HIV treatment for all: new choices, new contexts

We welcome the news that the World Health Organisation will issue new treatment guidelines later this year which will recommend that all people living with HIV should have access to HIV treatment on diagnosis.

The new guidelines will replace the current 2013 guidance and are the result of analysis of more recent randomised trials, including START, which showed that starting treatment at a CD4 cell count above 500 cells/mm3 can be hugely beneficial.

Also, it is anticipated that guidance will be made recommending pre-exposure prophylaxis (PrEP) as an additional HIV prevention choice within a comprehensive prevention package for people at substantial risk of HIV.

Dr Gitau Mburu, senior advisor, health systems and services, who is attending the 8th IAS Conference on HIV Pathogenisis, Treatment and Prevention in Vancouver this week said:

“This updated guidance will be a demonstration of a more nuanced understanding of the preventative benefits that anti-retroviral drugs (ARVs) can provide for both individuals who are already living with HIV, and for populations most at risk of future HIV infection.”

“However, these changes in guidelines alone will not achieve universal access to treatment for all those with HIV unless we make a concerted effort to increase the number of people who are being tested.  More than 50% of people with HIV still do not know their status, and therefore do not access treatment.”

The Alliance will continue to work with other stakeholders and communities to ensure that the new treatment guidance recognises a number of other key issues:

  • A special effort is needed to support adolescents and young people to access treatment through facilitated disclosure and family-centred care.
  • People living with HIV who are on treatment must be supported to remain linked to and engaged in long term care, and within this context, sustainable community-based interventions are prioritised and supported.
  • Specifically on PrEP, we acknowledge this as a powerful new tool for HIV prevention that could expand the range of prevention options available for people and communities to prevent HIV. Everyone should be given the possibility to choose from a range of prevention options, and we are working with the communities we support to create and share knowledge on PrEP, and to understand if, when and how taking PrEP might be feasible, and for whom.

HIV testing

At the conference this week, WHO launched new guidance on HIV testing services which we also welcome, in particular the strong recommendations around community-based HIV testing.  We particularly like their emphasis on the “test for triage” approach and recommendation for lay provider delivered HIV testing which will help overcome social and structural barriers to scaling up testing services among key populations.

In 2014, Alliance programming led to 919,000 adults and children being enrolled in HIV care services and 782,000 people receiving HIV testing and counselling services.

Useful resource: UNAIDS, AVAC and WHO have launched this publication to support the optimal use of oral PrEP to protect individuals.