WHO guidance on treatment and care
Update on transition to new HIV treatment regimens
WHO’s 2013 "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection" recommends a preferred treatment regimen of tenofovir (TDF) in combination with lamivudine (3TC) and efavirenz (EFV), or TDF with emtricitabine (FTC) and EFV, preferentially as a fixed-dose combination. To ensure that supply is available to meet anticipated demand, phasing in the new formulations a phased programme is highly recommended. A policy brief was developed to provide operational approaches to ensure that the procurement and supply management remains efficient and without stock-out or expired products. This policy brief was updated in March 2014 with guidance which suggests to phase out NVP in first-line treatment.
The updated policy brief, also in Russian, can be accessed at the links at the bottom of the page.
Improving procurement of HIV diagnostics: the procurement specification tool
WHO, with support from Centers for Disease Control and Prevention (CDC), developed the present tool on specifications and quantities for efficient procurement of essential equipment and laboratory commodities for HIV. The ultimate purpose of the tool is to facilitate the efficient procurement of laboratory equipment and laboratory commodities required to:
- perform HIV diagnostic tests in adults, adolescent and children;
- monitor treatment outcomes in patients on antiretroviral therapy.
The tool is now published and can be accessed at the link at the bottom of the page.
ARV price evolution 2010 – 2013
The December 2013 summary report on evolution of prices of critical ARV drugs from 2010 – 2013 from the Global Price Reporting Mechanism (GPRM) was released. The GPRM contains information on transaction prices, sources and quantities of antiretroviral medicines (ARVs) purchased by HIV/AIDS programmes in low-income countries, lower middle-income countries and upper middle-income countries.
The report can be accessed at the link at the bottom of the page.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection
In 2013, WHO issued its first "Consolidated guidelines for the use of antiretroviral drugs to treat and prevent HIV infection". The guidelines, which are structured along a continuum of HIV testing, care and treatment, are based on a public health approach to the further scaling-up of ARV drugs for treatment and prevention that considers feasibility and effectiveness across a variety of resource-limited settings. The operational guidance provides recommendations for strengthening key aspects of a continuum of HIV care and improving linkages across the health system. Guidance specifically developed for HIV programme managers address decision-making and planning for the strategic use of ARV drugs in the context of national governance process, HIV epidemiology, health system capacity, available resources and ethical and human rights considerations.
The guidance, also in Russian, can be accessed at the link at the bottom of the page.
New and important evidence
New and important evidence has emerged since the WHO Regional Office for Europe released its HIV/AIDS clinical guidelines in 2007. This evidence has an impact on several issues:
- initiation of antiretroviral therapy (ART);
- efficacy and toxicity profile of selected antiretrovirals;
- clinical management of co-infections, in particular hepatitis B and tuberculosis; and
- prevention of HIV transmission from mothers to their children via use of ARVs.
Consequently, WHO headquarters issued new global recommendations on ART for adults and adolescents, ART for infants and children, use of ARVs for treatment of HIV-infected pregnant women and infants born to them. The guidelines development process was conducted in accordance with revised WHO requirements for guidelines development which anticipate systematic reviews of new evidence and take into consideration feasibility and cost/financial implications of new recommendations for the treatment delivery.
While global WHO recommendations cover key global issues, regional and country adaptation is often needed in order to reflect regional context, existing infrastructure and health care system capacities. In the WHO European Region, countries of eastern Europe and central Asia have similar epidemic trends and HIV prevalence in different most at risk populations. Though they often have limited resources for HIV/AIDS response, their health care systems and resources are organized and equipped better than in many other resource-limited countries outside of the European Region.
WHO Regional Office for Europe has thus initiated a revision of some of its 2007 HIV/AIDS clinical guidelines for the WHO European Region, though technical consultation with country experts, revision of available evidence, countries needs and capacity of health systems.
The revision process will impact following protocols:
- Protocol 1: Patient Evaluation and Antiretroviral Treatment for Adults and Adolescents
- Protocol 4: Management of Tuberculosis and HIV Coinfection
- Protocol 7: Management of Hepatitis B and HIV Coinfection
- Protocol 10: Prevention of HIV Transmission from HIV-infected Mothers to Their Infants
- Protocol 11: Paediatric HIV & AIDS Treatment and Care.
