Monitoring of individuals on ART is important to ensure treatment efficacy and improved health outcomes. Updated WHO Consolidated ARV Guidelines will be available in December 2015 and include recommendations on routine monitoring and the diagnosis of treatment failure.
WHO recommends initiation of ART for all people living with HIV at any CD4 cell count fixed dose combinations (FDCs) containing TDF/XTC/EFV remain the preferred first line regimen for adults, adolescents and older children For the first time, DTG and EFV400 have been included as alternative first line regimens for adults and adolescents. DRV/r is an alternative option as part of secondline regimens, along with LPV/r and ATV/r.
Differentiated care for HIV requires delivery of different care packages for people based on their needs. As more people start treatment it is important to maximise the quality of care and ensure efficient health services.
Adolescents face significant barriers accessing and remaining in HIV treatment and care services. WHO guidelines in 2015 support initiation of antiretroviral therapy for all adolescents living with HIV. Adolescent friendly health services should be developed, including support for adherence and retention in care.
The international community has committed to ending the AIDS epidemic as a public health threat by 2030 – an ambitious target of the 2030 Agenda for Sustainable Development adopted by the United Nations General Assembly in September 2015. Interim targets have been established for 2020. This strategy describes the health sector contribution towards the achievement of these targets. It outlines both what countries need to do and what WHO will do. If implemented, these fast-track actions by countries and by WHO will accelerate and intensify the HIV response in order for the “end of AIDS” to become a reality.
The latest UNAIDS data, covering 160 countries, demonstrate both the enormous gains already made and what can be achieved in the coming years through a Fast-Track approach. In just the last two years the number of people living with HIV on antiretroviral therapy has increased by about a third, reaching 17 million people—2 million more than the 15 million by 2015 target set by the United Nations General Assembly in 2011. Since the first global treatment target was set in 2003, annual AIDS-related deaths have decreased by 43%. In the world’s most affected region, eastern and southern Africa, the number of people on treatment has more than doubled since 2010, reaching nearly 10.3 million people. AIDSrelated deaths in the region have decreased by 36% since 2010.
In 2015, the IATT monitoring and evaluation working group (MEWG) finalized and disseminated the IATT B+ M&E Framework. One mechanism used to disseminate was to convene a 15 Country Consultation that was determined as follows: the eight 2015 priority countries (Cameroon, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda & Zambia) that contributed 70% of new infections among the Global Plan countries in 2013, three countries (Malawi, Rwanda and Zimbabwe) representing best practices from the region and four countries (Botswana, Cote d’Ivoire, DRC and Namibia) who are in the process of reviewing their M&E systems for B+ roll out.
The 2015 WHO consolidated guidelines on the use of antiretrovirals updates the 2013 edition following an extensive review of evidence.
The guidelines include 10 new recommendations to improve the quality and efficiency of services to people living with HIV. In addition, for the first time the guideline includes "good practice statements" on interventions whose benefits substantially outweigh the potential harms. The guidelines will be a valuable resource for health-care providers and should shape the priorities of policy makers. Meaningful engagement of people living with HIV will be essential for successful implementation.
The 2016 High-Level Meeting on Ending AIDS will focus the world’s attention on the importance of a Fast-Track approach to the AIDS response over the next five years. The UNAIDS Fast-Track approach aims to achieve ambitious targets by 2020, including:
The global commitment to ending the AIDS epidemic, as set forth in the 2030 Agenda for Sustainable Development, represents an unparalleled opportunity to end one of the most devastating modern-day health challenges and also to build on the momentum of the AIDS response in order to accelerate results across the sustainable development agenda.