The WHO recommendation 'Treat All & # 39; against HIV widely adopted at the global level

Faced with a global HIV epidemic, the World Health Organization announced in 2015 that a new health policy, called "Treat Everyone," should be adopted in all health facilities around the world treating patients with HIV. This recommendation to immediately treat all known HIV-positive patients has been implemented almost immediately in the vast majority of test and treatment centers, unlike many other policies, and has become standard practice.

The All Treat or Test and Treat policy guideline for people living with HIV (PLHIV) states that 90% of these people are diagnosed, that 90% of diagnosed cases are treated with combined antiretroviral therapy, and that 90% Treated patients manage to suppress their viral load. by 2020. The goal of the program was to interrupt the transmission of the virus, prevent HIV-related illnesses and deaths, and achieve the objectives of the United Nations Program on HIV / AIDS. AIDS 2014, which aims to halt the HIV epidemic.

This is a map of the implementation of WHO's "Treat All" recommendation worldwide. Image Credit: CUNY ISPH

The current study published in the report shows that the degree of compliance with this recommendation is high. Journal of the International Society on AIDS. He reviewed a sample of more than 200 health care centers in 41 countries participating in the International Research Initiative on Epidemiology to Assess AIDS (IeDEA) initiative to evaluate the level of implementation of this policy. With 93% of all sites treating HIV cases in adults, regardless of region or location, the practice moved to Treat All. In fact, in the countries that had adopted this national directive, 97% of the sites had implemented this policy.

The biggest discrepancy occurred in West Africa, where only 63% of HIV health facilities had adopted this practice, and was linked to a failure of the national policy change in these states at the time of the study. . Overall, even in countries where All-Treat is not part of national policy, nearly 70% of health care facilities had already adopted this strategy approximately seven months on average prior to this study.

National policy support followed the implementation of this directive in about one-third of cases, and in all cases there was generally less than a month lag between its integration into national policy and its adoption. in the field. The WHO and other agencies have issued other guidelines on HIV treatment, but none has been implemented as quickly.

Even in low-income countries, most patients receive anti-HIV treatment on the same day as the diagnosis. Overall, 77% of facilities are able to start antiretroviral therapy within 14 days of confirmed diagnosis. Although similar differences were also observed in the use of routine counseling prior to initiation of ART in patients, they did not affect the timing of treatment initiation. HIV is widely available everywhere, with no significant gaps in geographical location, national economic level, urban or rural location, or type of health facility.

Lead author, Ellen Brazier, said, "These findings are promising in terms of the ability to comprehensively improve access to early treatment in low-resource settings, which will improve health outcomes for women. people living with HIV and prevent new infections. "

The speed of implementation of the Treat All guidelines may be due, in part, to their simplicity compared to previous recommendations which required that the eligibility criteria for HIV treatment be badessed for each patient in terms of immune status (clbadification). stage based on clinical criteria). and CD4 +).

A relevant outcome that could affect the long-term success of the strategy is that most resource-poor communities would not be able to support routine surveillance of viral load after HIV treatment began. In low-income and lower-middle-income groups, only 40% and 52% of treatment centers, respectively, had facilities for routine viral load testing, compared to rates greater than 93% in the treatment centers. high-income country. This disparity was also evident in urban sites compared to rural sites (81% versus 37%) and in higher level centers compared to health centers (82% vs. 57%). Globally, one third of treatment centers can not systematically control viral load.

Lead author of the study, Denis Nash, pointed out that the limited scope of viral load monitoring is a serious problem. Nash points out: "Many sites that initiate antiretroviral therapy patients do not have sufficient resources to monitor key patient outcomes through viral load testing, including treatment failure or development of drug resistance. . This is a problem that needs urgent attention because it is essential to evaluate and optimize the outcomes of HIV care in the longer term in the "Treat All" era.