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Implementing the new WHO HIV treatment guidelines

10 December 2013

Earlier this year the World Health Organisation published new guidelines on the use of antiretroviral therapy (ART) to treat and prevent HIV. These guidelines include some major changes, with ambitious recommendations about increasing the number of people eligible for treatment, and the use of expensive laboratory tests to monitor people on treatment. However, the announcement of these new recommendations has not been accompanied by news of increased funds for treating HIV. National governments will need to prioritise which recommendations to implement, given the financial constraints. To help with this, the MRC CTU at UCL has published a policy brief examining the question of which recommendations to prioritise.

The policy brief, written by members of the Lablite team, examines whether policymakers should prioritise increasing access to life-saving treatment, or improving monitoring of people already on treatment. It is based on the results of trials, including DART and ARROW, that have shown that expensive laboratory tests make little difference in outcomes compared to good clinical monitoring alone. It also draws on modelling and cost-effectiveness work done by the HIV Modelling Consortium, including Lablite collaborators, published today in the Lancet Global Health. They found that, in places with less than full coverage of those in need of ART, more lives will be saved by using the available resources to put more people onto life-saving treatment rather than paying for expensive laboratory tests for those already on treatment.

The policy brief recommends that increasing access to ART with clinical or immunological monitoring should be a higher priority than moving to routine viral load monitoring. Lack of access to viral load testing should not be a barrier to ART roll out. These recommendations may help policymakers prioritise how best to use the resources available to them in the efforts to reduce AIDS-related deaths.