When the World Health Organization released an announcement in Vancouver this month that its updated and highly anticipated HIV treatment guidelines were “moving towards” advising treatment for all people living with HIV, the international agency noted that the recommendations follow scientific evidence from three major clinical research trials showing that immediate access to antiretroviral treatment protects health and prevents HIV transmission. It also noted challenges, that, all the same, may slow worldwide embrace of those recommendations.
Those included barriers still standing between marginalized and criminalized populations and access to HIV treatment under current guidelines, current unmet needs and gaps in delivery of services, and continuing lags in addressing HIV coinfections of tuberculosis and hepatitis.
Now a web portal from the International Association of Providers of AIDS Care provides a picture of how the world has responded so far to existing guidelines, which include treatment access for children, pregnant women, people coinfected with tuberculosis, and for infected individuals whose immune cell — or CD4 — count has dropped to 500 or less per cubic millimeter of blood (more or less a drop of blood). The site, HivPolicyWatch.org, which currently incorporates the policies of 149 countries on an interactive map, shows widening inequities, leadership, examples of what countries with a wide range of resources consider possible and necessary, and offers a chance to follow and compare country policies in real time as they continue to evolve.
What countries make antiretroviral treatment available regardless of immune count? The answer is not surprising, with that policy predominately adopted by among some of the world’s wealthiest and most developed countries. Some of the lags in adopting current guidelines, on the other hand, are less predictable. While Malawi, one of the world’s poorest countries followed the WHO’s last recommendations, Botswana, a country with greater resources, has yet to move on from previous guidelines, dating back 5 years and requiring a more damaged immune system, and graver state of health before treatment eligibility begins. The Russian Federation follows a policy based on guidelines issued in 2007. You can go ahead and look up other countries lagging behind, including China. Interesting as well is the number of countries across Africa as well as Eastern Europe that have challenging epidemics but where policies on HIV treatment remain unavailable.
Also revealing is a map of policies for treatment eligibility among those populations known as “key” — including men who have sex with men, people who inject drugs, people who earn or augment their income through sex work, and incarcerated people — because of the high risks of their circumstances and low access to health services. Tanzania and Cameroon stand alone in sub-Saharan Africa with policies making people counted among those populations eligible for antiretroviral treatment regardless of CD4 count.
The site also offers the chance to peruse and compare policies on treatment eligibility for children, pregnant women, infected partners of uninfected people, people infected with both HIV and tuberculosis and people with HIV and hepatitis. In addition, it gives a look at readiness to follow science and future guidelines with data from Médecins Sans Frontieres showing recommendations for and availability of viral load testing. A downloadable table gives access to national HIV treatment, testing, prevention of mother to child transmission, HIV/TB, and opportunistic infections guidelines.
The ultimate point, statements on the site and on a press release that announced the site last week, is to highlight and cut lags in translating science to policy, and then delivery of services, and show gaps that further disadvantage people already marginalized by where they live. In the process, IAPAC Vice President and Chief Technical Officer Dr. Reuben Granich said, it is hoped that accountability will follow.
“This heterogeneity in global policies with many countries being years behind the times threatens global public health by inhibiting our collective ability to address the epidemic and directly adds to the toll of new HIV infections and AIDS-related deaths,” Dr. Granich said in the statement.
A work in progress, like the policies it tracks, HIVPolicyWatch.org provides opportunities to contribute policies and feedback, and seeks to ensure that it reflects current responses to the advances in science and evidence, Dr. Granich said.
The release today of the updated U.S. National AIDS Strategy, which seeks to ensure that 80 percent of all people living with HIV in this country are treated effectively and consistently enough to suppress their virus, which, a release from IAPAC notes is more ambitious than the UNAIDS 90-90-90* goal, underscores the evolution the site seeks to capture.
*90 percent of all people with HIV being aware of it, 90 percent of them on treatment, and treatment effective and consistent enough to suppress the virus in 90 percent of those on treatment.