WHO publishes new guidelines for HIV treatment and care

As the world continues to tackle the ongoing COVID-19 pandemic the World Health Organisation (WHO) is concerned about maintaining the pace and progress in treating and managing HIV.

The new recommendations outline key new actions that countries can take to improve the delivery of HIV testing, treatment and care services by providing greater options for individual approaches such as, supporting HIV treatment start in the community, ensuring that children are diagnosed and treated early, and that viral load treatment monitoring is more accessible, focused and linked into care – including starting antiretroviral treatment (ART).

‘Strong recommendations’ from the WHO include:

• The use of point of care (POC) testing to diagnose HIV in infants and children younger than 18 months of age.
• Starting ART as soon as possible, regardless of CD4 cell count, for adults, adolescents, children and infants living with HIV.
• People on ART for at least 6 months and responding well, should be offered clinical visits every 3 to 6 months, preferably every six months, if feasible.
• People on ART for at least 6 months and responding well, should be offered refills of ART lasting 3 to 6 months, preferably six months, if feasible.
• HIV programmes should implement interventions to trace people who have disengaged from care and provide support for re-engagement.
• Psychosocial interventions should be provided to all adolescents and young adults living with HIV.

‘Conditional recommendations’* include: 

• Point of care (POC) viral load testing may be used to monitor treatment among people living with HIV receiving ART.
• ART initiation may be offered outside of the health facility.
• Sexual and reproductive health services, including contraception, may be integrated within HIV services.
• Diabetes and hypertension care may be integrated with HIV services.

* A conditional recommendation is issued when the evidence around the benefits and risks of an intervention are less certain.

Officials from ministries of health, researchers and medical workers will begin testing the new manual on the fight against tuberculosis and HIV. Of these, the WHO has formed two groups to develop the principles outlined in the recommendations. In each group there are people living with HIV, whose experience played an important role in revising the algorithm for monitoring treatment.

“Clinical and service guidelines are today launched and published independently for rapid use and access by ministries of health, HIV program managers, civil society members and all other stakeholders,” the WHO explains.

By the middle of summer, a unified set of rules for HIV treatment will be launched, which will combine the new recommendations and the old 2016 WHO ‘Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection’.

The new document focuses on the continuity of HIV treatment. It specifies the conditions for point of care testing of children under 18 months of age and addresses the monitoring of treatment for people living with HIV, including the tracking algorithm, adherence to antiretroviral therapy, as well as possible integration with tuberculosis, diabetes and hypertension treatment.

“These recommendations clearly show that achieving our goals of ending AIDS as a public health issue by 2030 will require an integrated delivery of people-centered HIV, TB, mental, sexual and reproductive health services,” said Dr. Meg Dougherty, Director of Global WHO programs on HIV, hepatitis and STIs.