Health systems implications of the 2013 WHO consolidated antiretroviral guidelines and strategies for successful implementation


Holmes, Charles; Pillay, Yogan; Mwango, Albert; Perriens, Jos; Ball, Andrew; Barreneche, Oscar; Wignall, Steven; Hirnschall, Gottfried; Doherty, Meg C.


AIDS: March 2014 – Volume 28 – p S231-S239 doi: 10.1097/QAD.0000000000000250

To successfully implement the 2013 WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at country level, the implications for national and regional health systems need to be considered and addressed.

The guidelines target the entire continuum of care for the HIV-infected individual, and in some cases, their partners, and those with unknown status. The guidelines include not only a more inclusive treatment initiation threshold of CD4þ T-cell count of 500 cells/ml or less for adults and adolescents, treatment for life for pregnant and breastfeeding women (or treatment for the duration of pregnancy and breastfeeding regardless of CD4þ T-cell count), treatment regardless of CD4þ T-cell count for children under 5 years of age, discordant couples, those co-infected with either tuberculosis (TB) or severe hepatitis B virus (HBV), and diversification of effective strategies to reach those with unknown status through couples testing and community-based testing.

The changes, if fully enacted, will lead to an increase in treatment eligibility of over 60%, from 17.6 million globally, to 28.6 million globally, with variation in that increase by epidemic type and other epidemiologic factors. However, within these increases in volume, health systems will be serving a healthier mix of patients starting antiretroviral therapy (ART), and greater proportions of pregnant women and children, and sexual partners seeking care together.

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