WHO “test and start” ART guideline highlights difference between “finding” and “prioritizing” funding for equitable care access . . . We’re reading responses, and more

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NewWWRThe World Health Organization’s early release last week of some of the agency’s updates to guidelines on antiretroviral treatment for people living with HIV served as a heartening new sign of the direction HIV-fighting efforts will take, but also as a reminder, for those who need it, of the stark difference between medical and political standards of care, depending on where you live. Responses to the guidelines, which call for immediate treatment access for all diagnosed with HIV, also served up a reminder of a divide from the past, when efforts to fight HIV and AIDS in the most affected countries lagged amid questions of how they would be financed. Those questions came again last week with false equivalencies of the current price tags — for antiretroviral medicines for HIV treatment and pre-exposure prophylaxis — and the actual costs (the recent mysterious price increase for the toxoplasmosis drug that went from $13.50 to $700 overnight, while still costing less than a dollar to manufacture should remind us of that difference). Much coverage also left out the costs of delayed treatment being paid now — in lives as well as public health burden, and other economic impacts. In the meantime, the International Association of Providers of AIDS Care released its own Guidelines on Optimizing the HIV Care Continuum, recommending ‘Test and Start’ irrespective of CD4 count, and the summary table of the recommendations shows some of the practices, that if followed, cut costs and obstacles to care.

IAPAC Guidelines for Optimizing the HIV Care Continuum – In addition to recommending the immediate offer of antiretroviral treatment after HIV diagnosis irrespective of CD4 count (or measure of how much the virus has damaged the immune system), the recommendations include decriminalizing or lifting punitive measures surrounding same sex relations, substance use, sex work and HIV transmission where such laws and policies exist, shifting and sharing HIV testing, medicine dispensing and other appropriate tasks, including for antiretroviral treatment initiation and maintenance to nurses and associate clinicians, community engagement along each step of care, community located antiretroviral treatment distribution, and use of mobile communication technologies including two-way weekly text messaging.

The tools to fight HIV – The editorial board of the New York Times shows they get the goals of the WHO guidelines, as well as some of the ways they can be put into practice. The editorial follows breaking news reporting by global health reporter Donald McNeil that emphasized cost unknowns, and his longer article examining the realities that prompted the guideline shift.

World Health Organization Pushes Earlier Use of HIV Treatment – This Wall Street Journal article by health writer Betsy McKay sums up some of the research backing the WHO guidelines, and includes U.S. Global AIDS Coordinator Ambassador Deborah Birx’s observation that immediate treatment of infected men will also protect the young women and girls now disproportionately affected by HIV.

Aggravation and jubililation – So what’s to be aggravated about in the new guidelines? Because first U.N. Ambassador for HIV/AIDS in Africa and AIDS-free World co-founder Stephen Lewis lets us know he is outraged — that the guidelines didn’t come sooner.

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