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WHO publishes new clinical recommendations and recommendations for the provision of HIV prevention, treatment and care services
These guidelines provide new and updated recommendations on the use of on-site care tests in children under 18 months of age and on-site tests to monitor treatment in people living with HIV; treatment monitoring algorithm; and the schedule of antiretroviral therapy (ART) among people living with HIV and being treated for tuberculosis.
The new recommendations released today outline key new actions that states can take to improve the delivery of HIV testing, treatment and care services by providing greater opportunities for different approaches, such as supporting early HIV treatment in the community, ensuring early diagnosis and treatment of children. monitoring viral load treatment is more accessible, focused, and triggers clinical action.
“These recommendations make it clear that there is now evidence that the integrated delivery of HIV, TB, NCDs, mental health and human-centered sexual and reproductive health services will be geared to achieving our AIDS eradication goals as an issue. public health by 2030. said Dr. Meg Doherty, director of the WHO Global Program on HIV, Hepatitis and STIs.
These new recommendations are a supplement to WHO Consolidated Guidelines on the Use of ARVs for the Treatment and Prevention of HIV Infection in 2016. Since the release of the 2016 version, the WHO has provided updates in several areas of this guideline – Antiretroviral options for first- and second-line treatment, infant diagnosis, post-exposure prophylaxis, advanced HIV disease and management cryptococcal infections and provision of HIV services.
The COVID-19 pandemic presented unique challenges to the continuity of HIV care, and it is crucial to ensure that the progress of the past decade is not undone. The WHO also remains committed to ensuring the principle of providing people-centered, harmonized and simplified care, within a public health approach, to provide fair, evidence-based guidance that leads to greater impact on health.
Following an extensive scope determination process, the WHO convened two guidelines development groups that met almost in September and October 2020 to formulate recommendations and considerations for implementation. The guidelines development groups consisted of people living with HIV, policy makers from ministries of health, researchers, and health care providers.
WHO now strongly recommends:
- Use of nucleic acid (POC) testing for the diagnosis of HIV in infants and children under 18 months of age.
- Initiate ART as soon as possible within two weeks of starting TB treatment, regardless of CD4 cell count, for adults, adolescents, children, and infants living with HIV.
- People on ART who respond well for at least 6 months should be offered clinical visits every 3 to 6 months, preferably every six months, if feasible.
- People on ART who are at least 6 months old and who respond well should be offered a 3 to 6 month ART supplement, preferably six months, if possible.
- HIV programs should conduct interventions to search for people who have been excluded from care and provide support for re-engagement.
- Psychosocial interventions should be provided to all adolescents and young adults living with HIV.
- The division of tasks for sampling and on-site testing (POC) with non-laboratory staff should be carried out when the capacity of professional staff is limited.
WHO now conditionally* recommends:
- At-site viral load testing (POC) can be used to monitor treatment in people living with HIV receiving ART.
- Initiation of ART may be offered outside of the health facility.
- Sexual and reproductive health services, including contraception, can be integrated into HIV services.
- Diabetes and hypertension care can be integrated with HIV services.
The guidelines development groups also developed statements of good practice for providing HIV services and revised the treatment monitoring algorithm for people living with HIV.
These clinical and service recommendations are launched and published today independently for rapid use and access by ministries of health, HIV program managers, members of civil society and all other stakeholders. In July 2021, the WHO will update the Consolidated Guidelines for HIV and integrate all new and older recommendations into one simple guidance document.
WHO would like to thank the experts who shared valuable time contributing to these updates during the global COVID-19 crisis and we dedicate this work to all health professionals in the first place who respond and succeed in combating the common HIV and COVID-19 public health crises.
* A conditional recommendation is issued when evidence of the benefits and risks of the intervention is less certain.
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