;mkeqIøynwgsMNYr
160
suc©nkr (Indicator) ¬3¦
5> ° énkumarRbQmEdl)andwgtamry³kmHviFIbgáarkarcmøgemeraKeGds_
BImþayeTAkUn )anTTYl»sfRbqaMgemeraKeGds_ edIm,Ibgáarkarcmøg
emeraKeGds_BImþayeTAkUn
vas;GRtacUlrYmrbs;RsIþ nigkumarEdlcUlrYmkñúgkmHviFIbgáarkarcmøg
emeraKeGds_BImþayeTAkUn
6> ° nigcMnYnkumarRbQmEdl)anTTYl»sfRbqaMgemeraKeGds_enAeBlekIt
nig)aneFIVetsþQamenAGayu18Ex
vas;GRtaqøgemeraKeGds_BImþayeTAkUn eRkayBI)anTTYl»sfbgáar
7> cMnYnbuKÁliksuxaPi)al Gñkpþl;RbwkSa nig GñkpÞúkeeraKeGds_Edl)an
TTYlkarbNúþúHbNþalsIþBIkarbgáarkarcmøgemeraKeGds_BImþayeTAkUn
kñúgry³eBl12ExknøgeTA
vas;karksagsmtßPaB.
24
sMNMuTinñn½y
®sIþmkesvaBinitüépÞeBaH mkraa kumÖ³ mIna emsaa ]sPaa mifuna srub
cMnYn®sIþmanépÞeBaHsrub 345 287 299 302 355 260 1848
cMnYn®sIþBinitüépÞeBaHelIkTI1 124 132 140 153 107 110 766
cMnYn®sIþ)anTTYlRbwkSamuneBleFIVetsþQam 65 80 50 56 80 82 413
cMnYn®sIþ)aneFIVetsþQam 58 70 40 38 71 68 3455
cMnYn®sIþ)anTTYlRbwkSaeRkayetsþQam 57 60 30 27 50 60 284
cMnYn®sIþKHanpÞúkemeraKeGds_ 56 66 36 34 60 29 281
cMnYn®sIþmanpÞúkemeraKeGds_ 1 4 0 0 4 3 122
cMnYn®sIþeFIVetsþQamelIkTI2 5 0 0 6 2 5 188
cMnYn®sIþ)anTTYlRbwkSaeRkayetsþQam 3 1 0 5 1 4 14
cMnYn®sIþKHanpÞúkemeraKeGds_ 3 1 0 5 1 3 13
cMnYn®sIþmanpÞúkemeraKeGds_ 0 0 0 0 0 1 1
°®sIþsH½RKcitþeFIVetsþQam 47 53 29 25 66 62 45
°®sIþRtLb;mkTTYllTæpletsþ 98 86 75 71 70 88 82
sMNYrnigcemIøy
s 1 etIsmamaRténemeraKeGds_enAelI®sIþmanépÞeBaH Edl)aneFIVetsþelIkTI1kñúgry³eBl6Ex manb:unHan?
s 2 etIsmamaRténemeraKeGds_enAelI®sIþmanépÞeBaHEdl)aneFIVetsþelIkTI2 manb:unHan?
s 3 etIGñkmaneyabl;ya:gNacMeBaHlT§pletsþenH?
s 4 RkeLkemIlmkPaKryén®sIþmkBinitüépÞeBaHelIkTI1Edl)anTTYlRbwkSamunetsþQamkñúgExnImYy² etIGñkkt;smÁal;eXIjGIVxøH?
s 5 RkeLkemIlmkPaKryén®sIþmkBinitüépÞeBaHelIkTI1Edl)anTTYlRbwkSaeRkayetsþQamkñúgExnimYy² etIGñkkt;smÁal;eXIjya:gdUcemþcxøH?
s 6 bnÞab;mkeTotetIGñknwgeFIVGIVeTot?
161
skmHPaBTI8³ karcuHGPi)all
etIkarGPi)almaneKalbMNgGIV?
karGPi)al³
SKWCaEpñkd¾sMxan;mYyénkartamdanRtYtBinitü
SmaneKalbMNgEsVgrknUvcMNucxøaMgénkarpþl;esva nigrkcMNucxVHxat
EdlnwgRtUveFIV[RbesIreLIg
Spþl;nUvB½t’manRtLb;sMrab;eFIV[kmHviFIkan;Etl¥RbesIr
SRtUveFIVenAfñak;mUldæan fñak;extþ nig fñak;Cati
29

bBaðaKnwøH²sMrab;karGPi)al karcuHeFIGV Pi)al

karGPi)almaneKalbMNgEsVgrkcMNucxøagM eCaKC½y RBmTaMgbBaðapgEdr.
karGPi)almaneKalbMNgkMNt;nUvynþkmH edIm,IeqIøytbeTAnwgbBaða.
bBaðaGPi)alTak;TgeTAnwgbuKÁliksuxaPi)al
SkarKaMRTkñúgbrisßankargar
SkarbNþúHbNþalnigGPivDÆviC¢aCIv³
karGPi)alTak;TgeTAnwgkarpþl;esva
SesvaBinitüépÞeBaHsmRsbsMrab;RsIþmanépÞeBaHTaMgGs;
Skarpþl;RbwkSaEdlmanKuNPaBx<s;sMrab;RsIþmanépÞeBaHnigédKU
Skarlak;karsm¶at;cMeBaHlT§pletsþ
S»sfRbqaMgemeraKeGds_sMrab;bgáarmanRKb;RKan;nigeRbI)anRtwmRtUv
SbBa¢ÚneTAesvaEfTaM[)anCaRbcaMnigTan;eBl
SsþúkTuksMPar³brikçarnig»sfkMu[mandac;[esaH 30
SGñksMrbsMrYlextþRtUvcuHGPi)alesvabgáarkarcmøgemeraKeGds_BImþay
eTAkUnenAkñúgextþrbs;xøÜn[)anmþgkñúg1RtImas nigBinitübBaI¢epÞógpÞat;
Sm®nIþkmHviFICatiRtUvcuHGPi)almNÐlnImYy²[)an2dgkñúg1qñaMb¤cuHGPi)al
kñúgkrNIBiess ebIcaM)ac;
SbBaIe¢ pÞógpÞat;Edl)anBinti ürYcehIy RtUvbBa¢nÚ eTAkariyal½ykmHviFI
SB½t’manRtLb;RtUvepJICUneTAmUldæanvij eRkayBIkarcuHGPi)alrYcehIy
edaymansresrnUveyabl;viC¢man nigEsVgrknUvcMNucNamYyEdlRtUv
eFIV[kan;EtRbesIreLIg.
SKuNPaBmnIÞrBiesaFn_nwgRtUv)anRtYtBinitüedaymCÄmNÐlCatiRbyuT§nwg
Cm¶WeGds_ esIEs,knigkameraK.
31
See Appendix F, National Guidelines for PMTCT, 2005

162
cMNucKnwøH

m:UDulTI6³ cMNucKnwøH
ƒ esovePAcuHbBaI¢nigkMNt;RtaRtwmRtÚvenAtamRKwHsßansuxaPi)al pþl;nUvB½t’manya:gsMxan;
sRmab;tamdanskmHPaBbgáarkarcmøgemeraKeGds_BImþayeTAkUn
ƒ kartamdanTinñn½yEdlTak;TgeTAnwgkarbgáarkarcmøgemeraKeGds_BImþayeTAkUn
Gac[³
ƒ eK)a:n;RbmaN)anGMBIkarpþl;esva
ƒ eKrkeXIjbBaðanigEktRmÚvbBaðaenaH
ƒ cat;EcgFnFannigeRbIva[kan;EtmanRbsiTi§PaB
ƒ karvaytémøEdlsMedAeTArkkarpøas;bþÚrkñúgsuc©nkr EdlmanTinñn½y)anmkBIkartamdan
RtÜtBinitü GacsnHtfaCaGnþraKmn_kñúgkarbgáarkarcmøgemeraKeGds_BImþayeTAkUn
ƒ lT§plEdl)anmkBIkarvaytémø RtÚv)aneRbIR)as;sRmab;eFIVEpnkareTAmuxeTotedIm,IeFIV
[karpþl;esvakan;Etl¥RbesIr.

163
]bsm½<n§TI6³ esovePAcuHbBa¢I PMTCT enAEpñkBinitüépÞeBaHH
esovePAcuHbBa¢I PMTCT sRmab;®sþIépÞeBaHTaMgGs;Edl)anTTYlkarpþl;RbwkSanigeFVIetsþQamrkemeraKeGds_
bBa¢ÚneTA
munetsþþ etsþþ eRkayetsþþ lT§plénkareFVIetsþQamm
Ga bBa¢ÚnmkBI Epñk CoC
elxkUd muxrbrr (HBC, NGO, éf¶¶ ExqñaM kMNt;smÁal;;
PMTCT yuu elIk elIk elIk elIk elIk elIk VCCT, elIkTI1 elIkTI2
Nat;CYb ma KHa
OI/ART)
TI1 TI2 TI1 TI2 TI1 TI2 (-) (+) (+/-) (-) (+) (+/-) n n
dd/mm/yy
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r) (s) (t)

Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ Ƒ
164
 bBaI¢kt;Rtaa PMTCT sRmab;®sIþmanépÞeBaHpÞúkemeraKeGds__
AZT ry³eBll
fñaM ARV Edl[dMbUg TTYlbEnßmelIk1 TTYlbEnßmelIk2 TTYlbEnßmelIk3 TTYlbEnßmelIk4 [ ARVsrub
éf¶ExqñaM cMnYnéf¶ cMnYnéf¶ cMnYnéf¶ cMnYnéf¶ cMnYnéf¶ <4 kMNt;cMNaMM
elxkUd >4
Rbhak;RbEhl éf¶ Ex qñaM Edl)an éf¶ Ex qñaM Edl)an éf¶ Ex qñaM Edl)an éf¶ Ex qñaM Edl)an éf¶ Ex qñaM Edl)an
PMTCT
sRmal pþl; pþl; pþl; pþl; pþl; s)þah_ s)þah_
(a) (b) (c) {d} {e} {f} (g) (h) (i) (j) (k) (l) (m) (n) (o)

165
 bBaI¢kt;Rtaa PMTCT sRmab;®sIþmanépÞeBaHpÞúkemeraKeGds__ enAesvasmÖB PMTCT
s)þah_Edl®sþI)anTTYl s)þah_Edl®sþI)anTTYl cMnYn ARV kumarTTYl NVP cMnYn karciBaw©m
HAART
éf¶-Ex-qñaM elxkUd enAeBlkMBugmann AZT enAeBlkMBugman Edl)anelbenAA kumarTTYl 1kRmitnig AZT AZT+3TC kUnedayy
sRmall PMTCT épÞeBaHH épÞeBaHH eBlkMBugQWeBaHH fñaMEt NVP eBlecjBII enAeBlecj ¬TwkedaHmþayb¤¤ kMNt;smáal;
1kRmit mnÞIreBTüü BImnIÞreBTüü emSATwkedaHeKa¦¦
>4 s)þah__ <4 s)þah__ >4 s)þah__ <4 s)þah__ (AZT+ NVP) (NVP) (HAART) (NON)
1s)þah__ 4s)þah__
ca++ eT (B) (R)
(a) (b) (c) {d} {e} {f} (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …
… … … … … … … … … … … … … … …

166
 TRmg;r)aykarN_segçbRbcaMExenAesvaEfTaMépÞeBaHH
TRmg;r)aykarN_segçbRbcaMEx enAEpñkBinitüépÞeBaH
eQGaHRKwHsßan³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>fñak;>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_Ex>>>>>>>>>>>>>>>>>>>
Rsúk>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_qñaM>>>>>>>>>>>>>>>>>>>
extþ-Rkúg>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>éf¶ExqñaMeFIVr)aykarN_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
_________________________________________________________________________________________________________________________________
-ANC01 ³ cMnYn®sIþmkBinitüépÞeBaHTaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC02 ³ cMnYn®sIþmkBinitüépÞeBaHelIkTI1TaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC03 ³ cMnYn®sIþmkBinitüépÞeBaHEdl)anTTYlkarRbwkSamuneFIVetsþQamrkemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC04 ³ cMnYn®sIþmkBinitüépÞeBaHEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC05 ³ cMnYn®sIþmkBinitüépÞeBaHEdl)anTTYlkarRbwkSaeRkayeFIVetsþQam>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC05.1 ³ cMnYn®sIþEdlmanlT§pletsþQamGviC¢man ¬-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC05.2 ³ cMnYn®sIþEdlmanlT§pletsþQamviC¢man ¬+¦ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC05.3 ³ cMnYn®sIþEdlmanlT§pletsþQamminc,as;las; >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC06 ³ cMnYn®sIþEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_elIkTI2>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC07 ³ cMnYn®sIþEdlmkTTYllT§pletsþnigkarRbwkSaeRkayeFIVetsþQamelIkTI2>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC07.1 ³ cMnYn®sIþEdlmanlT§pletsþQamGviC¢man>¬-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC07.2 ³ cMnYn®sIþEdlmanlT§pletsþQamviC¢man¬+¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------
-ANC07.3 ³ cMnYn®sIþEdlmanlT§pletsþQamminc,as;las; >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
_________________________________________________________________________________________________________________________________
-ANC08 ³ cMnYnbIþEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC09 ³ cMnYnbIþEdl)anmkTTYllT§pletsþQam>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC09.1 ³ cMnYnbIþEdlmanlT§pletsþQamGviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC09.2 ³ cMnYnbIþEdlmanlT§pletsþQamviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------
-ANC09.3 ³ cMnYnbIþEdlmanlT§pletsþQamminc,as;las;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------
-ANC10 ³ cMnYnbIþEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_elIkTI2>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC11 ³ cMnYnbIþEdleFIVetsþQamelIkTI2)anmkTTYllT§plnigRbwkSaeRkayetsþ>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------
-ANC11.1 ³ cMnYnbIþEdlmanlT§pletsþQamGviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC11.2 ³ cMnYnbIþEdlmanlT§pletsþQamviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC11.3 ³ cMnYnbIþEdlmanlT§pletsþQamminc,as;las;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------
_________________________________________________________________________________________________________________________________
-ANC12 ³ cMnYnmþayEdl)anTTYlZDV>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
________________________________________________________________________________________________________________________________
-ANC13 ³ cMnYnmþayEdlmanpÞúkemeraKeGds_bBa¢ÚnmkBI>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC14 ³ cMnYnmþayEdlmanpÞúkemeraKeGds_bBa¢ÚneTAesva CoC>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-ANC15 ³ cMnYnbIþEdlmanpÞúkemeraKeGds_bBa¢ÚneTAesva CoC>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->

167
 TRmg;r)aykarN_segçbRbcaMExenAEpñksmÖB
eQGaHRKwHsßan³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>fñak;>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_Ex>>>>>>>>>>>>>>>>>>>
Rsúk>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_qñaM>>>>>>>>>>>>>>>>>>>
extþ-Rkúg>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>éf¶ExqñaMeFIVr)aykarN_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
_________________________________________________________________________________________________________________________________
-MAT 01 ³ cMnYn®sIþEdl)ansRmalkUnTaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ------->
-MAT 01.1 ³ cMnYn®sIþKHanpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn¬-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 01.2 ³ cMnYn®sIþpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn ¬+¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 01.3 ³ cMnYn®sIþEdlmindwgBIsßanPaBpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn>>>>>>>>>>>>>>>>>>>>------->
-MAT 02 ³ cMnYn®sIþpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.1 ³ cMnYn®sIþEdl)aneRbI»sf ZDV enAeBlmanépÞeBaH>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.1.1 ³ cMnYn®sIþEdl)aneRbI»sf ZDV> 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.1.2 ³ cMnYn®sIþEdl)aneRbI»sf ZDV< 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.1.3 ³ cMnYn®sIþEdl)anbnþeRbI »sf ZDV+ NVP enAeBlQWeBaHsRmal*>>>>>>>>>>>>>>>>------->
-MAT 02.2 ³ cMnYn®sIþEdl)aneRbIEt»sf ZDV+ NVPb¤ SD NVP enAeBlQWeBaHsRmal>>>>>>>>>>>>>>>>>>------->
-MAT 02.3 ³ cMnYn®sIþEdl)aneRbI HAART enAeBlmanépÞeBaH>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.3.1 ³ cMnYn®sIþEdl)aneRbI HAART > 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.3.2 ³ cMnYn®sIþEdl)aneRbI HAART < 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 02.4 ³ cMnYn®sIþEdlmin)aneRbI ARV esaH>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 03 ³ cMnYnkUnEdlekItBImþayEdlmanpÞúkemeraKeGds_TaMgGs; **>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ------->
-MAT 03.1 ³ cMnYnkUnEdl)anTTYl»sf SD NVP + ZDV 1GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 03.2 ³ cMnYnkUnEdl)anTTYl»sf SD NVP + ZDV 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-MAT 03.3 ³ cMnYnkUnEdl)anTTYlEt»sf SD NVP >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------
-MAT 04 ³ cMnYnkUnEdlbMe)AedayTwkedaHmþay>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------>-
-MAT 05 ³ cMnYnkUnEdlbMe)AedayTwkedaHeKaemSA>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------

*cMnYnenHKitbnþBImþayEdl)anTTYl ZDV enAeBlmanépÞeBaH. BuMcaM)ac;rab;bBa©ÚlCamYYy MAT 02.1.1 b¤ MAT 02.1.2edIm,I[)ancMnYn MAT 02.1 eT.
**cMnYnkUnTaMgekItrs; nig ekItsøab; b¤ ekItminRKb;Ex.

168
TRmg;r)aykarN_segçbRbcaMExenAEpñkBinitüCMgWeRkA
eQGaHRKwHsßan³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>fñak;>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_Ex>>>>>>>>>>>>>>>>>>>
Rsúk>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_qñaM>>>>>>>>>>>>>>>>>>>
extþ-Rkúg>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>éf¶ExqñaMeFIVr)aykarN_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
_________________________________________________________________________________________________________________________________
-OPD 01 ³ cMnYnkumarRbQmEdl)anmktamdanTaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ------->
-OPD 02 ³ cMnYnkumarRbQmbBa¢ÚneTAesvaCMgWeGds_kumar>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-OPD 03 ³ cMnYnkumarRbQmEdleRbIkURTIm:uksasul>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-OPD 04 ³ cMnYnkumarRbQmEdl)aneFIVetsþrkemeraKeGds_enAGayu18Ex>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-OPD 04.1 ³ cMnYnkumaraviC¢manenAGayu18Ex>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-OPD 04.2 ³ cMnYnkumarIviC¢manenAGayu18Ex >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->
-OPD 05 ³ cMnYnkumarcab;epþImeRbI ARTTaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->

169
170
 ,CMnaajpþ
s)þ h_TI1l;RbwkSaCamUldæan
cemøIy
CMnajpþl;RbwkSaCamUldæ

vtßúbMNg
1> cemIøyénsMNYrniglMhat;kñúgkrNIsikSaa Edl)anGnuvtþkñúgkmHviFIbNþúHbNþalkarbgáarkarr
cmøgemeraKeGds_BImþayeTAkUnmanenAEpñkenHH

171
m:UDulTI1 skmHPaBTI5³ emeron³³ dMeNIrvivtþBIemeraKeGds_eTACaCMgWeGds_-³ sMNYrsIþGMBIdMNak;kalKIønikéneGds_CMgW
sMNYr søayTI31 dMNak;kal
1 bury³eBlCag1Ex
rspÞúkemeraKeGds_Gayu25qñaMmñak; mandMe)ApSitenAmat;nigmanrakmþgmáal 3

2 ®sI þpÞúkemeraKeGds_Gayu40qñaMmñak; manehImkUnkNþúrtUc²enAknigeRkamekøók 1

rbs;Kat;. Kat;mansuxPaBl¥nigenAeFIVskmHPaB)anFmHta
3 buRKúrnspÞry³eBl3ExmkehI
úkemeraKeGds_Gayu36qñaMmñak; manrUbragsÁmya:gxøaMgt¥ÚjEt¥rfaman
ynigminGaceRkakecjBIERK)aneT 4
4 ®sI þpÞúkemeraKeGds_Gayu30qñaMmñak;manCMgWrebgsYt nigmanekIt Herpes 3
Zoster elIRTÚgrbs;nag

5 ®sI þrksIupøÚvePTpÞúkemeraKeGds_Gayu28qñaMmñak; manekIt Herpes Zoster 2

elIenAelIépÞmuxrbs;nag nigrmas;BgEbkeBjxøÜnTaMgGs;
6 bumanrlakeRsamxY
rspÞúkemeraKeGds_Gayu34qñaMmñak; mandMe)Akñúgmat;nigCMuvijmat; nig
rk,aledayemeraK Cryptocoque 4
m:UDulTI1³ skmHPaBTI7³ sMNYrnigcemøIy³ sMNYrEdlCYmRbTHjwkjab;;
s søayTI38 cemøIy
1 etImnusSmñak;GacqøgemeraKeGds_)anEdrb¤eT RbsinCaKat;hUb)ayrYmtuCamYynwgGñkpÞúkemeraKeGds_? eT
2 etIqHbmñak;RbQmnwgkarqøgemeraKeGds_Edrb¤eT RbsinCaKat;begIátkUn[®sIþpÞúkemeraKeGds_mñak;eday c+ab¤)aT
mineRbIeRsaméd?
3 enAkñúgfñak;eronmYy RbsinebImankumarpÞúkemeraKeGds_mñak;eronenAkñúgfñak; etIkumardéTeTotRbQm eT
nwgkarqøgemeraKeGds_Edrb¤eT?
4 etIbursmñak;GacqøgemeraKeGds_)anEdrb¤eT RbsinCaKat;rYmePTCamYyGñkpÞúkemeraKeGds_tamrn§ c+ab¤)aT
lamk?
5 etI ®sIþGacqøgemeraKeGds_Edrb¤eT RbsinebIbursmñak;rYmePTCamYy®sIþBIrnak;kñúglkçN³CaRkúmEtman c+ab¤)aT
Bak;eRsamGnam½y?
172
m:UDulTI3 ³ skmHPaBTI1³ sMNYrnigcemøIy³ karmanépÞeBaHnigkarqøgemeraKeGds__
søayTI5 t¼x
1 karmanépÞeBaHCamUlehtuEdleFIV[CMgeW Gds_mankarvivtþn_eTAmuxya:gelOn x
2 emeraKeGds_minGacbNþal[kUnkñúgépÞmanrUbragminFmHtaeT t
3 bBaðaemeraKeGds_-CMgWeGds_enAelI®sIþépÞeBaHmansPaBGaRkk;Cag®sIþEdl x
KHanépÞeBaH
4 ®sþImanépÞeBaHpÞúkemeraKeGds_TMngCamankarrlUtkUn b¤kUnsøab;kñúgeBaH t
eRcInCagGñkCa
5 ®sIþpÞúkemeraKeGds_manlT§PaBbnþBUC dUc®sIþEdlKHanpÞúkemeraKeGds_Edr ?? **
6 CMgWeGds_minTak;TgeTAnwgkarsRmalminRKb;Ex b¤kUnekItminRKb;KILÚeLIy x
karsøab;CMuvijkMeNItb¤karsøab;énTarkeTIbekIt manlkçN³dUcKña
7 cMeBaHTarkEdlekItBImþaymanpÞúkb¤KHanpÞúkemeraKeGds_ x
8 ®sþImanépÞeBaHGaccmøgemeraKeGds_eTAkUnrbs;Kat; t
**
cemøIyRtÚvb¤xusvaGaRs½yeTAnwgdMNak;kalénCMgWeGds_. enAdMNak;kaldMbUgEdleTIbnwgqøgemeraKeGds_ lT§PaBbnþBUCminTan;mankarb:HBal;eT.
enAkñúgdMNak;kalcugeRkayénCMgWeGds_ lT§PaBbnþBUCGacmankarfycuH nigcMNg;kñúgkarrYmePTk¾)anfycuHEdr.
m:UDulTI4>3>1³³ skmHPaBTI6³ lMhat;³ kareRbI»sfeGGrvII sRmab;bgáardl;kumar³³ KNnakRmit»sff
Tarkk Tm¶n;eBlekIt kRmit NVP (ml) kRmit AZT (ml)
0.2ml-KRk k 0.4ml/KRk
k
1kRmitKt;; 2dg¼1éf¶¶
1 2>5 KRk 0> 6 ml 1>0 ml
2 2250Rk 0> 5 ml 1>0 ml
3 3010Rk 0> 6 ml 1>2 ml
4 2>7KRk 0> 5 ml 1>1 ml
5 3240Rk 0> 7 ml 1>3 ml
173
m:UDulTI4>3>2³³ skmHPaBTI2³ krNIsikSaenAesvaEfTaMépÞeBaHH
krNIsikSaelI®sIþmaépÞeBaHH
PaKK “NaNa” Gayu22qñaMmanépÞeBaHCaelIkTI1. nag)anmkesvaEfTaMépÞeBaHenAEdlKP’manGayu24GaTitü. bnÞab;BIsþab;karGb;rMenAbnÞb;Gb;rM
mþaymk nag)anseRmccitþTTYlkarpþl;RbwkSanigeFIVetsþQamrkemeraKeGds_.
s 1 etIGñkpþl;RbwkSaRtÚvcat;;viFankarN_y:agdUcemþcxøH?
1> Gñkpþl;RbwkSaKYrEtTTYl)annUvkaryl;RBmBIGtifiCnCamunsin munnwgbUmQamKat;
c1 2> bMBg;TIbQamEdl)anbUmrYc RtÚvbBa¢ÚneTAmnÞIrBiesaFn_CamYynwglixitbBa¢ÚnedaymanP¢ab;;elxkUd PMTCTeTAmYypg.
3> RtÚvR)ab; “NaNa”[RtLb;mkTTYllT§pletsþvijenAeBlresol.
PaKK 2 “NaNa”)anRtLb;mkTTYlkarpþ;l;RbwkSaeRkayetsþenAéf¶bnÞab;. nagmanpÞúkemeraKeGds_.
s 2 etIviFankarN_GIVEdlKYreFIV edIm,IRKb;RKgEfTaM®sIþenAeBlmanépÞeBaH kñúgeBlbc©úb,nñenH?
1> {NaNa} KYrEt)anTTYlkarpþl;RbwkSaeRkayetsþQam
c 2 2> RtÚvelIkTwkcitþ {NaNa{ [naMédKUrbs;nagmkTTYlkarRbwkSanigeFViIetsþQam
3> RtÚvpþl;B½t’mandl;nagsIþGMBIplcMeNjénesvaBüa)alCMgW»kasniymnigBüa)aleday»sfRbqaMgemeraKeGds_ ¬OI/ART¦.
RbsinCamankaryl;RBmBInag RtÚveFIVlixitbBa¢ÚnmYy edIm,I[nageTATTYlesvaenaHenAÉmnÞIreBTübEg¥k
Pat33 { NaNa} )aneTATTYlesva OI/ART. ekasikaCD4 rbs;nagman350¼mm3
s 3 etI {NaNa} KYrTTYl)annUvkarENnaMGIVxøH?
c 3 1> RtÚvR)ab;nagfa nagminTan;dl;eBlTTY3l)ankarBüa)aleday»sfRbqaMgemeraKeGds_ sRmab;CMgWrbs;nagenAeLIyeT BIeRBaHekasikaCD4
rbs;nagenAmancMnYnelIsBI250¼mm
2> RtÚvR)ab;nagGMBIkarBüa)albgáareday»sfRbqaMgemeraKeGds_ nigR)ab;nagGMBIRbsiTi§PaBén»sfEdlGackarBardl;kUnrbs;nag
3> RtÚvesIñ[nagRtLb;eTAesva OI/ARTenAs)þah_TI28énKP’ edIm,ITTYl»sfRbqaMgemeraKeGds_sRmab;bgáar
4> RtÚvR)ab;nagnUvB½t’mansþIGMBIesvaEfTaMBüa)albnþnigesvaKaMRTdéTeTot nigRtÚvbBa¢ÚnnageTARkúmEfTaMCMgWeGds_tampÞH GgÁkarsH½RKcitþenAtam
mUldæanb¤k¾RkúmKaMRTdl;GñkpÞúkemeraKeGds_ RbsinCaKat;manbMNgcg;TTYlesvaTaMgenaH RtÚvR)ab;Kat;GMBImNÐlmitþCYymitþ.
5> RtÚvrMlwk[nagRtLb;mkesvaEfTaMépÞeBaHvijedIm,ItamdanCaRbcaM.
6> RtÚvpþl;B½t’mansþIGMBIsar³sMxan;kñúgkarmksRmalkUnenAkñúgmnIÞreBTüEdlmanesva PMTCT

174
m:UDul4>3>2³³ skmHPaBTI4³ krNIsikSaenAEpñksRmall
EpñksmÖB ³ krNIsikSa³11
PaK1 “NaNa”)anmkdl;EpñksmÖBenAeBlQWeBaHsRmal. Gñk)anBinitübBa¢Ikt;Rta eXIjfanagmanpÞúkemeraKeGds_nig)anTTYl AZTEdlCa»sf
bgáarRbqaMgemeraKeGds_. nagniyayfa nagQWeBaHkan;EtxøaMgeLIg²nigQWImþg²manry³eBlRbEhl4naTI. Gñk)anBinitümat;s,ÚnnigeFVIkar
sniñdæanfa ya:gehacNas;k¾Cag2em:ageTotEdreTIb“NaNa”sRmalkUn. Gñkpþl;fñaM NVP1kRmiteTA[nagenAeBlkMBugQWeBaH.
s 1>1 etIGñkRtÚveRbIeRsamédEdrb¤eT enAeBlBinitüGñkCMgWEdlmanpÞúkemeraKeGds_? tameKalkarN_bgáarCaskl etItRmÚv[GñkeRbIeRsamédsRmab;
BinitüRKb;®sIþEdlmksRmaldUc²KñaEdrb¤eT KitTaMgeBlkMBugQWeBaHsRmalnigsRmaledayminKitGMBIsßanPaBpÞúkemeraKeGds_rbs;®sIþ?
c>1>1 eRsamédKYrBak;BinitüRKb;GñkCMgWTaMgGs; edayminKitGMBIsßanPaBpÞúkemeraKeGds_rbs;GñkCMgWeLIy
s 1>2 etIenATIkEnøgeFVIkarrbs;Gñk mankarpÁt;pÁg;eRsaméd)anRKb;RKan;Edrb¤eT? etIeRsamédTaMgenaHmanTMhMepSg²RsbeTAnwgTMhMédEdrb¤eT?
c 1>2 [sikaçkamCaGñkeqIøy
s 1>3 etIeyIgGacdwgGMBITMnak;TMngrvagkarcmøgemeraKeGds_BImaþyeTAkUnnigkarBinitümat;s,Únya:gdUcemþcxøH cMeBaH®sþImanépÞeBaHpÞúkemeraKeGds_ ?
c 1>3 karBinitümat;s,ÚnGacGnuBaØat[eFIVEtkñúgkal³eTs³caM)ac;Etb:ueNÑaH BIeRBaHkarBinitüjwkjab; GacbegáInkarRbQmnwgkarcmøgemeraKeGds_eTA
Tark)an.
PaK2 “NaNa”)anEbkeRsamTwkeBaHePaøHGs;ry³eBlCag4em:agmkehIy. nagGs;kmøaMgCaxMøag. bnÞab;BIkarBinitütamry³Partogramrbs;nag
RKÚeBTü)anseRmccitþeRbIOxytocin edIm,I[nagqab;)ansRmalkUn.
s 2>1 etIehtuGVI)anCacaM)ac;bRgÜjeBlevlaénkarsRmal KitcenøaHBIeBlEbkeRsamTwkePøaHnigkarsRmalcMeBaH®sþImanpÞúkemeraKeGds_?
c 2>1 karbnøayeBlevlaQWeBaHsRmal KWCakarbegáInnUvkarcmøgemeraKeGds_BImaþyeTAkUnkan;Etx<s;
PaK3 \LÚvenH mat;s,Ún “NaNa” )anebIkTaMgRsúgeRtómnwgsRmalehIy. enAeBlEdlk,alkUnlUnecjmk Gñk)anykés,CUtTwkrMGilkñúgmat;nigrn§
RcmuHkUnya:gRbúgRby½tñ. bnÞab;BIRbwgCaelIkcugeRkaykUnk¾)ansRmalecjmk. Gñk)anhuckUneTAGñkCMnYykarEdlmanBak;eRsamédEdlCaGñkCUt
sMgYtnigEfTaMTarkbnþ. bnaÞb;mksukk¾Føak;ecj.
s 3>1 cUrrab;sMelokbMBak;karBarEdlsmRsbsRmab;eRbIenAEpñksRmal.
c 3>1 RtÚvEtBak;eRsaméd ma:s; Ev:ntasRmab;karBarEPñk GavEvg nigEs,keCIgkEvg
s 3>2 sUmRtiHriHBicarNaGMBIkare)aHecalvtßúßmutRsÜcenAEpñksRmalEdl)aneRbIrYcehIy. etIenAmnIÞreBTürbs;GñkmanRbGb;suvtißPaBb¤FugsRmab;Tukdak;
vtßúTaMgenHEdrb¤eT?
175
c 3>2 [sikçakamCaGñkeqIøy
s 3>3 etIenAmnIÞreBTürbs;GñkmaneKalkarN_sIþGMBIkare)aHecalsMramEdrb¤eT? etIGñkRtÚve)aHecalsuknigsmÖar³déTya:gdUcemþc?
c 3>3 [sikçakamCaGñkeqIøy
PaK 4 “NaNa” KWCa®sIþTI8ehIyEdlGñk)ansRmalkUn[enAkñúgry³eBl24ema:gknøgeTAenH. GñkRtÚvRtLb;eTApÞHnigCYbCMuRKÜsar. k¾bu:Enþ GñkEdl
RtÚvbnþevnBIGñkminTan;mkdl;. Gñk)anniyayesIñeTAkan;RbFanrbs;Gñk[CYyrkGñkNamñak;;mkCMnYsGñk.
s 4>1 etIGñkmanGarmHN_y:agNaEdr enAeBlEdlRbFanrbs;GñkfaGñkGaceTApÞH)an?
c 4>1 GñkmanGarmHN_FUrRsal. buKÁlikEdleFIVkarhYskmøaMgnigmankarht;enOyxøaMg gaynwgeFVI[mankarPøat;PøaMgkúñgeBlRKb;RKgGñkCMgW ehIynwggay
eFIV[xøÜnKat;TTYlrgnUve®sþs (Stress) nigbWnGav (burnout) eTotpg.
s 4>2 enAkEnøgeFVIkarrbs;Gñk etImanGñkNaEdlGacCYYyGñkkñúgkarrkbuKÁlikmkCMnYskargarGñkEdrb¤eT ebIsinCamankarcaM)ac;?
c 4>2 [sikçakamCaGñkeqIøy

176
m:UDulTI4>3>4³³ skmHPaBTI6³ cemøIykñúgkrNIsikSasIþGMBIkarRbQmnwgeRKaHfñak;kñúgkargarenAEpñksRmall
dMNak;kalEdlRtÚveFIV bnÞab;BImaneRKaHfñak;kñúgkargar
1> RbsinCamanQam Tuk[QamhUrRbEhl2-3vinaTI. minRtÚvRc)ac;muxrbYseT. bnÞab;mkRtÚvlagmuxrbYsnwgTwkCamYysab‘U
2> raykarN_R)ab;RbFanRkúmyamenAEpñksmÖB
3> Bnül;R)ab;GñkCMgWGMBIehtukarN_Edl)anekIteLIg nigesIñsMuKat;[eFIVetsþQamrkemeraKeGds_
4> esIñ[supaNayl;RBmeFIVetsþQamrkemeraKeGds_
5> FanarkSa[)annUvkarsm¶at;rbs;supaNanigGñkCMgW
6> pþl;karKaMRTdl;GtifiCnnigsupaNa. pþl;B½t’maneTAsupaNasIþGMBIkargarRbQmnwgkarqøgemeraKeGds_
7> karBüa)al PEP KYrcab;epIþmkñúgGMLuúgeBl4ema:geRkayeRKaHfñak;b¤Pøam²tamEdlGaceFIV)an. EtminRtÚv[hYsBI36ema:geT
BIeRBaHvaRbEhlCaminGackarBar)aneLIy
8> mincaM)ac;rg;caMlTæpletsþQameT munnwgcab;epIþmeFIVkarBüa)al PEP
9> eFIVkartamdansuxPaBrbs;supaNa³
ƒ RbsinGñkCMgWmanpÞúkemeraKeGds_ RtÚvpþl;karBüa)albgáardl;supaNarhUtdl;RKb;4GaTitü nigpþl;karKaMRTdl;supaNa
dUcCaeFIVetsþQamdl;nagenAGaTitüTI6/ ExTI3 nigExTI6 eRkayBIeRKaHfñak;.
ƒ RbsinCaGñkCMgWminmanpÞúkemeraKeGds_eT RtÚvbBaÄb;karBüa)al PEPPøam.
ƒ RbsinCasupaNaxøÜnÉgmanpÞúkemeraKeGds_ k¾mincaM)ac;eFIVkarBüa)al PEP Edr. RtÚvrkSakarsm¶at;enH. pþl;karRbwkSa
dl;nagnigbBa¢ÚnnageTAesva OI/ARTedIm,IEfTaMBüa)alnigKaMRTbnþ.

177
m:UDulTI6³ skmHPaBTI5³ cemøIysRmab;; r)aykarN_egçbRbcaMExsRmab;esvaEfTaMépÞeBaH
TRmg;r)aykarN_segçbRbcaMEx enAEpñkBinitüépÞeBaH
eQGaHRKwHsßan³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>fñak;>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_Ex>>>>>>>>>>>>>>>>>>>
Rsúk>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_qñaM>>>>>>>>>>>>>>>>>>>
extþ -Rkúg>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>éf¶ExqñaMeFIVr)aykarN_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
_________________________________________________________________________________________________________________________________
-ANC01 ³ cMnYn®sIþmkBinitüépÞeBaHTaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ----20-
-ANC02 ³ cMnYn®sIþmkBinitüépÞeBaHelIkTI1TaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ----10->
-ANC03 ³ cMnYn®sIþmkBinitüépÞeBaHEdl)anTTYlkarRbwkSamuneFIVetsþQamrkemeraKeGds_>>>>>>>>>>>>>>>>>>>-----5->
-ANC04 ³ cMnYn®sIþmkBinitüépÞeBaHEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-----4->
-ANC05 ³ cMnYn®sIþmkBinitüépÞeBaHEdl)anTTYlkarRbwkSaeRkayeFIVetsþQam>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-----4->
-ANC05.1 ³ cMnYn®sIþEdlmanlT§pletsþQamGviC¢man ¬-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>----- 3->
-ANC05.2 ³ cMnYn®sIþEdlmanlT§pletsþQamviC¢man ¬+¦ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>---- -0->
-ANC05.3 ³ cMnYn®sIþEdlmanlT§pletsþQamminc,as;las; ¬+/-¦ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>---- -1->
-ANC06 ³ cMnYn®sIþEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_elIkTI2>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-----2->
-ANC07 ³ cMnYn®sIþEdlmkTTYllT§pletsþnigkarRbwkSaeRkayeFIVetsþQamelIkTI2>>>>>>>>>>>>>>>>>>>>>>>>>>>-----2->
-ANC07.1 ³ cMnYn®sIþEdlmanlT§pletsþQamGviC¢man>¬-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>---- -1->
-ANC07.2 ³ cMnYn®sIþEdlmanlT§pletsþQamviC¢man¬+¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------1-
-ANC07.3 ³ cMnYn®sIþEdlmanlT§pletsþQamminc,as;las; ¬+/-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0-
_______________________________________________________________________________________________________________________
-ANC08 ³ cMnYnbIþEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-----1->
-ANC09 ³ cMnYnbIþEdl)anmkTTYllT§pletsþQam>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-----1->
-ANC09.1 ³ cMnYnbIþEdlmanlT§pletsþQamGviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0-
-ANC09.2 ³ cMnYnbIþEdlmanlT§pletsþQamviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------1-
-ANC09.3 ³ cMnYnbIþEdlmanlT§pletsþQamminc,as;las;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-----0-
-ANC10 ³ cMnYnbIþEdl)ansH½RKcitþeFIVetsþQamrkemeraKeGds_elIkTI2>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0-
-ANC11 ³ cMnYnbIþEdleFIVetsþQamelIkTI2)anmkTTYllT§plnigRbwkSaeRkayetsþ>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0-
-ANC11.1 ³ cMnYnbIþEdlmanlT§pletsþQamGviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0-
-ANC11.2 ³ cMnYnbIþEdlmanlT§pletsþQamviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0-
-ANC11.3 ³ cMnYnbIþEdlmanlT§pletsþQamminc,as;las; ¬+/-¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------0->
-ANC12 ³ cMnYnmþayEdl)anTTYlZDV>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------3 -
________________________________________________________________________________________________________________________________
-ANC13 ³ cMnYnmþayEdlmanpÞúkemeraKeGds_bBa¢ÚnmkBI>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------2-
-ANC14 ³ cMnYnmþayEdlmanpÞúkemeraKeGds_bBa¢ÚneTAesvaCoC>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------3-
-ANC15 ³ cMnYnbIþEdlmanpÞúkemeraKeGds_bBa¢ÚneTAesvaCoC>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------1-

178
skmGPaBTI5³ cemøIysRmab; TRmg;r)aykarN_segçbRbcaMExenAEpñksmÖB
eQGaHRKwHsßan³>>>>>>>>>>>>>>>>>>>>>>>>>>>>>fñak;>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_Ex>>>>>>>>>>>>>>>>>>
Rsúk>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>r)aykarN_qñaM>>>>>>>>>>>>>>>>>>
extþ-Rkúg>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>éf¶ExqñaMeFIVr)aykarN_>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
_________________________________________________________________________________________________________________________________
-MAT 01 ³ cMnYn®sIþEdl)ansRmalkUnTaMgGs;>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ----100>
-MAT 01.1 ³ cMnYn®sIþKaHnpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn¬->¦>>>>>>>>>>>>>>>>>>>>>>>>>>------92
-MAT 01.2 ³ cMnYn®sIþpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn>>¬+¦>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------8->
-MAT 01.3 ³ cMnYn®sIþEdlmindwgBIsßanPaBpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn>>>>>>>>------0->
-MAT 02 ³ cMnYn®sIþpÞúkemeraKeGds_TaMgGs;Edl)anmksRmalkUn>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------8->
-MAT 02.1 ³ cMnYn®sIþEdl)aneRbI»sf ZDV enAeBlmanépÞeBaH>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------4-
-MAT 02.1.1 ³ cMnYn®sIþEdl)aneRbI»sf ZDV> 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------2-
-MAT 02.1.2 ³ cMnYn®sIþEdl)aneRbI»sf ZDV< 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------2-
-MAT 02.1.3 ³ cMnYn®sIþEdl)anbnþeRbI »sf ZDV+ NVP enAeBlQWeBaHsRmal*>>>>------>4-
-MAT 02.2 ³ cMnYn®sIþEdl)aneRbIEt»sf ZDV+ NVPb¤ SD NVP enAeBlQWeBaHsRmal>>>>>>>>>-----1->
-MAT 02.3 ³ cMnYn®sIþEdl)aneRbI HAART enAeBlmanépÞeBaH>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------2->
-MAT 02.3.1 ³ cMnYn®sIþEdl)aneRbI HAART > 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------1-
-MAT 02.3.2 ³ cMnYn®sIþEdl)aneRbI HAART < 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------1-
-MAT 02.4 ³ cMnYn®sIþEdlmin)aneRbI ARV esaH>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->1-
-MAT 03 ³ cMnYnkUnEdlekItBImþayEdlmanpÞúkemeraKeGds_TaMgGs; **>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ------->8-
-MAT 03.1 ³ cMnYnkUnEdl)anTTYl»sf SD NVP + ZDV 1GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------3>-
-MAT 03.2 ³ cMnYnkUnEdl)anTTYl»sf SD NVP + ZDV 4GaTitü>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------->5-
-MAT 03.3 ³ cMnYnkUnEdl)anTTYlEt»sf SD NVP >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------0-
-MAT 04 ³ cMnYnkUnEdlbMe)AedayTwkedaHmþay>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>------>-6-
-MAT 05 ³ cMnYnkUnEdlbMe)AedayTwkedaHsib,nimHt i >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>-------2-
*cMnYnenHKitbnþBImþayEdl)anTTYl ZDVenAeBlmanépÞeBaH. min)ac;rab;bBa©ÚlCamYYy MAT 02.1.1 b¤ MAT 02.1.2edIm,I[)ancMnYn MAT 02.1eT.
**cMnYnkUnTaMgekItrs; nig ekItsøab; b¤ minRKb;Ex.
179
m:UDulTI6³ skmHPaBTI7³ karviPaKTinñn½y

s 1 etIsmamaRténemeraKeGds_enAelI®sIþmanépÞeBaHEdl)aneFIVetsþelIkTI1manb:unHan?
c 1 ¬ 12¼345¦¦ ¯ 1000 = 3>5°°
s 2 etIsmamaRténemeraKeGds_enAelI®sIþmanépÞeBaHEdl)aneFIVetsþelIkTI2manb:unHan?
c 2 ¬ 1¼18¦¦ ¯ 1000 = 5>5°°
s 3 etIGñkmaneyabl;ya:gNacMeBaHlT§pletsþenH?
c 3 ®sIþEdleFIVetsþCaelIkTI2 edaysarEtmankar)armÖBIry³eBlcMhénemeraKRtÚv)anrMBwgfamanGRtaemeraKeGds_x<s;
s 4 RkeLkemIlmkPaKryén®sIþmkBinitüépÞeBaHelIkTI1Edl)anTTYlRbwkSamunetsþQamkñúgExnImYy² etIGñkkt;smÁal;eXIjGIV?
c 4 Føak;cuHTabenAExmInanigExemsaa
s 5 RkeLkemIlmkPaKryén®sIþmkBinitüépÞeBaHelIkTI1Edl)anTTYlRbwkSaeRkayetsþQamkñúgExnImYy² etIGñkkt;smÁal;eXIjGIV?
x 5 Føak;cuHTabenAExemsaa
s 6 bnÞab;mkeTotetIGñknwgeFIVGIV?
RtÚvsYrfaehtuGIV)anCavaGIcwg³ BinitüemIlr)aykarN_edIm,IrkemIlkMhuskñúgkarbBa©ÚlTinñn½y. rkemIlktþaEdlGaceFIV[®sIþTTYlesvapþl;RbwkSamunnig
c6
eRkayetsþmancMnYntic

180
bBaI¢rayÉksareyagg
1. National Maternal Child Health Centre Prevention of Mother-to-Child Transmission of HIV Training Curriculum
MoH, National Maternal and Child Health Centre June 2002

2. WHO/CDC Prevention of Mother-to-Child Transmission of HIV Generic Training Package

WHO 2004

3. Voluntary Confidential Counseling and Testing for HIV (VCCT), A Guide for Implementation
MoH, NCHADS, January 2004

4. HIV Sentinel Survey Report

MoH, NCHADS, 2004

5. Voluntary Confidential Counseling and Testing for HIV, VCCT Counseling Training Manual
MoH, NCHADS October 2004

6. Continuum of Care for People Living with HIV/AIDS, Operational Framework

MoH, NCHADS 1st edIrtion, April 2003

7. Cambodia National Guidelines for the use of PaedIratric ÀRV

MoH, NCHADS 1st edIrtion, October 2004

8. Cambodia National Guidelines for the Prevention of Mother-to-Child Transmission of HIV

MoH, National Maternal and Child Health Centre
2nd edIrtion, September 2005

9. Cambodia National Training Programme: Clinicians Training on Management of Opportunistic Infection and Antiretroviral Therapy for
Adults
MoH, NCHADS 1st edIrtion, September 2004

10. Cambodia National Training Programme: Clinicians Training on Management of Opportunistic Infection and Antiretroviral Therapy for
Children
11.
MoH, NCHADS 1st edIrtion, 2006

12. Cambodia National Training Programme: Opportunistic Infection and Antiretroviral Therapy Counseling for Nurses
MoH, NCHADS 1st edIrtion, May 2005

181
13. Cambodia National Training Programme: Drugs and Logistic Management for Pharmacists of Referral Hospital Opportunistic
Infection & Antiretroviral Services
MoH, NCHADS 1st edIrtion, August 2005

14. Cambodia National Training Programme: Drugs and Logistic Management for Logistic Officers at Referral Hospital Opportunistic
Infection & Antiretroviral Services
MoH, NCHADS 1st edIrtion, February 2006

15. Infant and Young Child FeedIrng Counseling: An Integrated Course

WHO, 2005

16. HIV Prevention in Maternal Health Services: Training Guide: Session 8, Voluntary Counseling and Testing for HIV
UNFPA and EngenderHealth, 2004

17. Kenya PMCT Project, PMCT Training Curriculum: Module 4, Counseling Skills for the Prevention of Mother-to-child Transmission of
HIV
Population Council 2002

18. VCT Toolkit, Trainer’s Manual: Counselling Supervision and Training

Family Health International, August 2005
Retrieved June 2006 from: www.fhi.org/en/HIVAIDS/pub/guide/VCTToolkitCounseling.htm

19. Voluntary HIV Counseling and Testing, Manual for Training of Trainers. Module 5, sub-module 5: Counsellor Ethics
WHO Regional Office for SE Asia, 2004
Retrieved June 2006 from:
www.whosea.org /LinkFiles/Training_Materials_voluntary-intro.pdf

20. Projections for HIV/AIDS in Cambodia: 2000-2010

The Cambodia Working Group on HIV/AIDS Projection
November 2002

21. PMTCT Programme Management Training

Thailand MOPH – US CDC collaboration
March 2003

22. Transplacental transmission of HIV: a potential role for HIV binding lectins
E.J. Soilleux, N. Coleman / The International Journal of Biochemistry & Cell Biology 35 (2003) 283–287
Retrieved June 2006 from: www.chu.cam.ac.uk/~EJS17/transplac.pdf

182