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Realizing the Potential of Treatment as Prevention: Global ART Policy and Treatment Coverage

  • Treatment as Prevention (RM Granich, Section Editor)
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Abstract

This article reviews the antiretroviral therapy (ART) initiation criteria from published national guidelines for 94 countries (representing 86 % of global HIV burden) and compares them with the 2013 World Health Organization (WHO) ART guidelines. As of 31st of July 2014, 19 countries have adopted the WHO-recommended CD4 eligibility criteria of ≤500 cells/mm3, while seven have opted to treat irrespective of CD4 cell count (“test and treat”). Together, these 26 countries represent 27 % of 2013 global HIV burden. Additionally, test and treat is recommended for selected groups of HIV-positive individuals, namely, (a) people with tuberculosis in 58 countries, (b) pregnant women in 42 countries, (c) people with liver disease due to hepatitis B co-infection in 52 countries, (d) serodiscordant couples in 35 countries and (e) children below 5 years in nine countries. Global access to treatment has improved; however in 2013, ART coverage was 12.9 million or 37 % of people living with HIV. Rapidly translating new science into policy is a critical component of the HIV response. Adapting and implementing the 2013 WHO treatment recommendations are necessary to prevent unnecessary illness, death, HIV transmission and costs.

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Acknowledgements

The authors are grateful to Dr. Reuben Granich and Dr. Eleanor Gouws for the UNAIDS global database of national guidelines and for assisting with the review. The authors also thank UNAIDS, WHO, CDC and national MoH staff for the published national guidelines for the database.

Compliance with Ethics Guidelines

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Conflict of Interest

Somya Gupta, Brian Williams and Julio Montaner declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Independent Consultant, New Delhi, India

    Somya Gupta

  2. South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa

    Brian Williams

  3. BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada

    Julio Montaner

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  1. Somya Gupta
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  2. Brian Williams
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  3. Julio Montaner
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Correspondence to Somya Gupta.

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Gupta, S., Williams, B. & Montaner, J. Realizing the Potential of Treatment as Prevention: Global ART Policy and Treatment Coverage. Curr HIV/AIDS Rep 11, 479–486 (2014). https://doi.org/10.1007/s11904-014-0230-z

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  • DOI: https://doi.org/10.1007/s11904-014-0230-z

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