Share
 
Title
Presenter
Authors
Institutions

Background: Progress towards the ending the AIDS epidemic by 2030 depends on adoption and implementation of global guidelines to optimally treat all people living with HIV. With the 2015 Consolidated ARV Guidelines, WHO successfully updated and launched new policy recommendations on the clinical and service delivery aspects of HIV treatment and care, and raised the bar to treat all PLHIV.
Methods: WHO operates a country intelligence monitor to better follow policy trends at country level. Data from country surveys, MoH HIV focal points, and Global AIDS Response Progress Reporting (GARPr) have been triangulated and validated for the adoption of priority HIV treatment policies within 144 LMIC and 20 WHO focus countries for Fast Track support.
Results: Data are presented for 144 LMIC and 20 fast track counties, respectively. 54% of all LMIC and 80% of fast track countries adopted a CD4 count threshold of ≤500 cells/mm3, while 7% and 10% have moved to a treat all policy regardless of CD4 cell count. Adoption and implementation of treatment eligibility varied by WHO region (Figure 1).

Uptake of WHO Policy for ART initiation threshold among adults and adolescents living in LIMC, 2015
[Uptake of WHO Policy for ART initiation threshold among adults and adolescents living in LIMC, 2015]

83% and 100% adopted PMTCT Option B/B+; 80% and 95% adopted TDF + 3TC (or FTC) + EFV as the preferred first-line therapy, 60% as a fixed dose combination (FDC); and 63% and 70% implement routine viral load monitoring; all other fast track countries implement targeted viral load monitoring. An update on the country implementation of these policies will be available in April 2016.
Conclusions: With the 2015 Consolidated ARV Guidelines, WHO has rapidly updated global guidance to reflect new science regarding the benefit of early HIV treatment. There is broad support for universal treatment among fast track countries and many are committed to adopting ''Treat All'' policies; challenges to full implementation remain. Differentiated service delivery models are key to improving efficiency while maintaining quality as programs expand.