Please note that this is under construction and is a dynamic area policies are changing and we do not have written policies for some countries let us know if you see errors andor there are new policies for the database ID: 935916
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Slide1
Review of Global Guidelines from 172 countriesPlease note that this is “under construction” and is a dynamic area – policies are changing and we do not have written policies for some countries – let us know if you see errors and/or there are new policies for the database
Last updated:
June 2017
Slide2Objectives and methodology: “wiki strategy”
Objective:
Compare national
ART guidelines for 172 countries
with WHO 2015 guidelines
Recommendation on ART initiation criteria and monitoring for different target population abstracted
Search end date: June 2017
* 22 countries with old version of guidelines
Slide3ART initiation for asymptomatic peopleART initiation criteriaNo. of Countries
People with HIV (2015)
Countries
Irrespective of CD4 count
48
23,132,000 (63%
)
Argentina, Australia, Austria, Botswana, Brazil, Burundi, Cambodia, China, Croatia, Denmark, France
, Georgia, Germany, Haiti, India, Italy, Jamaica, Japan, Kenya, Korea (Republic), Lao PDR, Lesotho, Malawi, Malaysia, Maldives, Mexico, Montenegro, Mozambique, Namibia, Netherlands, Norway, Papua New Guinea, Poland, Portugal, Romania, Rwanda,
South Africa,
Spain
, Sri Lanka, Sweden, Switzerland, Thailand, Turkey, Uganda, United Kingdom, US, Zambia, ZimbabweConsider for >5005284,000 (0.8%)Colombia, Greece, Guyana, Hong Kong, Venezuela≤500339,811,000 (27%) Algeria, Bangladesh, Bhutan, Bolivia, Cameroon, Chile, Democratic Republic of Congo, Ecuador, El Salvador, Ethiopia, Fiji, Gabon, Honduras, Liberia, Madagascar, Mali, Mauritania, Moldova, Myanmar, Nepal, Nigeria, Oman, Pakistan, Peru, Russia, South Sudan, Sudan, Swaziland, Tanzania, Tunisia, Ukraine, Uruguay, Viet Nam≤350 (consider for CD4 ≤ 500)5178,000 (0.5%)Belize, Costa Rica, Finland, Guinea, Philippines≤350242,309,600 (6%)Afghanistan, Angola, Benin, Burkina Faso, Canada, Cote d’Ivoire, Djibouti, Dominican Republic, Ghana, Guatemala, Indonesia, Kazakhstan, Latvia, Marshall Islands, Morocco, Nicaragua, Niger, Panama, Paraguay, Samoa, Sierra Leone, Timor-Leste, Tuvalu, Vanuatu≤3001200 (<0.1%) Macedonia≤200 (consider for CD4 ≤ 350)566,000 (<0.2%)Belarus, Cape Verde, Cuba, Estonia, Hungary≤200246,500 (0.1%) Comoros, Senegal
Source
: published policy
Slide4WHO recommendations and published national guidelines (2003-2017)Countries in the green boxes were consistent with the WHO ART guidelines in a given year, countries in blue boxes were recommending early ART compared to WHO guidelines while countries in red boxes were recommending delayed ART compared to WHO guidelines.2003-052006-09
2010
2011
2012
20132014
2015
20162017
ALLDenmark, ItalyALLNetherlands, United StatesALLAustralia, Brazil, France, Romania, South Korea, Turkey ALLMexico, Spain, Sweden, Thailand
ALLArgentina, Austria, Croatia, Georgia, Germany, Maldives, Montenegro, Switzerland, United KingdomALLBotswana, Burundi, Cambodia, China, Haiti, Japan, Kenya,
Lao PDR, Lesotho
, Malawi,
Malaysia, Mozambique, Namibia, Norway, Poland, Portugal, Rwanda, South Africa, Sri Lanka Uganda, Zambia, ZimbabweALLIndiaJamaicaPapua New Guinea >500Guyana >500Hong Kong>500Colombia, Greece, Venezuela <500Bolivia<500Algeria <500Chile, Democratic Republic of the Congo, Ecuador, Ethiopia, Fiji, Honduras, Madagascar, Mali, Oman, Russia, Tunisia<500Bangladesh, Bhutan, Cameroon, El Salvador, Gabon, Liberia, Mauritania, Moldova, Myanmar, Nepal, Nigeria, South Sudan, Sudan, Uruguay<500Pakistan, Peru, Swaziland, Tanzania, Ukraine, Viet Nam Consider for <500GuineaConsider for <500Belize Consider for <500Costa Rica, Finland, Philippines <350Burkina Faso, Canada, Djibouti, Ghana, Nicaragua, Niger,, Panama, Paraguay, Sierra Leone<350Guatemala, Kazakhstan, Morocco<350Afghanistan, Angola, Indonesia, Timor-Leste<350Benin<350Cote d’Ivoire, Dominican Republic, Marshall Islands, Samoa, Tuvalu, Vanuatu<350Latvia <300Macedonia Consider for <350Cape Verde, EstoniaConsider for <350Belarus, CubaConsider for <350Hungary <200Senegal<200Comoros
Slide5Source: published policyART initiation for asymptomatic people2015 WHO Recommendation : Irrespective of CD4 count
<200, <250 or <300
<350
<500
>500
Irrespective of CD4 count
Slide6Source: published policyART initiation criteria in Africa2015 WHO Recommendation : Irrespective of CD4 count
<200
<350
<500
Irrespective of CD4 count
Slide7Reported ART initiation criteria in 71 countries (missing written policy document)ART initiation criteriaNo.
of Countries
Countries
Irrespective of CD4 count
25
Bahamas, Barbados, Cameroon, Cyprus, Czech Republic, Democratic Republic of Congo, Estonia, Ethiopia, Fiji, Finland, Greece, Hungary, Iceland, Ireland, Malta, Mongolia, Myanmar, Nigeria, Panama, Serbia, Slovakia, Slovenia, Solomon Islands, Timor-Leste, Vanuatu
>500
1
New Zealand≤500
24
Antigua
and Barbuda, Armenia, Belgium, Belize, Bulgaria, Central African Republic, Chad, Costa Rica, Cuba, Dominica, Dominican Republic, Grenada, Guatemala, Luxemburg, Mauritius, Morocco, Palau, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Saudi Arabia, Trinidad and Tobago, Uzbekistan, Yemen≤35020Albania, Azerbaijan,, British Virgin Islands, Cape Verde, Comoros, Congo, Egypt, Equatorial Guinea, Eritrea, Gambia, Guinea- Bissau, Iran, Kyrgyzstan, Lithuania, Sao Tome, Senegal, Seychelles, Somalia, Tajikistan, Togo, Turkmenistan≤2001 Suriname
Slide8ART initiation for asymptomatic peopleART criteriaCountries
PLHIV (2015)
Countries
Irrespective of CD4 count
73
28,615,000 (78%
)
Argentina, Australia, Austria, Botswana, Brazil, British Columbia (Canada), Burundi, Cambodia, China, Croatia, Denmark,
France, Georgia, Germany, Haiti, India, Italy, Jamaica, Japan, Kenya,
Korea (
Republic),
Lao PDR, Lesotho, Malawi, Malaysia, Maldives, Mexico, Montenegro, Mozambique, Namibia, Netherlands, Norway, Papua New Guinea, Poland, Portugal, Romania, Rwanda, South Africa, Spain, Sri Lanka, Sweden, Switzerland, Thailand, Turkey, Uganda, United Kingdom, United States, Zambia, Zimbabwe, Bahamas, Barbados, Cameroon, Cyprus, Czech Republic, Democratic Republic of Congo, Estonia, Ethiopia, Fiji, Finland, Greece, Hungary, Iceland, Ireland, Malta, Mongolia, Myanmar, Nigeria, Panama, Serbia, Slovakia, Slovenia, Solomon Islands, Timor-Leste, VanuatuConsider for CD4 >5005268,000 (0.7%)Colombia, Guyana, Hong Kong, New Zealand, Venezuela≤500514,907,500(13%) Algeria, Bangladesh, Bhutan, Bolivia, Chile, Ecuador, El Salvador, Gabon, Honduras, Liberia, Madagascar, Mali, Mauritania, Moldova, Nepal, Oman, Pakistan, Peru, Russia, South Sudan, Sudan, Swaziland, Tanzania, Tunisia, Ukraine, Uruguay, Viet Nam, Antigua and Barbuda, Armenia, Belgium, Belize, Bulgaria, Central African Republic, Chad, Costa Rica, Cuba, Dominica, Dominican Republic, Grenada, Guatemala, Luxemburg, Mauritius, Morocco, Palau, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Saudi Arabia, Trinidad and Tobago, Uzbekistan, Yemen≤350 (consider for CD4 ≤ 500)2162,000 (0.4%)Guinea, Philippines≤350392,646,500 (7%)Afghanistan, Angola, Benin, Burkina Faso, Canada, Cote d’Ivoire, Djibouti, Ghana, Indonesia, Kazakhstan, Latvia, Marshall Islands, Nicaragua, Niger, Paraguay, Samoa, Sierra Leone, Tuvalu, Albania, Azerbaijan, British Virgin Islands, Cape Verde, Comoros, Congo, Egypt, Equatorial Guinea, Eritrea, Gambia, Guinea- Bissau, Iran, Kyrgyzstan, Lithuania, Sao Tome, Senegal, Seychelles, Somalia, Tajikistan, Togo, Turkmenistan≤3001200 (0%) Macedonia≤200 (consider for CD4 ≤ 350)135,000 (0.1%) Belarus≤20013,800 (<0.1%) SurinameSource: published policy + reported
Slide92015 WHO Recommendation : Irrespective of CD4 countSource: published policy + reportedART initiation for asymptomatic people
<200, <250 or <300
<350
<500
>500
Irrespective of CD4 count
Slide10Source: published policy + reportedART initiation criteria in Africa2015 WHO Recommendation : Irrespective of CD4 count
<200
<350
<500
Irrespective of CD4 count
Slide11GDP per capita and ART coverage
Slide12National policy on task shiftingSource: MSF UNAIDS. Speed up scale-up: Strategies, tools and policies to get the best HIV treatment to more people, sooner
Nurses can initiate ART and lay workers can provide ART adherence counselling
Nurses
can initiate ART Lay workers can provide ART adherence counselling
Neither nurses can initiate ART nor lay workers can provide ART adherence counselling
Slide13National policy on ARV drug dispensing
2-3 month routine drug refills for people in stable
condition
and
ARV dispensing at community levelARV dispensing at community level2-3 month routine drug refills for people in stable condition
ARV dispensing
is not recommendedSource: MSF UNAIDS. Speed up scale
-up: Strategies, tools and policies to get the best HIV treatment to more people, sooner
Slide14CountriesNurses can initiate ARTLay workers can provide adherence counseling
2-3 month
routine ARV refills
for people in stable condition
ARV dispensing at community level
Zambia
YESYES
YESYESKenya, Malawi, South Africa, Swaziland
YESYES
YES
x
Botswana, Central African Republic, Lesotho, Uganda, ZimbabweYESYESxxEthiopiaYESxYESxMozambiqueYESxxYESIndia, TanzaniaxYESYESxGuineaYESxxxBrazil, Cameroon, China, Democratic Republic of Congo, Namibia, Nigeria, UkrainexYESxxMyanmarxxxxTask shifting and ARV drug dispensingSource: MSF UNAIDS. Speed up scale-up: Strategies, tools and policies to get the best HIV treatment to more people, sooner
Slide15ART eligibility criteria for children below age of 15Of the
123 countries with guidelines, 88
countries (91% burden) have recommendations on
paediatric
ARTART initiation criteria for children <15 vary considerablyOf the 88 countries, 23 (60%
global paediatric
burden) are consistent with WHO 2015 guidelines
2015 WHO Recommendation : Irrespective of CD4 count
Slide16ART eligibility criteria for children <15 yearsART INITIATION CRITERIA
NUMBER
CHILDREN WITH HIV
COUNTRIES
Irrespective of CD4 count for children <15
23
1,085,500
(60%)
Botswana, Burundi, Cambodia, China, Ethiopia, Georgia, Haiti, India, Kenya, Lao PDR, Lesotho, Malawi, Mozambique, Namibia, Papua New Guinea, Rwanda, South Africa, Sri Lanka,
Tanzania, Uganda,
United States,
Zambia, ZimbabweIrrespective of CD4 count for children <525448,300 (25%)Angola, Bangladesh, Bhutan, Cameroon, Colombia, Democratic Republic of Congo, El Salvador, Fiji, Gabon, Honduras, Indonesia, Liberia, Maldives, Mali, Mauritania, Myanmar, Nepal, Nigeria, Oman, Pakistan, Philippines, South Sudan, Sudan, Swaziland, Viet NamIrrespective of CD4 count for children <21658,300 (3.2%)Afghanistan, Algeria, Argentina, Benin, Cote d’Ivoire, Ghana, Guyana, Kazakhstan, Marshall Islands, Morocco, Panama, Samoa, Timor-Leste, Tuvalu, Vanuatu, VenezuelaIrrespective of CD4 count for children <11731,000(2%)Brazil, Burkina Faso, Chile, Costa Rica, Dominican Republic, Finland, Guatemala, Hong Kong, Madagascar, Mexico, Paraguay, Romania, Russia, Sweden, Thailand, Tunisia, UruguayConditional(clinical prerequisites)720,800 (1.2%)Cape Verde, Comoros, Djibouti, Guinea, Peru, Sierra Leone, UkraineWHO 2015 Guidelines: ART irrespective of CD4 countSource: published policy
Slide17ART eligibility criteria for children <15 yearsWHO 2015 Guidelines: ART irrespective of CD4 count
Source: published policy
ART for all children <1
Clinical prerequisites
ART for all children <2
ART for all children <5
ART for all children <15
Slide18<1 year
Paraguay
<1 year
Brazil, Burkina Faso, Sweden
<2 years
Guyana
Pre-requisitesCape Verde, Comoros, Djibouti, Peru, Ukraine,Sierra Leone
<2 yearsAlgeria, Ghana, Morocco
<2 yearsAfghanistan Kazakhstan Panama, Timor-Leste
<2 years
Argentina,
Benin<15 yearsNamibia, Uganda, Zambia <5 yearsColombia, Democratic Republic of Congo, Fiji, Honduras, Mali, Oman<15 yearsTanzania<5 yearsAngola, Bangladesh, Bhutan, Cameroon, El Salvador, Gabon, Indonesia, Liberia, Nigeria, Mauritania, Myanmar, Nepal, South Sudan, Sudan <2 yearsCote d’Ivoire, Marshall Islands, Samoa, Tuvalu, Vanuatu <2 yearsVenezuela<5 yearsMaldives, Pakistan,Philippines, Swaziland, Viet Nam <15 yearsBotswana, BurundiCambodiaChinaEthiopiaHaitiKenya Lao PDR Lesotho, Malawi, South AfricaSri Lanka, Mozambique RwandaZimbabwe Pre-requisitesGuinea<1 yearGuatemala<1 yearChile, Russia Dominican Republic, Hong Kong, Madagascar, Romania, Tunisia <1 yearCosta Rica, Finland, Mexico, Thailand, Uruguay WHO paediatric recommendations and published national guidelines (2004-2016)<15 yearsGeorgia, US<5 yearsIndia,Papua New Guinea
Slide19ART initiation for people with HIV and TB
ART INITIATION CRITERIA
COUNTRIES
COUNTRIES
Irrespective of CD4 count
107
Afghanistan, Algeria, Angola, Argentina
, Australia, Austria, Bangladesh, Belize, Benin, Bhutan, Bolivia, Botswana, Brazil, Britain, Burundi, Cambodia, Cameroon,
Canada, Chile, China, Colombia, Costa Rica, Croatia, Democratic Republic of Congo, Denmark, Dominican Republic, Ecuador, El Salvador, Ethiopia, France, Fiji, Finland, Gabon
,
Georgia, Germany, Ghana, Greece, Guatemala, Guyana, Haiti
, Honduras, Hong Kong, India, Indonesia, Italy, Jamaica, Japan, Kenya, Korea, Lao PDR, Latvia, Lesotho, Liberia, Madagascar, Malawi, Malaysia, Maldives, Mali, Marshall Islands, Mauritania, Mexico, Moldova, Montenegro, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, Nigeria, Norway, Oman, Pakistan, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Romania, Russia, Rwanda, Samoa, South Africa, Spain, Sri Lanka, South Sudan, Sudan, Swaziland, Sweden, Switzerland, Tanzania, Timor-Leste, Thailand, Tunisia, Turkey, Tuvalu, Uganda, United States, Ukraine, Uruguay, Vanuatu, Venezuela, Viet Nam, Zambia, Zimbabwe≤3509Burkina Faso, Cote d’Ivoire, Cuba, Djibouti, Guinea, Kazakhstan, Nicaragua, Niger, Sierra Leone≤3001 Macedonia≤2501 Hungary≤2005 Belarus, Cape Verde, Comoros, Estonia, SenegalSource: published policy
Slide20ART initiation for pregnant women
ART INITIATION CRITERIA
NO.
OF COUNTRIES
COUNTRIES
Option B+
94
Algeria, Angola, Argentina, Australia, Austria, Bangladesh, Benin, Bhutan, Bolivia, Botswana, Brazil, Burundi, Cambodia, Cameroon, Chile, China, Costa Rica, Croatia, Democratic Republic of Congo, Denmark, Dominican Republic, Ecuador, El Salvador, Ethiopia, France, Fiji, Finland, Gabon, Germany, Georgia, Greece, Ghana, Guatemala, Haiti, Honduras, India, Indonesia, Italy, Jamaica, Japan, Kenya, Korea, Lao PDR, Lesotho, Liberia, Madagascar, Malawi, Malaysia, Maldives, Mali, Mauritania, Mexico, Moldova, Montenegro, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, Nicaragua, Nigeria, Norway, Pakistan, Papua New Guinea,
Paraguay, Peru, Philippines, Poland, Portugal, Romania, Russia, Rwanda, Spain, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Sweden, Switzerland, Uganda, UK, US, Uruguay, Venezuela, Tanzania, Thailand, Tunisia, Turkey, Ukraine, Viet Nam, Zambia, Zimbabwe
≤500
3
Colombia, Hong Kong (China), Oman≤35018Afghanistan, Belize, Burkina Faso, Canada, Cote d’Ivoire, Djibouti, Guinea, Guyana, Kazakhstan, Latvia, Marshall Islands, Niger, Panama, Samoa, Sierra Leone, Timor-Leste, Tuvalu, Vanuatu≤3001 Macedonia≤200 (consider for ≤350)4Belarus, Cape Verde, Estonia, Hungary≤2003Comoros, Cuba, SenegalSource: published policy
Slide21ART initiation for serodiscordant couples
ART INITIATION CRITERIA
NO.
OF COUNTRIES
COUNTRIES
Irrespective of CD4 count
86
Algeria, Argentina, Australia, Austria, Bangladesh, Benin, Bhutan, Bolivia, Botswana, Brazil, Britain, Burundi, Cambodia, Cameroon, Canada, Chile, China, Costa Rica, Democratic Republic of Congo, Denmark, Ecuador, El Salvador, Ethiopia, France, Fiji, Gabon, Georgia, Germany, Haiti, Honduras, Hong Kong, India, Indonesia, Italy, Jamaica, Japan, Kenya, Korea, Lao PDR, Lesotho, Madagascar, Malawi, Malaysia, Maldives, Mali,
Mauritania, Mexico, Moldova, Montenegro, Mozambique, Myanmar, Namibia, Nepal, Netherlands, Norway, Oman, Pakistan, Papua New Guinea, Peru, Philippines, Poland, Portugal, Russia, Rwanda, Spain, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Sweden, Switzerland, United States, Uganda, Uruguay, Tanzania, Thailand, Tunisia, Turkey, Ukraine, Venezuela, Viet Nam, Zambia, Zimbabwe, Romania, Norway
>350
1
AngolaConsider 1 Nigeria2015 WHO Recommendation : Irrespective of CD4 countSource: published policy
Slide22ART initiation for people with Hepatitis B
ART INITIATION CRITERIA
NO.
OF COUNTRIES
COUNTRIES
Irrespective of CD4 count
101
Afghanistan, Algeria, Angola, Argentina, Australia, Austria, Bangladesh, Belize, Bhutan, Brazil, Britain, Botswana, Burundi,
Cambodia, Cameroon, Chile, China, Costa Rica, Croatia, Cuba, Democratic Republic of Congo, Denmark, Dominican Republic, Ecuador, El Salvador, France, Fiji, Finland, Gabon
,
Georgia, Germany
, Greece, Guatemala, Haiti, Honduras, Hong Kong, India, Indonesia, Italy, Jamaica, Japan, Kenya, Lao PDR, Latvia, Lesotho, Liberia, Madagascar, Malawi, Malaysia, Maldives, Mali, Marshall Islands, Mauritania, Mexico, Moldova, Montenegro, Morocco, Myanmar, Mozambique, Namibia, Nepal, Netherlands, Nicaragua, Nigeria, Norway, Pakistan, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Romania, Russia, Rwanda, Samoa, South Korea, Spain, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Sweden, Switzerland, Tanzania, Timor-Leste, Thailand, Tunisia, Turkey, Tuvalu, Uganda, Ukraine, United States, Uruguay, Vanuatu, Venezuela, Viet Nam. Zambia, Zimbabwe Same as eligibility 22Belarus, Benin, Bolivia, Burkina Faso, Canada, Cape Verde, Colombia, Comoros, Cote d’Ivoire, Djibouti, Ethiopia, Ghana, Guinea, Guyana, Hungary, Kazakhstan, Macedonia, Niger, Oman, Panama, Senegal, Sierra Leone2015 WHO Recommendation : Irrespective of CD4 countSource: published policy
Slide23ART initiation criteria for key populations
COUNTRY
TEST AND
TREAT (ART IRRESPECTIVE OF CD4 COUNT) FOR KEY POPULATIONS
48 countries
Test and treat for all, including key populations
Cameroon
MSM, sex workers, injecting drug usersIndonesia
MSM, sex workers, injecting drug users, transgenderMoldova
High risk populations
Myanmar
MSM, female sex workers, injecting drug users, transgenderTanzania MSM, sex workers, injecting drug users, prisonersUkraine High risk populations (e.g., injecting drug users)Viet Nam MSM, sex workers, injecting drug users2015 WHO Recommendation : No specific recommendationSource: published policy
Slide24No recommendation specific for KP
Irrespective of CD4 count for KP
Irrespective of CD4 count for all, including KP
Source
: published policy
KP: Key populations
ART
initiation criteria
for
key populations
2015
WHO Recommendation : Irrespective of CD4 count
Slide25FREQUENCYNooCOUNTRIES
Month 1; 3-monthly thereafter
1
Madagascar
Every 3 months
1
Ukraine
Every 3-monthly for 1 year; 6-monthly thereafter
1China
Every 3-4 months
1
Sierra LeoneEvery 3-6 months2Angola, ColombiaMonth 3 and 6; 6-monthly thereafter1Burkina FasoMonth 3; 6-monthly thereafter1PakistanMonth 3; every 4-6 months thereafter 1ChileEvery 4-6 months2Dominican Republic, Mexico6-monthly 23Benin, Brazil, Cambodia, Cote d'Ivoire, Democratic Republic of Congo, Ecuador, Ethiopia, Guatemala, Guinea, Haiti, India, Indonesia, Mali, Myanmar, Nepal, Niger, Nigeria, Peru, South Sudan, Sudan, Tanzania, Viet Nam, ZimbabweEvery 6-12 months1VenezuelaMonth 3, 6 and 12; yearly thereafter1BotswanaMonth 6; yearly thereafter1GhanaEvery 6 months, annually if CD4 >350 and VL <10001LesothoEvery 4-6 months; yearly after 2 years if CD4 count >3501ArgentinaNo routine CD4 ART monitoring14Burundi, Cameroon, Kenya, Malawi, Malaysia, Mozambique, Namibia, Papua New Guinea, Rwanda, South Africa, Swaziland, Thailand, Uganda, ZambiaNo recommendation2Morocco, SenegalFrequency of CD4 monitoring (55 countries)
Slide26RECOMMENDATIONNUMBERCOUNTRIES
Routine
viral load for ART monitoring
(WHO recommendation)
51
Angola, Argentina, Benin
, Botswana, Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, Chile, China, Colombia, Cote d'Ivoire, Democratic Republic of Congo, Dominican Republic, Ecuador, Ethiopia,
Ghana, Guatemala, Guinea, Haiti, India, Indonesia, Kenya, Lesotho, Madagascar, Malawi, Malaysia, Mali, Mexico, Mozambique, Namibia, Nepal, Niger, Nigeria, Pakistan, Papua New Guinea, Peru, Rwanda,
Sierra Leone, South Africa, Sudan, Swaziland, Tanzania, Thailand, Uganda, Ukraine, Venezuela, Viet Nam, Zambia, Zimbabwe
Targeted viral load monitoring
3
Morocco, Myanmar, South SudanNo recommendation1SenegalViral load monitoring (55 countries)
Slide27Frequency of routine VL (49 countries)
MONTH AFTER ART INITIATION
Month
1
Month 3Month 6 Month 9Month 12
Month 18
Month 24 Post the last VL testAngola, Dominican Republic, Ecuador, Guatemala, Mali, Niger, Venezuela, Viet Nam
✔✔✔✔
6-monthlyColombia✔
✔
✔
✔✔3-6 monthsArgentina✔✔✔✔✔4-6 monthsUkraine✔✔✔✔✔✔6-monthlyBotswana, Brazil, Chile, Mexico, Pakistan, Peru, Sierra Leone✔✔✔✔✔6-monthlyThailand✔✔✔YearlyBenin, Burkina Faso, Burundi, Cambodia, Cameroon, China, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Haiti, Indonesia, Kenya, Lesotho, Madagascar, Mozambique, Namibia, Nepal, Nigeria, Papua New Guinea, Rwanda, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe✔✔✔YearlyGuinea✔✔YearlyMalawi✔✔BienniallyMalaysia recommends VL every 4-6 months and every 6-12 months when viral suppression for >1 year has been achieved. Frequency unavailable for India
Slide28Availability of Viral Load (55 countries)
Recommended and widely available
Recommended only for monitoring treatment failure
Recommended with limited availability
Recommended (availability unknown)
No recommendation
Slide29Early Infant Diagnosis within 2 Months of Birth (55 countries)Six countries without recommendations and one country (Sudan) recommending EID at first encounter are not shown. WHO 2016 guidelines recommend addition of nucleic acid testing at birth to existing EID testing approaches
Benin,
Botswana, Burkina
Faso, Cameroon, China,
Dominican Republic, Ethiopia, Ghana, Guinea, India, Lesotho, Malawi, Nepal, Papua New Guinea, Uganda
1
2
3
456
7
8
Haiti, Mozambique, VenezuelaAngola, Brazil, Democratic Republic of Congo, Indonesia, Madagascar, Mali, Myanmar, Nigeria, Pakistan, Peru, Tanzania, South Sudan, Viet NamRwanda, SwazilandGuatemala, Ukraine, ThailandArgentina, MalaysiaMexicoWeeks 0MoroccoBurundi, Cambodia, Kenya, Namibia, Zambia, ZimbabweChileColombia, South Africa
Slide30Recommended and widely available
Recommended with limited availability
Recommended (availability unknown)
Not recommended
Availability of IPT (24 countries)
Slide31TB exclusion criteria for IPT (24 countries)Recommendation not available for China
and DRC. IPT is not recommended by Cote d’Ivoire and Botswana
WHO recommendation
CAMEROON
ETHIOPIA
INDIAKENYALESOTHOMALAWI MYANMARSWAZILANDUGANDA
VIET NAM ZAMBIAZIMBABWE
TANZANIA
MOZAMBIQUE
INDONESIA
CoughFeverWeight lossNight sweatsCoughFeverWeight lossNight sweatsCoughFeverWeight lossNight sweatsCoughFeverWeight lossNight sweatsCoughFeverWeight lossNight sweatsEnlarged nodesCoughing bloodEnlarged nodesEnlarged nodesShortness of breathCoughing bloodCoughFeverWeight lossNight sweatsTSTBRAZILTSTSOUTH AFRICA
Shortness of breath
NIGERIA
THAILAND
TST
Cough
Fever
Weight loss
Night sweats
NAMIBIA
Enlarged nodes
Shortness of breath
Coughing blood
Chest pain
Fatigue
Diarrhoea
Loss of appetite
Slide32COUNTRYIPT RECOMMENDATIONDURATION
PLHIV on IPT
Botswana
Not recommended for
PLHIV > 12 years
Brazil
Recommended (TST) -
availability unknown6 months
CameroonRecommended with limited availability
6 months
China
Recommended with limited availability (algorithm unknown)3%Cote d’IvoireNot recommendedDRCRecommended with limited availability (algorithm unknown)4.4%EthiopiaRecommended with limited availability6 months22%IndiaRecommended with limited availability6 months3%IndonesiaRecommended with limited availability6 months22%KenyaRecommended with limited availability6 months13% (in care)LesothoRecommended with limited availability6 monthsMalawiRecommended (10 high burden districts) with limited availability6 months1.5%MozambiqueRecommended (availability unknown)6 monthsMyanmarRecommended with limited availability6 months8.5%NamibiaRecommended with limited availability9 monthsNigeriaRecommended with limited availability6 monthsSouth AfricaRecommended (TST) with limited availability
6, 12 or 36 months (TST and ART status)
10.4%
Swaziland
Recommended with limited availability
6 months
15%
Tanzania
Recommended (TST) with limited availability
Recommended for
adults & adolescents excluding pregnant women
6 months
11.5%
Thailand
Recommended with limited availability
6 months
11%
Uganda
Recommended with limited availability
6 months
<1%
Viet Nam
Recommended with limited availability
9 months
26% (in care)
Zambia
Recommended with limited availability
6 months
Zimbabwe
Recommended with limited availability
6 months
15%
Slide33LimitationsGuidelines may be outdated and/or in the process of being updated
Written policies may not reflect programme implementation or clinical practice
Other guidelines covering
ART, task shifting, drug dispensing
may exist
Slide34Guidelines from 16 countries released before 2015 recommend ART for asymptomatic people irrespective of CD4 count48 countries (63% global burden) recommend test and treatOnly 23 countries are consistent with the 2015 WHO paediatric ART recommendationPost 2015 WHO guidelines, countries are revising/ planning to
revise national guidelinesConclusion
Slide35Please send new and/or updated guidelines to:Reuben Granich MD MPHVice President and Chief Technical Advisor, IAPACE-mail: rgranich@iapac.org
www.HIVpolicywatch.org