When the World Health Organization issued an early update to its HIV treatment guidelines in September 2015, the new recommendations drew on years of mounting evidence that immediate antiretroviral treatment for people diagnosed with the virus saves lives, prevents transmission, averts serious illnesses, and is essential to control of the pandemic. In fact, by then,18 high- and middle income countries that include the United States already had adopted policies that reflected their recognition of the benefits early treatment offers individual and public health. Nearly a year after the release of the WHO update, however, only three countries in sub-Saharan Africa have adopted the latest guidelines as their criteria for treatment access.
That lag reflects a trend that has slowed treatment access and progress against HIV in countries with the greatest numbers of people living with the virus, say authors of a report published this week in the Southern African Journal of HIV Medicine. Their study examined the amount of time between the issuance of WHOs 2009, 2013 and 2015 guidelines, and national policies adopting them across 33 sub-Saharan African countries. Although each change in WHO guidelines reflected an accumulated consensus of best practices that had been evaluated by experts and supported by evidence, adoption of the guidelines has been slow, authors found.
Countries took an average of two years to adopt 2009 guidelines recommending people with HIV start treatment when their CD4 or immune cell counts dropped to 350 per cubic millimeter of blood, rather than waiting until their immune systems were more damaged, as previous guidelines had indicated, with counts of 200 or below. Three years after the release of 2013 guidelines that treatment should start earlier, when immune cell counts dropped to 500 or below, 11 countries, including some with the highest rates of infection, have yet to incorporate the recommendations into their national policies.
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