VANCOUVER, Canada – It is lost on no one here that history in the fight against AIDS was made in this city once before, nearly two decades ago with the announcement that a combination of three drugs could turn HIV from an almost inevitably fatal illness to a manageable one.
Now this conference, bringing details of findings showing the impact of antiretroviral drugs on health, life expectancy and prevented transmission, may also be known for its emphasis on treatment, Rachel Baggaley of the World Health Organization noted, as well as for its emphasis on the goal of 90 percent of all people living with HIV knowing they have the virus, 90 percent of them receiving treatment, and 90 percent of them receiving treatment consistently and correctly enough to suppress the virus.
But, she added, with estimates that fewer than half of people who have the virus knowing they have it, “the first 90 is the most problematic.”
New guidelines released by the World Health Organization at a pre-conference session today seek to address the reasons that is the case with recommendations on changing approaches to testing to reach more people living with HIV. As it stands, Baggaley said, while about 600 million people were tested for HIV between 2010 and 2014, more than half of them in Africa, where prevalence of the virus is highest, they weren’t necessarily the right people. While the majority of people tested are women, with a relatively low rate testing positive, the low number of men who test have a much higher rate of testing positive for the virus. This difference, largely attributable to success in saturating prenatal — or antenatal — care settings with testing services as the first step to preventing mother to child HIV transmission, highlights the need to reach more people at highest risk in relevant effective settings, Baggaley and other speakers at the session noted.
New recommendations in the guidelines and highlighted at the session include expanding provision of HIV testing through lay providers, and through services based in communities where risks are high. Guidelines also address the quality of tests used, with some countries reporting rates of incorrect results as high as from 2 to 10 percent. This is critical, Baggaley stressed with changes to treatment eligibility access, including Option B+ (offering treatment initiation to pregnant women with HIV, regardless of immune cell count), that make antiretroviral treatment immediately available.
The guidelines are critical, said Dr. Praphan Phanuphak, who diagnosed the first cases of HIV in 1989, and now heads the Thai Red Cross AIDS Research Centre, with community led HIV testing not allowed by law and lay testing frowned on by the medical establishment in his country, while the the one self-test made available there proved to be of poor quality.
“We need guidance to tell us,” he said. “These are promising.”
You can download the guidelines here.