While discussions cover journey from knowledge . . . to guidelines . . . to policy and action . . .
DURBAN, South Africa – The latest World Health Organization HIV treatment guidelines distributed here came in a weighty tome — “a heavy book, and a heavy lift,” as Dr. Meg Doherty of WHO put it at a session discussing how it will be used.
With sections released earlier, including on recommendations to treat all people diagnosed with HIV upon diagnosis, improve service delivery, and provide antiretroviral treatment for prevention, it is 475 pages, delineating more than 40 new recommendations, that took about 200 experts about 15 months to compile. But with a basis in experience, trial participation and input from the ground that informs the recommendations, “really it’s from you,” Dr. Doherty told the audience.
It has been a slow lift then, as well as a heavy one. While the concept of treating people who have been diagnosed with an illness, for that illness, when they have been diagnosed, is otherwise standard medical practice, the track to memorializing the evidence of trials showing the benefits of treating HIV as well as tuberculosis into policy has been anything but fast. That includes acting on evidence that goes back to the development of antiretroviral therapy, continued through the early 2000s, culminated with HPTN 052 proving treatment also prevents transmission, and START showing immediate treatment more than halves risks of serious illness, Dr. Reuben Granich noted at a pre-conference event here.
He presented data on adoption of HIV treatment guidelines and practices that support them from the interactive HIVpolicywatch, from the International Association of Providers of AIDS Care presented at a pre-conference session. Mapping a comprehensive compilation of country policies on criteria for starting treatment — including through monitoring CD4 count (or immune system damage), and monitoring the success of treatment through viral load testing, it is based on published guidelines. And with policies indicated by the colors of the countries on the map — for example for antiretroviral treatment eligibility ranging from the blue “irrespective of CD4 count” to the green treatment eligibility recommended by WHO in 2013, to the pink 2009 eligibility, to the red prior to even those, and the white no policy available — it makes for colorful viewing.
In contrast, Dr. Granich showed a map upon which all the countries were blue. “What’s going on here?” he asked. It represents policy on vaccination for polio eradication — one policy, he noted.