Context
The global expansion of access to HIV treatment ranks
among the great recent achievements in public health. At the end of 2011, an
estimated 8 million people in low-and middle-income countries were receiving
ART – a 25-fold increase since 2002. Nevertheless, most low- and middle-income
countries are yet to achieve ‘Universal Access’ to ART. Reasons for this
include lack of awareness of HIV status, high cost of ART, late initiation of
ART, human rights issues affecting people living with HIV and key populations
and substantial attrition in the ‘test-treat-retain’ continuum. Addressing
structural barriers, reducing costs and strengthening the continuum of care is
critically important if the full gains of expanded HIV treatment are to be
realised.
Access to ART is not yet equitable. For example, the 28%
coverage for children in need of treatment in 2011 was considerably lower than
the 57% coverage for adults. Providing ART to pregnant HIV-positive women
reduces the risk of HIV transmission to their unborn child to less than 5%,
however less than one third of the women eligible for ART for their own health
in 2010 were receiving it.
The role of WHO
A key role of the WHO is to assess new evidence and
experience, and translate this into global guidance that can inform and guide
country decisions. WHO’s technical, operational and normative guidance in
the area of HIV treatment, prevention, care and support is pivotal for
achieving global targets which were jointly set by all Governments. WHO first
published ART guidelines for adults and adolescents in 2002 and subsequently
revised them in 2003, 2006 and 2010. Since 2006, additional but separate
guidelines for ART in children and PMTCT were developed. Previous versions can
be found here.
New evidence and the role of communities and
civil society
Since the publication of revised global guidelines in
2010 there have been a series of landmark studies highlighting new evidence on
HIV treatment and prevention benefits of earlier ART, more affordable point of
care HIV diagnostics and laboratory services, new strategies for expanding HIV
testing, innovations in HIV Care Service Delivery and new formulations for
optimisation of drug regimens.
The critical role that people living with HIV, their families and communities, and civil society play in supporting effective treatment and prevention, through community and home-based care, adherence support and peer counselling among other activities is also becoming increasingly clear.
2013 guidance update
In 2013, WHO will release a revised and consolidated set
of guidelines related to the use of ARVs for both HIV treatment and prevention,
prioritising those who are most at risk of HIV mortality and morbidity and
aiming to accelerate progress towards universal access of HIV diagnostics,
treatment, care and support to all people in need.
The new generation of guidelines will include, in
addition to the clinical guidelines for adults, adolescents and maternal and
child health, operational and programmatic guidance, to help countries take the
best strategic decisions on the use of ARVs.
Following a process of drafting, peer review and
submission to the Guidelines Review Committee, the guidelines will be published
and disseminated from May-July 2013. Guidelines will be available online in the
WHO library database in all official WHO languages, and will be widely
distributed.
Countries will be supported to adapt the guidelines to
their specific needs and integrate the material into existing national
guidelines, including ensuring alignment with Treatment 2.0. Regional,
sub-regional and country-level workshops will be organised to create space
where the adaptation of each recommendation to national epidemiological,
cultural and socio-economic settings can be practically discussed.
This is a critical opportunity to help shape guidelines
that will define the future use and provision of ARVs in HIV treatment and
prevention, particularly with regards to key and most-affected populations.
We
hope you will take the time to take part, input and make sure the voice of
civil society and communities is heard in the development of these guidelines.
Community consultation
Recognising the critical role of communities and civil
society, in particular PLHIV, in informing the content and process of implementation
of the guidelines, WHO seeks to undertake a consultative process with
communities to inform these consolidated guidelines.
WHO HIV Department established a Civil Society Reference
Group to support systematic and effective dialogue between WHO HIV department
and civil society and maximise opportunities of synergy and meaningful
collaborations between WHO programmes and community actions. The reference
group will guide the revision of the 2013 guidelines.
In addition, WHO has asked the International HIV/AIDS
Alliance and the Global Network of People Living with HIV (GNP+), in
collaboration with WHO, will conduct an online consultation for community input
into these guidelines. While it is crucial that the guidelines are based on new
scientific evidence, it is important the guidelines reflect the realities of
the lives of people living with and affected by HIV, and of civil society.
Involvement of civil society will encourage greater ownership of the guidelines
and encourage a strong role for civil society in their roll-out and
implementation of and in monitoring and evaluation their application.
A Civil Society Working Group will be formed to
strengthen the quality and validity of the consultation and promote effective
and inclusive engagement of civil society, key populations and affected
communities. The Working Group will function to provide technical review of the
preliminary and final consultation reports, guidance on how to maximise civil
society input into surveys and e-discussions, and guidance on communicating
with and feeding results back to civil society.
Opportunities to feed into the consultation will take place between 7th November and late December 2012 and will include:
* An online survey available in five languages: English, French, Spanish, Russian, and Arabic. This will be online from 7th November 2012 to 14th January 2013* E-forum discussions providing opportunities for more in-depth qualitative input around key technical issues and areas of concern. This will take place between 12th November 2012 – 14th January 2013
The Civil Society Working Group mandate will end upon
submission and dissemination of the final consultation report, by end of
January 2012.
A report from the community consultation process will be
published in January 2013.
For more information on the consultation process, contact
Nick Keeble (nkeeble@aidsalliance.org).
