from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import copy

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)

blank = prs.slide_layouts[6]

# ── COLOUR PALETTE ──────────────────────────────────────────────────────────
RED       = RGBColor(0xC0, 0x20, 0x20)   # deep red (NACO / AIDS ribbon)
DARK_NAVY = RGBColor(0x0D, 0x2B, 0x55)   # dark navy
MID_BLUE  = RGBColor(0x1A, 0x5C, 0x96)   # mid blue
ORANGE    = RGBColor(0xE8, 0x6B, 0x1A)   # accent orange
WHITE     = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_BG  = RGBColor(0xF4, 0xF7, 0xFB)   # near-white slide bg
YELLOW    = RGBColor(0xFF, 0xD7, 0x00)
GRAY_TEXT = RGBColor(0x33, 0x33, 0x33)
LIGHT_RED = RGBColor(0xF9, 0xE6, 0xE6)
TEAL      = RGBColor(0x00, 0x7B, 0x83)

def add_rect(slide, l, t, w, h, fill, alpha=None):
    shape = slide.shapes.add_shape(1, Inches(l), Inches(t), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill
    shape.line.fill.background()
    return shape

def add_textbox(slide, l, t, w, h, text, size, bold=False, color=WHITE,
                align=PP_ALIGN.LEFT, wrap=True, italic=False):
    tb = slide.shapes.add_textbox(Inches(l), Inches(t), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(0); tf.margin_right = Pt(0)
    tf.margin_top = Pt(0);  tf.margin_bottom = Pt(0)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tb

def add_multiline_tb(slide, l, t, w, h, lines, size, color=GRAY_TEXT,
                     bold=False, spacing=None, align=PP_ALIGN.LEFT):
    """lines = list of (text, bold_override, color_override)"""
    tb = slide.shapes.add_textbox(Inches(l), Inches(t), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(2); tf.margin_right = Pt(2)
    tf.margin_top = Pt(2);  tf.margin_bottom = Pt(2)
    first = True
    for item in lines:
        if isinstance(item, str):
            txt, b, c = item, bold, color
        else:
            txt = item[0]
            b   = item[1] if len(item) > 1 else bold
            c   = item[2] if len(item) > 2 else color
        if first:
            p = tf.paragraphs[0]; first = False
        else:
            p = tf.add_paragraph()
        p.alignment = align
        if spacing:
            p.space_before = Pt(spacing)
        run = p.add_run()
        run.text = txt
        run.font.size = Pt(size)
        run.font.bold = b
        run.font.color.rgb = c
        run.font.name = "Calibri"
    return tb

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)

# Full background
add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)

# Red accent bar left
add_rect(s, 0, 0, 0.45, 7.5, RED)

# Gold/orange accent top bar
add_rect(s, 0.45, 0, 12.883, 0.12, ORANGE)

# Bottom strip
add_rect(s, 0.45, 7.2, 12.883, 0.3, MID_BLUE)

# AIDS ribbon icon (text symbol)
add_textbox(s, 11.8, 0.8, 1.2, 1.2, "🎗", 48, color=RED, align=PP_ALIGN.CENTER)

# Main title
add_textbox(s, 0.7, 1.3, 10.5, 1.4,
            "NACO GUIDELINES 2026",
            40, bold=True, color=WHITE, align=PP_ALIGN.LEFT)

# Subtitle
add_textbox(s, 0.7, 2.75, 10.5, 0.7,
            "National AIDS Control Organisation — HIV Care & Treatment",
            22, bold=False, color=ORANGE, align=PP_ALIGN.LEFT)

# Line
add_rect(s, 0.7, 3.5, 9.5, 0.04, ORANGE)

add_textbox(s, 0.7, 3.65, 10.5, 0.55,
            "MD Medicine Postgraduate Seminar  |  NACP-V (2021–2026)",
            17, bold=False, color=RGBColor(0xCC, 0xDD, 0xFF), align=PP_ALIGN.LEFT)

add_textbox(s, 0.7, 4.3, 10.5, 0.5,
            "Incorporating WHO Updated Recommendations — January 2026",
            15, bold=False, color=RGBColor(0xAA, 0xBB, 0xDD), align=PP_ALIGN.LEFT, italic=True)

# Bottom credits
add_textbox(s, 0.7, 6.5, 11, 0.55,
            "Reference: NACO National Guidelines for HIV Care & Treatment 2021  |  WHO HIV Clinical Management Guidelines 2026",
            11, bold=False, color=RGBColor(0x88, 0x99, 0xBB), align=PP_ALIGN.LEFT)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — OVERVIEW / INDEX
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, DARK_NAVY)
add_rect(s, 0, 1.05, 0.07, 6.45, RED)

add_textbox(s, 0.3, 0.18, 12, 0.7, "OUTLINE OF PRESENTATION", 26, bold=True, color=WHITE)

topics = [
    ("1", "Epidemiology & India HIV Burden 2025–26"),
    ("2", "NACP-V Goals & 95-95-95 Targets"),
    ("3", "HIV Diagnosis — Testing Algorithm"),
    ("4", "ART Initiation — Treat All Policy"),
    ("5", "First-Line ART Regimens (Adults & Special Populations)"),
    ("6", "Second-Line & Third-Line ART"),
    ("7", "WHO 2026 Updates — New Recommendations"),
    ("8", "Opportunistic Infection Prophylaxis & Management"),
    ("9", "HIV-TB Co-infection"),
    ("10", "PPTCT — Prevention of Parent-to-Child Transmission"),
    ("11", "PrEP & PEP"),
    ("12", "Monitoring — Viral Load, CD4, Treatment Failure"),
    ("13", "ART in Special Populations"),
    ("14", "Key Summary & Take-Home Points"),
]

col1 = topics[:7]
col2 = topics[7:]

for i, (num, title) in enumerate(col1):
    y = 1.2 + i * 0.76
    add_rect(s, 0.3, y, 0.5, 0.5, RED)
    add_textbox(s, 0.3, y+0.05, 0.5, 0.4, num, 14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, 0.9, y+0.05, 5.5, 0.5, title, 13, bold=False, color=DARK_NAVY)

for i, (num, title) in enumerate(col2):
    y = 1.2 + i * 0.76
    add_rect(s, 6.9, y, 0.5, 0.5, MID_BLUE)
    add_textbox(s, 6.9, y+0.05, 0.5, 0.4, num, 14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, 7.45, y+0.05, 5.5, 0.5, title, 13, bold=False, color=DARK_NAVY)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — EPIDEMIOLOGY
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, RED)
add_rect(s, 0, 1.05, 0.07, 6.45, ORANGE)

add_textbox(s, 0.3, 0.15, 12, 0.75, "EPIDEMIOLOGY — HIV BURDEN IN INDIA", 26, bold=True, color=WHITE)

# Stat boxes
stats = [
    ("~24 Lakh", "PLHIV in India\n(2023 estimate)"),
    ("~65,000", "New infections\nper year"),
    ("~42,000", "AIDS-related\ndeaths/year"),
    ("78%", "Adults on ART\n(Treatment Coverage)"),
]
for i, (val, label) in enumerate(stats):
    x = 0.4 + i * 3.2
    add_rect(s, x, 1.2, 2.9, 1.5, DARK_NAVY)
    add_textbox(s, x, 1.3, 2.9, 0.85, val, 28, bold=True, color=YELLOW, align=PP_ALIGN.CENTER)
    add_textbox(s, x, 2.1, 2.9, 0.6, label, 11, bold=False, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(s, 0.3, 2.95, 12.5, 0.04, ORANGE)

bullets = [
    "▶  India has the 3rd largest HIV epidemic globally after South Africa and Nigeria",
    "▶  High risk groups: Men who have sex with men (MSM), People who inject drugs (PWID), Sex workers, Transgender persons",
    "▶  States with highest burden: Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu, Telangana, Manipur",
    "▶  Sexual transmission accounts for ~86% of new infections; PWID ~5%; PPTCT ~4%",
    "▶  NACP-V target: Reduce new infections & AIDS-related deaths by 80% by 2026 (from 2010 baseline)",
    "▶  Global target: End AIDS as public health threat by 2030 (UNAIDS 95-95-95 framework)",
]
add_multiline_tb(s, 0.3, 3.05, 12.5, 4.2, bullets, 13.5, color=DARK_NAVY, spacing=3)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — 95-95-95 TARGETS
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, MID_BLUE)
add_rect(s, 0, 1.05, 0.07, 6.45, RED)

add_textbox(s, 0.3, 0.15, 12, 0.75, "NACP-V GOALS & UNAIDS 95-95-95 TARGETS", 26, bold=True, color=WHITE)

boxes = [
    (RED,      "95%",  "1st 95",  "Of all PLHIV\nknow their\nHIV status"),
    (MID_BLUE, "95%",  "2nd 95",  "Of those who\nknow their status\nare on ART"),
    (TEAL,     "95%",  "3rd 95",  "Of those on ART\nachieve viral\nsuppression"),
]
for i, (col, pct, label, desc) in enumerate(boxes):
    x = 0.8 + i * 4.1
    add_rect(s, x, 1.2, 3.5, 3.8, col)
    add_textbox(s, x, 1.3, 3.5, 1.2, pct, 52, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, x, 2.5, 3.5, 0.5, label, 16, bold=True, color=YELLOW, align=PP_ALIGN.CENTER)
    add_textbox(s, x, 3.05, 3.5, 0.95, desc, 13, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(s, 0.3, 5.2, 12.5, 0.04, ORANGE)

nacp_goals = [
    "NACP-V Strategic Objectives (2021–2026):",
    "• Zero new HIV infections (esp. vertical transmission — EMTCT goal)",
    "• Zero AIDS-related deaths (universal access to free ART & OI management)",
    "• Zero discrimination (legal protection, stigma reduction, rights-based approach)",
    "• India's current status: ~78% diagnosed, ~72% on ART, ~89% virally suppressed (among those on ART)",
]
add_multiline_tb(s, 0.3, 5.3, 12.5, 2.0, nacp_goals, 13, color=DARK_NAVY, spacing=2)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — HIV TESTING / DIAGNOSIS
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, DARK_NAVY)
add_rect(s, 0, 1.05, 0.07, 6.45, TEAL)

add_textbox(s, 0.3, 0.15, 12, 0.75, "HIV DIAGNOSIS — TESTING ALGORITHM (NACO)", 26, bold=True, color=WHITE)

# Algorithm boxes
steps = [
    (MID_BLUE, "STEP 1 — Screening", "Rapid antibody test (ELISA / Rapid Kit 1)\nUsed at ICTC/PPTCT/Blood banks\nReactive → proceed to Step 2"),
    (TEAL,     "STEP 2 — Confirmatory", "Repeat reactive with different Rapid Kit 2\n(different antigen / format)\nReactive → proceed to Step 3"),
    (ORANGE,   "STEP 3 — Tie-breaker", "Third rapid kit (Kit 3) or Western Blot\nALL 3 reactive = HIV Positive\nDiscordant → HIV-indeterminate → repeat in 14 days"),
]
for i, (col, title, desc) in enumerate(steps):
    x = 0.4 + i * 4.2
    add_rect(s, x, 1.15, 3.8, 0.55, col)
    add_textbox(s, x, 1.2, 3.8, 0.45, title, 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(s, x, 1.7, 3.8, 1.6, RGBColor(0xEE, 0xF4, 0xFB))
    add_textbox(s, x+0.1, 1.75, 3.6, 1.5, desc, 12, color=DARK_NAVY)

# Arrows between boxes
for xi in [4.2, 8.4]:
    add_textbox(s, xi, 1.9, 0.4, 0.5, "→", 22, bold=True, color=RED, align=PP_ALIGN.CENTER)

add_rect(s, 0.3, 3.45, 12.5, 0.04, MID_BLUE)

points = [
    ("NAT Testing:", "Nucleic Acid Testing — used for blood bank screening to detect window period donations"),
    ("Window Period:", "~3–4 weeks (4th gen Ag/Ab), 6 weeks (3rd gen Ab), 3 months (2nd gen). Repeat if high-risk exposure"),
    ("4th Generation tests:", "Detect both p24 Antigen AND anti-HIV antibodies simultaneously — reduces window period"),
    ("HIV RNA PCR:", "Used for infant diagnosis <18 months (maternal antibodies confound serology); also virological monitoring"),
    ("CD4 count:", "Not for diagnosis; used at baseline for staging, OI prophylaxis guidance, and monitoring"),
    ("WHO Clinical Staging:", "Stage 1 (Asymptomatic) → Stage 2 (Mild) → Stage 3 (Advanced) → Stage 4 (AIDS-defining)"),
]
y = 3.55
for label, text in points:
    add_multiline_tb(s, 0.4, y, 12.3, 0.45,
                     [(f"● {label}  ", True, RED), (text, False, DARK_NAVY)],
                     12, spacing=0)
    y += 0.5

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — ART INITIATION / TREAT ALL
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, RED)
add_rect(s, 0, 1.05, 0.07, 6.45, ORANGE)

add_textbox(s, 0.3, 0.15, 12, 0.75, "ART INITIATION — TREAT ALL POLICY", 26, bold=True, color=WHITE)

# Big callout box
add_rect(s, 0.4, 1.15, 12.3, 1.0, DARK_NAVY)
add_textbox(s, 0.5, 1.2, 12.1, 0.9,
            "TREAT ALL:  Initiate ART in ALL HIV-positive individuals regardless of CD4 count or WHO clinical stage",
            19, bold=True, color=YELLOW, align=PP_ALIGN.CENTER)

add_rect(s, 0.3, 2.3, 12.5, 0.04, ORANGE)

col_l = [
    ("When to START:", True, RED),
    ("• All PLHIV — regardless of CD4 count or stage (Treat All, since 2017)", False, DARK_NAVY),
    ("• Preferred: Same-day ART (rapid initiation) if patient is ready & no contraindication", False, DARK_NAVY),
    ("• Within 3–5 days if baseline workup needed", False, DARK_NAVY),
    ("", False, DARK_NAVY),
    ("Deferral Situations (temporary):", True, RED),
    ("• Active cryptococcal meningitis — defer ART 4–6 weeks post antifungal Rx", False, DARK_NAVY),
    ("• Active TB with CD4 >50 — defer ART 8 weeks (start antitubercular first)", False, DARK_NAVY),
    ("• Active TB with CD4 <50 — start ART within 2 weeks of ATT", False, DARK_NAVY),
    ("• Severe OI — stabilize first, then start ART", False, DARK_NAVY),
]

col_r = [
    ("Benefits of Early ART:", True, MID_BLUE),
    ("• Prevents disease progression & AIDS-defining events", False, DARK_NAVY),
    ("• Reduces incident TB by ~65%", False, DARK_NAVY),
    ("• Prevents HIV transmission (U=U: Undetectable = Untransmittable)", False, DARK_NAVY),
    ("• Reduces non-AIDS co-morbidities (CVD, renal, malignancy)", False, DARK_NAVY),
    ("", False, DARK_NAVY),
    ("IRIS — Immune Reconstitution Inflammatory Syndrome:", True, MID_BLUE),
    ("• Paradoxical worsening after ART start", False, DARK_NAVY),
    ("• Most common with TB, Cryptococcus, CMV", False, DARK_NAVY),
    ("• Management: Continue ART; steroids for severe IRIS", False, DARK_NAVY),
]

add_multiline_tb(s, 0.35, 2.4, 6.2, 4.9, col_l, 12, spacing=1)
add_multiline_tb(s, 6.8, 2.4, 6.2, 4.9, col_r, 12, spacing=1)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — FIRST LINE ART REGIMENS
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, MID_BLUE)
add_rect(s, 0, 1.05, 0.07, 6.45, RED)

add_textbox(s, 0.3, 0.15, 12, 0.75, "FIRST-LINE ART REGIMENS — ADULTS & ADOLESCENTS", 26, bold=True, color=WHITE)

# Table header
cols_w = [4.0, 3.8, 4.8]
cols_x = [0.3, 4.35, 8.2]
headers = ["Regimen", "Components", "Notes / Indications"]
for i, (hdr, cx, cw) in enumerate(zip(headers, cols_x, cols_w)):
    add_rect(s, cx, 1.1, cw-0.05, 0.52, DARK_NAVY)
    add_textbox(s, cx+0.05, 1.15, cw-0.1, 0.42, hdr, 13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows = [
    ("TLD\n(Preferred)", "TDF + 3TC + DTG\n(Tenofovir + Lamivudine\n+ Dolutegravir)", "WHO 2026 & NACO preferred\nFirst-line for MOST adults\nHigh barrier to resistance"),
    ("TLE\n(Alternative)", "TDF + 3TC + EFV 400mg\n(Efavirenz low dose)", "When DTG not available or\nNeuropsychiatric side-effects\nto DTG"),
    ("ABC/3TC + DTG", "Abacavir + Lamivudine\n+ Dolutegravir", "When TDF contraindicated\n(CrCl <50 mL/min)\nTest HLA-B*5701 before ABC"),
    ("DTG + 3TC\n(2-drug, WHO 2026)", "Dolutegravir + Lamivudine", "NEW WHO 2026 rec.\nTreatment simplification\nfor virally stable adults"),
]
row_colors = [LIGHT_RED, RGBColor(0xE8, 0xF4, 0xFF), RGBColor(0xE8, 0xFF, 0xF0), RGBColor(0xFF, 0xF8, 0xE0)]

for ri, (r0, r1, r2) in enumerate(rows):
    y = 1.65 + ri * 1.18
    rh = 1.15
    for ci, (txt, cx, cw, rc) in enumerate(zip([r0,r1,r2], cols_x, cols_w, [row_colors[ri]]*3)):
        add_rect(s, cx, y, cw-0.05, rh, rc)
        bold_f = (ci == 0)
        col_f = RED if ci == 0 else DARK_NAVY
        add_textbox(s, cx+0.08, y+0.08, cw-0.2, rh-0.1, txt, 11.5, bold=bold_f, color=col_f)

# Bottom note
add_rect(s, 0.3, 6.45, 12.5, 0.05, ORANGE)
add_textbox(s, 0.3, 6.55, 12.5, 0.8,
            "TDF = Tenofovir Disoproxil Fumarate  |  3TC = Lamivudine  |  DTG = Dolutegravir  |  EFV = Efavirenz  |  ABC = Abacavir  |  INSTI = Integrase Strand Transfer Inhibitor",
            10.5, color=RGBColor(0x44, 0x44, 0x66), italic=True)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — SECOND LINE & THIRD LINE ART
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, DARK_NAVY)
add_rect(s, 0, 1.05, 0.07, 6.45, TEAL)

add_textbox(s, 0.3, 0.15, 12, 0.75, "SECOND-LINE & THIRD-LINE ART", 26, bold=True, color=WHITE)

# Left column — 2nd line
add_rect(s, 0.3, 1.12, 5.9, 0.5, RED)
add_textbox(s, 0.35, 1.17, 5.8, 0.4, "SECOND-LINE ART", 15, bold=True, color=WHITE)

sl = [
    ("Indication:", "Virological failure on 1st line (VL >1000 c/mL on 2 readings 3 months apart after enhanced adherence counselling)"),
    ("Backbone change:", "Switch BOTH NRTIs:\n  • If 1st line had TDF → switch to AZT + 3TC\n  • If 1st line had AZT → switch to TDF + 3TC"),
    ("Add Boosted PI:", "LPV/r (Lopinavir/ritonavir) — standard 2nd line\nDRV/r (Darunavir/ritonavir) — WHO 2026 PREFERRED over LPV/r or ATV/r"),
    ("Preferred 2nd line\n(WHO 2026):", "AZT + 3TC + DRV/r\n(or TDF + 3TC + DRV/r if prior AZT-based 1st line)"),
    ("Key point:", "Genotype resistance testing preferred before 2nd line switch if available"),
]
y = 1.7
for label, text in sl:
    add_rect(s, 0.3, y, 1.5, 0.58, MID_BLUE)
    add_textbox(s, 0.32, y+0.05, 1.46, 0.48, label, 10, bold=True, color=WHITE)
    add_rect(s, 1.82, y, 4.35, 0.58, RGBColor(0xEE, 0xF4, 0xFB))
    add_textbox(s, 1.9, y+0.04, 4.2, 0.5, text, 10.5, color=DARK_NAVY)
    y += 0.64

# Right column — 3rd line
add_rect(s, 6.9, 1.12, 6.0, 0.5, TEAL)
add_textbox(s, 6.95, 1.17, 5.9, 0.4, "THIRD-LINE ART", 15, bold=True, color=WHITE)

tl = [
    ("Indication:", "Virological failure on 2nd line (PVL >10,000 c/mL confirmed; or PVL 1000–10,000: repeat after 3 months)"),
    ("Management:", "Referral to Paediatric/Adult Centre of Excellence (PCoE / SACEP)"),
    ("Drugs used:", "New drug classes — minimal cross-resistance:\n• Darunavir/ritonavir (if not already used)\n• Raltegravir / Dolutegravir (if INSTI-naive)\n• Etravirine (NNRTI 2nd gen)\n• Maraviroc (CCR5 antagonist)"),
    ("Principle:", "≥2 fully active drugs from ≥2 different drug classes"),
    ("Genotype testing:", "Mandatory before 3rd line initiation"),
]
y = 1.7
for label, text in tl:
    add_rect(s, 6.9, y, 1.5, 0.68, ORANGE)
    add_textbox(s, 6.92, y+0.05, 1.46, 0.58, label, 10, bold=True, color=WHITE)
    add_rect(s, 8.42, y, 4.45, 0.68, RGBColor(0xF0, 0xFB, 0xF8))
    add_textbox(s, 8.5, y+0.04, 4.3, 0.6, text, 10.5, color=DARK_NAVY)
    y += 0.74

add_rect(s, 0.3, 6.55, 12.5, 0.04, ORANGE)
add_textbox(s, 0.3, 6.62, 12.5, 0.7,
            "WHO 2026 Update: DRV/r replaces LPV/r and ATV/r as the preferred boosted PI in second-line regimens.  |  Tenofovir and Abacavir may be reused in subsequent regimens.",
            11, color=RED, italic=True, bold=True)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — WHO 2026 UPDATES
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
add_rect(s, 0, 0, 13.333, 1.05, ORANGE)
add_rect(s, 0, 1.05, 0.07, 6.45, YELLOW)

add_textbox(s, 0.3, 0.1, 12, 0.8, "WHO 2026 HIV GUIDELINES — KEY UPDATES (January 2026)", 24, bold=True, color=DARK_NAVY)

updates = [
    ("🔴", "DTG-based regimens CONFIRMED as preferred option for INITIAL and SUBSEQUENT HIV treatment across all populations"),
    ("🔴", "DRV/r (Darunavir/Ritonavir) is now PREFERRED boosted PI — replaces ATV/r and LPV/r in 2nd-line regimens"),
    ("🔴", "Long-Acting Injectable ART: CAB-LA (Cabotegravir LA) + RPV-LA (Rilpivirine LA) — recommended for adults/adolescents who struggle with daily oral adherence"),
    ("🔴", "Oral 2-Drug Regimens (e.g., DTG + 3TC) — recommended as treatment simplification for clinically stable, virally suppressed adults"),
    ("🔴", "Tenofovir (TDF/TAF) and Abacavir CAN be reused in subsequent regimens based on improved outcomes evidence"),
    ("🔵", "TB Preventive Therapy (TPT): 1HP (Isoniazid + Rifapentine weekly x4 wks) now a viable short-course option for PLHIV"),
    ("🔵", "Vertical Transmission: Updated guidance on ARV prophylaxis for infants — strengthened options to achieve EMTCT"),
    ("🔵", "Viral suppression target: <200 copies/mL (operational) or <50 copies/mL (laboratory) — both valid for monitoring"),
]

for i, (icon, text) in enumerate(updates):
    y = 1.1 + i * 0.76
    col = RED if icon == "🔴" else MID_BLUE
    add_rect(s, 0.3, y, 0.45, 0.62, col)
    add_textbox(s, 0.3, y+0.08, 0.45, 0.46, icon, 14, align=PP_ALIGN.CENTER)
    add_textbox(s, 0.85, y+0.08, 12.1, 0.55, text, 13, color=WHITE)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — OI PROPHYLAXIS & MANAGEMENT
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, TEAL)
add_rect(s, 0, 1.05, 0.07, 6.45, RED)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "OPPORTUNISTIC INFECTION PROPHYLAXIS & MANAGEMENT", 24, bold=True, color=WHITE)

# Table
hdrs = ["OI", "When (CD4)", "Prophylaxis Drug", "Treatment Drug", "Duration"]
hw   = [1.8, 1.5, 2.5, 3.5, 2.0]
hx   = [0.3, 2.12, 3.65, 6.18, 9.7]
for h, cx, cw in zip(hdrs, hx, hw):
    add_rect(s, cx, 1.1, cw-0.05, 0.48, DARK_NAVY)
    add_textbox(s, cx+0.05, 1.15, cw-0.1, 0.38, h, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows = [
    ("PCP\n(P. jirovecii)", "<200\nor stage 3/4", "Co-trimoxazole\n(TMP-SMX DS OD)", "TMP-SMX high dose\nx 21 days", "Until CD4 >200\nfor ≥3 months"),
    ("Toxoplasma", "<100\n(or Toxo IgG+)", "Co-trimoxazole DS BD\nor TMP-SMX DS OD", "Pyrimeth+Sulfadiazine\n+ Folinic acid x 6wk", "Secondary: lifelong\nuntil CD4 >200"),
    ("MAC", "<50", "Azithromycin 1200mg\nweekly", "Clarithromycin +\nEthambutol ± Rifabutin", "Lifelong unless\nCD4 >100 sustained"),
    ("Cryptococcus\n(secondary)", "After treatment\ncomplete", "Fluconazole 200mg OD", "Amphotericin B +\nFlucytosine (induction)", "Consolidation:\nFluconazole 400mg x8wk\nMaintenance: 200mg lifelong"),
    ("CMV Retinitis", "<50", "No routine prophylaxis;\nscreen at CD4 <50", "Ganciclovir IV /\nValganciclovir oral", "Until CD4 >100\nfor ≥3–6 months"),
]
row_bgs = [LIGHT_RED, RGBColor(0xE8,0xF4,0xFF), RGBColor(0xE8,0xFF,0xF0), RGBColor(0xFF,0xF8,0xE0), RGBColor(0xF0,0xEC,0xFF)]

for ri, row in enumerate(rows):
    y = 1.62 + ri * 1.0
    rh = 0.95
    for ci, (txt, cx, cw) in enumerate(zip(row, hx, hw)):
        add_rect(s, cx, y, cw-0.05, rh, row_bgs[ri])
        fc = RED if ci == 0 else DARK_NAVY
        add_textbox(s, cx+0.06, y+0.06, cw-0.15, rh-0.1, txt, 10.5, color=fc, bold=(ci==0))

add_rect(s, 0.3, 6.65, 12.5, 0.04, TEAL)
add_textbox(s, 0.3, 6.7, 12.5, 0.65,
            "Co-trimoxazole Prophylaxis (CTX) is given to ALL PLHIV with CD4 <200 or WHO Stage 3/4. Stop CTX when CD4 >200 for ≥3 months on ART.",
            11.5, color=MID_BLUE, bold=True)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — HIV-TB CO-INFECTION
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, RED)
add_rect(s, 0, 1.05, 0.07, 6.45, MID_BLUE)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "HIV-TB CO-INFECTION", 26, bold=True, color=WHITE)

add_rect(s, 0.3, 1.1, 12.5, 0.65, DARK_NAVY)
add_textbox(s, 0.4, 1.18, 12.3, 0.52,
            "TB is the MOST COMMON OI and leading cause of death in PLHIV in India. Risk of TB is 20x higher in PLHIV vs HIV-negative individuals.",
            14, color=YELLOW, bold=True)

# Two columns
left = [
    ("Diagnosis:", "• Screen ALL PLHIV for TB at every visit (4-symptom screen: cough, fever, weight loss, night sweats)\n• GeneXpert MTB/RIF first-line rapid test\n• AFB smear ± culture (LJ / MGIT)\n• CXR: may be atypical — miliary, lower-lobe, no cavitation\n• CBNAAT useful for extrapulmonary TB"),
    ("TB Treatment in PLHIV:", "• Standard 2HRZE + 4HR (rifampicin-based)\n• Same regimen as HIV-negative\n• Toxicity monitoring more important\n• Drug interactions with ART must be managed"),
    ("ART-ATT Interaction:", "• Rifampicin induces CYP3A4 → reduces PI and INSTI levels\n• Use EFV 600mg OD (not DTG) with rifampicin-based ATT\n• OR: use DTG 50mg BD (double dose) with rifampicin\n• AVOID: LPV/r or ATV/r with rifampicin"),
]
right = [
    ("When to Start ART:", "• CD4 <50: Start ART within 2 WEEKS of ATT\n• CD4 ≥50: Start ART within 8 WEEKS of ATT\n• TB Meningitis: Defer ART 8 weeks (IRIS risk is high)\n• NEVER delay ATT for ART workup"),
    ("TB Preventive Therapy (TPT):", "• Indicated for ALL PLHIV without active TB\n• 6H: Isoniazid 300mg OD x 6 months (NACO standard)\n• 3HP: Isoniazid + Rifapentine weekly x 12 wks (WHO)\n• 1HP: Isoniazid + Rifapentine weekly x 4 wks (WHO 2026 new rec)\n• Rule out active TB before starting TPT"),
    ("Drug-Resistant TB:", "• XDR-TB: Use ART regimens that avoid drug interactions\n• Avoid rifampicin-based regimens → use Bedaquiline-based\n• Bedaquiline: QTc prolongation — monitor with ART (EFV-QTc)"),
]

y = 1.9
for label, text in left:
    add_rect(s, 0.3, y, 1.4, 0.38, MID_BLUE)
    add_textbox(s, 0.32, y+0.04, 1.36, 0.3, label, 10, bold=True, color=WHITE)
    add_rect(s, 1.72, y, 4.7, 0.38, RGBColor(0xEE, 0xF4, 0xFB))
    add_textbox(s, 1.8, y+0.02, 4.6, 0.5, text, 9.5, color=DARK_NAVY)
    y += 1.42

y = 1.9
for label, text in right:
    add_rect(s, 6.8, y, 1.5, 0.38, RED)
    add_textbox(s, 6.82, y+0.04, 1.46, 0.3, label, 10, bold=True, color=WHITE)
    add_rect(s, 8.32, y, 4.7, 0.38, LIGHT_RED)
    add_textbox(s, 8.4, y+0.02, 4.6, 0.5, text, 9.5, color=DARK_NAVY)
    y += 1.42

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 12 — PPTCT
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, MID_BLUE)
add_rect(s, 0, 1.05, 0.07, 6.45, ORANGE)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "PPTCT — PREVENTION OF PARENT-TO-CHILD TRANSMISSION", 24, bold=True, color=WHITE)

# Transmission risk boxes
risks = [
    ("No ARV\nBreastfeeding", "30–45%"),
    ("No ARV\nNo Breastfeeding", "20–25%"),
    ("Short course ARV\nBreastfeeding", "15–25%"),
    ("Full ART\nNo Breastfeeding", "<2%"),
]
for i, (label, risk) in enumerate(risks):
    x = 0.4 + i * 3.2
    col = RED if i < 2 else (ORANGE if i==2 else TEAL)
    add_rect(s, x, 1.1, 2.9, 1.1, col)
    add_textbox(s, x, 1.15, 2.9, 0.52, risk, 26, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(s, x, 1.67, 2.9, 0.5, label, 11, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(s, 0.3, 2.35, 12.5, 0.04, MID_BLUE)

cols_data = [
    [
        ("Testing:", "All pregnant women offered HIV testing at 1st ANC visit (opt-out PPTCT)\nRepeat test at 3rd trimester if initially negative"),
        ("ART in Pregnancy:", "Start TLE or TLD (TDF + 3TC + DTG preferred)\nLifelong ART for ALL HIV+ pregnant women regardless of CD4\nOption B+ — lifelong ART initiated at ANC, continued postpartum"),
        ("Labour:", "Institutional delivery mandatory\nAvoid ARM, episiotomy unless necessary\nNo contraindication to vaginal delivery"),
    ],
    [
        ("Infant Prophylaxis:", "Nevirapine (NVP) 2mg/kg OD for 6 weeks (if mother on ART for >4 weeks)\nNVP + AZT if mother NOT on ART or on ART <4 weeks (high risk)"),
        ("Infant Feeding:", "Exclusive breastfeeding x 6 months with maternal ART\n(Formula feeding ONLY if replacement feeding is AFASS*)\n*Affordable, Feasible, Acceptable, Sustainable, Safe"),
        ("Infant Diagnosis:", "HIV DNA PCR (NAT) at 6 weeks and 6 months of age\nIf NAT positive → start infant ART immediately\nIf NAT negative but breastfed → test again 6 wks after cessation"),
    ]
]

y = 2.45
for label, text in cols_data[0]:
    add_rect(s, 0.3, y, 1.5, 0.42, MID_BLUE)
    add_textbox(s, 0.32, y+0.05, 1.46, 0.32, label, 10, bold=True, color=WHITE)
    add_textbox(s, 1.82, y+0.03, 4.6, 0.55, text, 10, color=DARK_NAVY)
    y += 1.3

y = 2.45
for label, text in cols_data[1]:
    add_rect(s, 6.8, y, 1.5, 0.42, ORANGE)
    add_textbox(s, 6.82, y+0.05, 1.46, 0.32, label, 10, bold=True, color=WHITE)
    add_textbox(s, 8.32, y+0.03, 4.7, 0.55, text, 10, color=DARK_NAVY)
    y += 1.3

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 13 — PrEP & PEP
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, DARK_NAVY)
add_rect(s, 0, 1.05, 0.07, 6.45, TEAL)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "PrEP (PRE-EXPOSURE PROPHYLAXIS) & PEP (POST-EXPOSURE PROPHYLAXIS)", 22, bold=True, color=WHITE)

# PrEP column
add_rect(s, 0.3, 1.1, 6.0, 0.5, TEAL)
add_textbox(s, 0.35, 1.15, 5.9, 0.4, "PrEP", 18, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

prep_items = [
    ("Indication:", "HIV-negative persons at high risk:\nMSM, Sex workers, discordant couples, PWID"),
    ("Drug:", "TDF + FTC (Tenofovir + Emtricitabine) OD — Daily PrEP\nOR: Cabotegravir LA (CAB-LA) injectable q8 weeks (WHO 2026)"),
    ("Protocol:", "• Confirm HIV-negative status before starting\n• Baseline renal function (eGFR)\n• Repeat HIV test every 3 months\n• STI screening every 6 months"),
    ("Efficacy:", "Daily oral PrEP: ~90–99% reduction in HIV acquisition\nCAB-LA: Superior to TDF/FTC in MSM (HPTN 083 trial)"),
    ("2-1-1 (Event-driven):", "For MSM: 2 pills 2–24h before sex, 1 pill 24h after,\n1 pill 48h after (Truvada only — NOT for PWID or women)"),
]
y = 1.68
for label, text in prep_items:
    add_rect(s, 0.3, y, 1.4, 0.5, RGBColor(0x00, 0x7B, 0x83))
    add_textbox(s, 0.32, y+0.06, 1.36, 0.38, label, 9.5, bold=True, color=WHITE)
    add_rect(s, 1.72, y, 4.55, 0.5, RGBColor(0xE8, 0xFB, 0xFB))
    add_textbox(s, 1.8, y+0.04, 4.45, 0.55, text, 10, color=DARK_NAVY)
    y += 0.58

# PEP column
add_rect(s, 6.9, 1.1, 6.0, 0.5, RED)
add_textbox(s, 6.95, 1.15, 5.9, 0.4, "PEP", 18, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

pep_items = [
    ("Indication:", "Potential HIV exposure (occupational or non-occupational):\nNeedle stick, sexual assault, condom failure, PWID needle sharing"),
    ("Timing:", "Start ASAP — within 72 hours of exposure\nDelay >72 hours: PEP NOT recommended (ineffective)"),
    ("Duration:", "28 days of continuous ART (full 4-week course is mandatory)"),
    ("Preferred Regimen\n(NACO):", "TDF + 3TC (or FTC) + DTG 50mg OD\nAlternative: TDF + 3TC + LPV/r (if DTG unavailable)"),
    ("Monitoring:", "• Baseline HIV test; repeat at 6 wks, 3 months, 6 months\n• Check renal function (TDF toxicity)\n• Counsel on safer sex during PEP course"),
    ("Counselling:", "Address: adherence, side effects, risk reduction,\npartner testing, linkage to care if HIV+ confirmed"),
]
y = 1.68
for label, text in pep_items:
    add_rect(s, 6.9, y, 1.5, 0.5, RED)
    add_textbox(s, 6.92, y+0.06, 1.46, 0.38, label, 9.5, bold=True, color=WHITE)
    add_rect(s, 8.42, y, 4.45, 0.5, LIGHT_RED)
    add_textbox(s, 8.5, y+0.04, 4.35, 0.55, text, 10, color=DARK_NAVY)
    y += 0.58

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 14 — MONITORING (VL, CD4, Treatment Failure)
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, MID_BLUE)
add_rect(s, 0, 1.05, 0.07, 6.45, ORANGE)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "MONITORING — VIRAL LOAD, CD4 & TREATMENT FAILURE", 24, bold=True, color=WHITE)

# Monitoring schedule table
add_rect(s, 0.3, 1.1, 12.5, 0.5, DARK_NAVY)
for hdr, cx, cw in [("Parameter", 0.3, 2.5), ("Baseline", 2.82, 2.5), ("3 Months", 5.34, 2.5), ("6 Months", 7.86, 2.5), ("12 Months+", 10.38, 2.42)]:
    add_textbox(s, cx+0.05, 1.15, cw-0.1, 0.38, hdr, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

mon_rows = [
    ("Viral Load", "Yes", "Yes\n(assess adherence)", "Yes\n(target <1000 c/mL)", "Every 6 months\n(target <50 c/mL)"),
    ("CD4 Count", "Yes", "Yes", "Yes\n(not mandatory if VL stable)", "Every 6–12 months;\ndiscontinue if VL suppressed & stable"),
    ("LFT/RFT/CBC", "Yes\n(baseline)", "If symptomatic", "If symptomatic", "Annually or as needed"),
    ("HBsAg/HCV", "Yes", "—", "—", "Repeat if new risk exposure"),
    ("Lipid Profile", "Yes (EFV/LPV)", "—", "—", "Annually on PI regimens"),
]
row_bg2 = [RGBColor(0xF5,0xF5,0xFF), LIGHT_RED, RGBColor(0xF0,0xFB,0xF0), RGBColor(0xFF,0xFB,0xED), RGBColor(0xF5,0xF0,0xFF)]
for ri, row in enumerate(mon_rows):
    y = 1.63 + ri * 0.72
    for ci, (txt, cx, cw) in enumerate(zip(row, [0.3,2.82,5.34,7.86,10.38], [2.5,2.5,2.5,2.5,2.42])):
        add_rect(s, cx, y, cw-0.05, 0.68, row_bg2[ri])
        fc = RED if ci==0 else DARK_NAVY
        add_textbox(s, cx+0.08, y+0.06, cw-0.18, 0.56, txt, 10.5, color=fc, bold=(ci==0), align=PP_ALIGN.CENTER)

add_rect(s, 0.3, 5.25, 12.5, 0.04, MID_BLUE)

failure_defs = [
    ("Virological Failure:", "VL >1000 c/mL on 2 readings 3 months apart AFTER Enhanced Adherence Counselling (EAC) x3 sessions"),
    ("Immunological Failure:", "CD4 <250 after clinical failure  OR  Persistent CD4 <100  (confirm with VL before switching)"),
    ("Clinical Failure:", "New or recurrent WHO Stage 3/4 event after ≥6 months on ART (rule out IRIS first)"),
    ("EAC:", "3 Enhanced Adherence Counselling sessions over 3 months before confirming virological failure and switching"),
]
y = 5.35
for label, text in failure_defs:
    add_multiline_tb(s, 0.4, y, 12.4, 0.45,
                     [(f"▶ {label}  ", True, RED), (text, False, DARK_NAVY)], 11.5, spacing=0)
    y += 0.5

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 15 — ART IN SPECIAL POPULATIONS
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, LIGHT_BG)
add_rect(s, 0, 0, 13.333, 1.05, DARK_NAVY)
add_rect(s, 0, 1.05, 0.07, 6.45, ORANGE)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "ART IN SPECIAL POPULATIONS", 26, bold=True, color=WHITE)

populations = [
    (MID_BLUE, "Pregnancy",
     "• TDF + 3TC + DTG preferred (Option B+)\n"
     "• Avoid EFV in 1st trimester (neural tube defect risk — though evidence reassuring with low-dose)\n"
     "• Monitor: NTDs if DTG started peri-conception (small increased risk — counsel patient)\n"
     "• Lifelong ART regardless of CD4"),
    (TEAL, "Renal Impairment\n(CrCl <50 mL/min)",
     "• AVOID TDF (nephrotoxic)\n"
     "• Use ABC + 3TC + DTG or AZT + 3TC + DTG\n"
     "• TAF (Tenofovir Alafenamide) safer for kidneys (not yet widely available in India)\n"
     "• Monitor creatinine, phosphate, proteinuria"),
    (ORANGE, "Hepatic Disease\n(HBV/HCV Co-infection)",
     "• If HBV co-infected: Always include TDF in ART (TDF treats both HIV & HBV)\n"
     "• AVOID: stopping TDF suddenly (HBV flare)\n"
     "• HCV co-infection: DAA therapy preferred (ledipasvir/sofosbuvir); check drug interactions\n"
     "• LFT monitoring mandatory"),
    (RED, "Children (<15 yrs)",
     "• Preferred: ABC + 3TC + DTG (weight-based dosing)\n"
     "• <3 years: LPV/r-based (DTG granules now available)\n"
     "• Diagnosis by NAT (DNA PCR) <18 months\n"
     "• EFV-based regimens in older children (>3 yrs)"),
    (RGBColor(0x5A, 0x1F, 0x7A), "TB-HIV\n(See Slide 11)",
     "• Use EFV 600mg or DTG 50mg BD with rifampicin-based ATT\n"
     "• AVOID LPV/r or ATV/r with rifampicin (reduced PI levels)\n"
     "• Start ART timing depends on CD4 count"),
    (RGBColor(0x1A, 0x6B, 0x3A), "Cryptococcal Meningitis",
     "• DEFER ART 4–6 weeks after antifungal induction\n"
     "• Induction: Amphotericin B + Flucytosine x 2 wks\n"
     "• Consolidation: Fluconazole 400mg OD x 8 wks\n"
     "• Maintenance: Fluconazole 200mg OD (lifelong until CD4 >200)"),
]

positions = [(0.3, 1.1), (6.9, 1.1), (0.3, 2.95), (6.9, 2.95), (0.3, 4.8), (6.9, 4.8)]
for (x, y), (col, title, content) in zip(positions, populations):
    add_rect(s, x, y, 6.2, 1.72, col)
    add_textbox(s, x+0.1, y+0.06, 6.0, 0.48, title, 13, bold=True, color=WHITE)
    add_textbox(s, x+0.1, y+0.55, 6.0, 1.12, content, 10.5, color=WHITE)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 16 — TAKE-HOME SUMMARY
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
add_rect(s, 0, 0, 13.333, 1.05, RED)
add_rect(s, 0, 1.05, 0.07, 6.45, YELLOW)

add_textbox(s, 0.3, 0.15, 12.5, 0.75, "KEY SUMMARY — TAKE-HOME POINTS", 26, bold=True, color=WHITE)

key_points = [
    ("1", "TREAT ALL — Start ART in ALL HIV+ individuals immediately, regardless of CD4 or stage. Prefer same-day initiation."),
    ("2", "TLD (TDF+3TC+DTG) is the PREFERRED first-line ART for most adults (NACO & WHO 2026 confirmed)."),
    ("3", "WHO 2026 Update: DRV/r is the NEW preferred boosted PI (replaces LPV/r and ATV/r) for second-line ART."),
    ("4", "WHO 2026: Long-acting injectable ART (CAB-LA + RPV-LA) recommended for adherence-challenged patients."),
    ("5", "WHO 2026: Oral 2-drug regimen (DTG + 3TC) is an option for stable, virally suppressed adults."),
    ("6", "HIV-TB: ATT first. Add ART within 2 weeks if CD4 <50, within 8 weeks if CD4 ≥50. Use EFV or DTG BD with rifampicin."),
    ("7", "Viral Load is the GOLD STANDARD for monitoring ART. Target VL <1000 c/mL; do EAC x3 before switching."),
    ("8", "CTX prophylaxis for ALL PLHIV with CD4 <200 or WHO Stage 3/4. Stop only after sustained CD4 >200 on ART."),
    ("9", "PPTCT Option B+: All HIV+ pregnant women on lifelong ART (TDF+3TC+DTG preferred)."),
    ("10", "PEP must start within 72 hours. Preferred regimen: TDF + 3TC + DTG x 28 days."),
    ("11", "U=U: Undetectable = Untransmittable — virally suppressed PLHIV do NOT transmit HIV sexually."),
    ("12", "NACP-V target (2026): 80% reduction in new infections & deaths vs 2010 baseline; 95-95-95 framework."),
]

for i, (num, point) in enumerate(key_points):
    col = i % 2
    row = i // 2
    x = 0.3 if col == 0 else 6.9
    y = 1.1 + row * 1.05
    add_rect(s, x, y, 0.45, 0.85, RED if col==0 else ORANGE)
    add_textbox(s, x, y+0.18, 0.45, 0.45, num, 15, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(s, x+0.45, y, 5.9, 0.85, RGBColor(0x14, 0x35, 0x65))
    add_textbox(s, x+0.55, y+0.1, 5.75, 0.68, point, 11, color=WHITE)

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 17 — REFERENCES / THANK YOU
# ════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
add_rect(s, 0, 0, 13.333, 0.12, RED)
add_rect(s, 0, 7.38, 13.333, 0.12, ORANGE)
add_rect(s, 0, 1.05, 0.07, 6.3, RED)

add_textbox(s, 0.3, 0.18, 12.5, 0.75, "REFERENCES & ACKNOWLEDGEMENTS", 22, bold=True, color=WHITE)

refs = [
    "1.  National Guidelines for HIV Care and Treatment 2021. National AIDS Control Organisation (NACO), Ministry of Health & Family Welfare, Govt. of India.",
    "2.  WHO Updated Recommendations on HIV Clinical Management — January 7, 2026. World Health Organization, Geneva.",
    "3.  NACP-V National Strategic Plan on HIV/AIDS & STIs (2021–2026). NACO, MoHFW, India.",
    "4.  National HIV Counselling and Testing Guidelines 2024. NACO / FOGSI. December 2024.",
    "5.  Goldman-Cecil Medicine, 27th Edition — Chapter 353: HIV/AIDS Management.",
    "6.  India HIV Estimates 2023: Technical Brief. NACO & ICMR-NIMS, New Delhi.",
    "7.  WHO Consolidated Guidelines on HIV, Viral Hepatitis and STIs for Key Populations, 2022.",
    "8.  UNAIDS Global AIDS Update 2025: Progress Towards 95-95-95 Targets.",
    "9.  NACO Operational Guidelines for ART Services, 2022.",
    "10. National Guidelines on Prevention, Management and Control of RTI/STI, MOH&FW, 2014.",
]
add_multiline_tb(s, 0.4, 1.15, 12.3, 5.2, refs, 12.5, color=RGBColor(0xCC, 0xDD, 0xFF), spacing=4)

add_rect(s, 2.5, 6.3, 8.3, 0.04, ORANGE)
add_textbox(s, 0.3, 6.4, 12.5, 0.7,
            "NACO Helpline: 1097 (Toll Free, 24×7)  |  www.naco.gov.in  |  PLHIV Support: ART Centres across India",
            14, bold=True, color=ORANGE, align=PP_ALIGN.CENTER)

# ════════════════════════════════════════════════════════════════════════════
# SAVE
# ════════════════════════════════════════════════════════════════════════════
output = "/tmp/workspace/naco2026-ppt/NACO_2026_HIV_Guidelines_MD_Medicine.pptx"
prs.save(output)
print(f"Saved: {output}")