The global expansion of access to HIV treatment ranks among the great recent achievements in public health. At the end of 2011, an estimated 8 million people in low-and middle-income countries were receiving ART – a 25-fold increase since 2002. Nevertheless, most low- and middle-income countries are yet to achieve ‘Universal Access’ to ART. Reasons for this include lack of awareness of HIV status, high cost of ART, late initiation of ART, human rights issues affecting people living with HIV and key populations and substantial attrition in the ‘test-treat-retain’ continuum. Addressing structural barriers, reducing costs and strengthening the continuum of care is critically important if the full gains of expanded HIV treatment are to be realised.
Access to ART is not yet equitable. For example, the 28% coverage for children in need of treatment in 2011 was considerably lower than the 57% coverage for adults. Providing ART to pregnant HIV-positive women reduces the risk of HIV transmission to their unborn child to less than 5%, however less than one third of the women eligible for ART for their own health in 2010 were receiving it.
The role of WHO
A key role of the WHO is to assess new evidence and experience, and translate this into global guidance that can inform and guide country decisions. WHO’s technical, operational and normative guidance in the area of HIV treatment, prevention, care and support is pivotal for achieving global targets which were jointly set by all Governments. WHO first published ART guidelines for adults and adolescents in 2002 and subsequently revised them in 2003, 2006 and 2010. Since 2006, additional but separate guidelines for ART in children and PMTCT were developed. Previous versions can be found here.
New evidence and the role of communities and civil society
Since the publication of revised global guidelines in 2010 there have been a series of landmark studies highlighting new evidence on HIV treatment and prevention benefits of earlier ART, more affordable point of care HIV diagnostics and laboratory services, new strategies for expanding HIV testing, innovations in HIV Care Service Delivery and new formulations for optimisation of drug regimens.
The critical role that people living with HIV, their families and communities, and civil society play in supporting effective treatment and prevention, through community and home-based care, adherence support and peer counselling among other activities is also becoming increasingly clear.
2013 guidance update
In 2013, WHO will release a revised and consolidated set of guidelines related to the use of ARVs for both HIV treatment and prevention, prioritising those who are most at risk of HIV mortality and morbidity and aiming to accelerate progress towards universal access of HIV diagnostics, treatment, care and support to all people in need.
The new generation of guidelines will include, in addition to the clinical guidelines for adults, adolescents and maternal and child health, operational and programmatic guidance, to help countries take the best strategic decisions on the use of ARVs.
Following a process of drafting, peer review and submission to the Guidelines Review Committee, the guidelines will be published and disseminated from May-July 2013. Guidelines will be available online in the WHO library database in all official WHO languages, and will be widely distributed.
Countries will be supported to adapt the guidelines to their specific needs and integrate the material into existing national guidelines, including ensuring alignment with Treatment 2.0. Regional, sub-regional and country-level workshops will be organised to create space where the adaptation of each recommendation to national epidemiological, cultural and socio-economic settings can be practically discussed.
This is a critical opportunity to help shape guidelines that will define the future use and provision of ARVs in HIV treatment and prevention, particularly with regards to key and most-affected populations.
We hope you will take the time to take part, input and make sure the voice of civil society and communities is heard in the development of these guidelines.
Recognising the critical role of communities and civil society, in particular PLHIV, in informing the content and process of implementation of the guidelines, WHO seeks to undertake a consultative process with communities to inform these consolidated guidelines.
WHO HIV Department established a Civil Society Reference Group to support systematic and effective dialogue between WHO HIV department and civil society and maximise opportunities of synergy and meaningful collaborations between WHO programmes and community actions. The reference group will guide the revision of the 2013 guidelines.
In addition, WHO has asked the International HIV/AIDS Alliance and the Global Network of People Living with HIV (GNP+), in collaboration with WHO, will conduct an online consultation for community input into these guidelines. While it is crucial that the guidelines are based on new scientific evidence, it is important the guidelines reflect the realities of the lives of people living with and affected by HIV, and of civil society. Involvement of civil society will encourage greater ownership of the guidelines and encourage a strong role for civil society in their roll-out and implementation of and in monitoring and evaluation their application.
A Civil Society Working Group will be formed to strengthen the quality and validity of the consultation and promote effective and inclusive engagement of civil society, key populations and affected communities. The Working Group will function to provide technical review of the preliminary and final consultation reports, guidance on how to maximise civil society input into surveys and e-discussions, and guidance on communicating with and feeding results back to civil society.
Opportunities to feed into the consultation will take place between 7th November and late December 2012 and will include:
* An online survey available in five languages: English, French, Spanish, Russian, and Arabic. This will be online from 7th November 2012 to 14th January 2013* E-forum discussions providing opportunities for more in-depth qualitative input around key technical issues and areas of concern. This will take place between 12th November 2012 – 14th January 2013
The Civil Society Working Group mandate will end upon submission and dissemination of the final consultation report, by end of January 2012.
A report from the community consultation process will be published in January 2013.
For more information on the consultation process, contact Nick Keeble (email@example.com).