MAC AIDS Project Brief on Innovations to Accelerate Access to Treatment and Care for Children and Adolescents Affected by HIV. The MAC AIDS Fund is designed to address unmet needs for HIV testing, treatment and care among children and adolescents in key BRICS countries (Brazil, the CEE/CIS region, India, and South Africa).
Report and recommendations from a meeting of the WHO and UNAIDS in collaboration with the UNAIDS Reference Group on Estimates, Modelling and Projections, London, UK, 28-29 October 2015.
The AIDS movement, led by people living with and affected by HIV, continues to inspire the world and offer a model for a people-centred, rights-based approach to global health and social transformation. And yet, today, amid a swirl of competing and complex global concerns, we confront a serious new obstacle: the oppressive weight of complacency. This is happening when we know that if we make the right decisions and the right investments now, the end of AIDS can be within our grasp. This moment is, however, fleeting. We have a fragile window of opportunity—measured in months—in which to scale up.
This document was created by ICAP’s Clinical and Training Unit with valuable input from our teams in Swaziland, Mozambique, Kenya, and Cote d’Ivoire. It was developed as a template document to be adapted for use in various contexts and is one component of a viral load monitoring tool-kit, to be used in conjunction with ICAP’s Viral Load Monitoring Flipchart and Enhanced Adherence Treatment Plan. This area is evolving rapidly therefore it is expected that this document will require frequent updating over time, as recommendations change, and needs to be adapted according to local guidelines and context.
Humanitarian emergencies in countries with a high HIV disease burden can cause considerable PMTCT antiretroviral treatment (ART) interruption. The risk of drug resistance emerging is increased, efficacy of treatment compromised and the effective scale-up of lifelong ART for pregnant and breastfeeding women living with HIV is impeded. Therefore, strategies to ensure the uninterrupted supply of antiretrovirals for PMTCT during crises are needed. This paper highlights lessons learned from PMTCT implementation in emergencies based on reported literature, key informant interviews, and recommendations made. The review focuses on delivering ART for PMTCT.
A robust monitoring and evaluation (M&E) system is a key component of a strong health system. With the current WHO recommendation of lifelong ART for all pregnant and breastfeeding women living with HIV, outcomes (including maternal survival and final infant HIV status) require monitoring through longitudinal data systems complemented with regular cohort analyses and enhanced monitoring. Additionally, as we move toward the need for more strategic policies and programming to garner system and resource efficiencies, M&E systems need to be designed to be able to inform differences arising from age, sex, and geographic trends as well as identify weaknesses such as sub-optimal commodity supply and testing quality.
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.
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.
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.