Review of Global Guidelines from 172 countries - PowerPoint Presentation

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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

Slide2

Objectives 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

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ART 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

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WHO 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       

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Source: published policyART initiation for asymptomatic people2015 WHO Recommendation : Irrespective of CD4 count

<200, <250 or <300

<350

<500

>500

Irrespective of CD4 count

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Source: published policyART initiation criteria in Africa2015 WHO Recommendation : Irrespective of CD4 count

<200

<350

<500

Irrespective of CD4 count

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Reported 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

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ART 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

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2015 WHO Recommendation : Irrespective of CD4 countSource: published policy + reportedART initiation for asymptomatic people

<200, <250 or <300

<350

<500

>500

Irrespective of CD4 count

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Source: published policy + reportedART initiation criteria in Africa2015 WHO Recommendation : Irrespective of CD4 count

<200

<350

<500

Irrespective of CD4 count

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GDP per capita and ART coverage

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National 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

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National 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

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CountriesNurses 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

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ART 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

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ART 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

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ART 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

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<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

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ART 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

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ART 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

Slide21

ART 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

Slide22

ART 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

Slide23

ART 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

Slide24

No 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

Slide25

FREQUENCYNooCOUNTRIES

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)

Slide26

RECOMMENDATIONNUMBERCOUNTRIES

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)

Slide27

Frequency 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

Slide28

Availability of Viral Load (55 countries)

Recommended and widely available

Recommended only for monitoring treatment failure

Recommended with limited availability

Recommended (availability unknown)

No recommendation

Slide29

Early 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

Slide30

Recommended and widely available

Recommended with limited availability

Recommended (availability unknown)

Not recommended

Availability of IPT (24 countries)

Slide31

TB 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

Slide32

COUNTRYIPT 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%

Slide33

LimitationsGuidelines 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

Slide34

Guidelines 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

Slide35

Please send new and/or updated guidelines to:Reuben Granich MD MPHVice President and Chief Technical Advisor, IAPACE-mail: rgranich@iapac.org

www.HIVpolicywatch.org