Multi-month HIV prescribing prohibited in many countries

Current advice from international experts such as the WHO, UNAIDS, the Global Fund, PEPFAR, EACS and others is that during the Coronavirus pandemic people living with HIV should be given prescriptions of HIV antiretrovirals (ART) covering three to six months.

Even before the Coronavirus pandemic many of the aforementioned bodies were already recommending that people living with HIV who were considered to be stable should be on multi-month prescriptions.

However, following an analysis by the O’Neill Institute of National and Global Law at Georgetown University up to 35% of countries are not permitting clinicians to write multi-month prescriptions with the results in higher-income countries being surprisingly poor.

The analysis by the O’Neill institute covered national guidelines, policies and strategies from 126 countries and compared both the definition of a ‘stable’ patient and whether three-monthly or six-monthly prescribing with permitted. Of those countries for which there was data only 63% permitted three-monthly prescriptions and only 23% permitted six-monthly prescribing.

Those with the greatest compliance tended to be in countries supported by PEPFAR, including those in Africa.

When the team looked at solely high-income countries only 39% and 19% permitted three-monthly and six-monthly prescribing, respectively.

Definitions of what constituted a ‘stable’ patient and therefor recommended a three- or six-month prescription varied wildly from country to country with Australia, France and UK being top rated, and Belgium, France, Ireland and Spain falling short of the mark and failing people living with HIV.