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A new study published in the Journal of the International AIDS Society shows that the 2015 recommendation formulated by the World Health Organization (WHO) for immediate treatment of all people living with HIV has become the standard of care in HIV treatment clinics in countries around the world. Although most countries have adopted WHO's "treat everyone" recommendation, it was unclear to what extent these guidelines have been put into practice in HIV treatment clinics around the world. .
Based on a survey conducted at over 200 HIV treatment and treatment sites in 41 countries participating in the International Consortium for Epidemiology Research to Assess AIDS (IeDEA), this study found that adoption The practice of Treat All at the site level is almost universal. . Although studies on past changes in HIV treatment guidelines have shown delays in implementation, this study found that the deployment of Treat All was rapid, with a median lag of one month between national policy change and introduction at the site level. The study also found that sites in low- and middle-income countries typically initiate HIV treatment within 14 days of confirmation of the HIV diagnosis. The study revealed no significant difference in the introduction of Treat All at the service delivery level by geographic region, country income level, urban / rural area or other facility characteristics, which suggests that gaps in access to treatment have decreased. However, the study also found that the majority of HIV care and treatment sites in resource-limited settings do not have the capacity to systematically monitor viral load once the patient has started treatment.
The study was led by researchers from the CUNY Institute for the Science of Population Health Implementation (PHAI) of the Graduate School of Public Health and Health Policy (CUNY SPH). ).
"These findings are promising in terms of the ability to comprehensively improve access to early treatment in low-resource settings, which will improve outcomes for the health of people living with HIV and prevent new infections," he said. said Ellen Brazier, the lead author of the study.
Dr. Denis Nash, Distinguished Professor of Epidemiology at CUNY SPH and lead author of the study, pointed out that the large-scale and rapid introduction of Treat All at the level of service delivery may reflect the fact that its guidelines are simpler to implement in contexts with few resources than the previous ones. , which required badessing the immune status of each patient to determine if he was eligible to start anti-HIV treatment. However, he warned that limited capacity for laboratory testing remained a concern.
"Many sites that initiate patients on antiretroviral therapy do not have sufficient resources to monitor key patient outcomes through viral load testing, including treatment failure or development of drug resistance, Nash said. "This is a problem that needs urgent attention, as it is essential to evaluate and optimize long-term HIV care outcomes at the time of treatment for all."
Funding
Funding for the study came from research grants U01AI069907, U01AI069923, U01AI096299, U01AI069911, U01AI069918, U01AI069924, U01AI069919 of the National Institutes of Health.
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Material provided by CUNY Graduate School of Public Health and Health Policy. Note: Content can be changed for style and length.
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