1.1 Context

These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the care of people living with HIV and the use of antiretroviral (ARV) drugs for treating and preventing HIV infection. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 WHO consolidated guidelines on the use of antiretroviral drugs (1), based on an extensive review of new evidence conducted in 2015. Although countries are at different stages of ART coverage and implementation of the 2013 edition of the guidelines, in 2016 there is a consistent trend towards further expanding access to ART, initiating treatment earlier and expanding the use of ARV drugs for HIV prevention. These guidelines present several new recommendations, including the recommendations to provide lifelong ART to all children, adolescents and adults living with HIV, including all pregnant and breastfeeding women living with HIV, regardless of CD4 cell count. WHO has also expanded earlier recommendations to offer pre-exposure prophylaxis (PrEP) to selected key populations, to all populations with an incidence of HIV above 3 per 100 person-years.1 A newer class of ARV drugs is now recommended as an option for first-line treatment option in resource-limited settings, as well as a reduced dosage of a previously recommended drug, efavirenz, to improve tolerability. Implementing the new recommendations and approaches in these guidelines at the national and global levels will have important implications for programme priority setting, funding and service delivery. Similar to the 2013 edition, the guidelines provide operational and service delivery guidance to help countries as they work to implement new approaches, including guidance on effective integration of HIV and other services and strategies to optimize the quality of services along the continuum of care, including linkage, retention, adherence to treatment and adolescent-friendly health services. Importantly, the service delivery guidance in 2016 (Chapter 6) emphasizes the need for countries to provide differentiated care through reduced frequency of clinic visits and community ART distribution to help countries manage the growing cohort of people who are stable on ART and reduce the burden on people receiving treatment and health facilities as more people become eligible for treatment in accordance with these guidelines.

Due to the anticipated public health impact, the new recommendations in these guidelines on when to start ART and pre-exposure prophylaxis (PrEP) were published in September 2015 (Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization, 2015 (http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en, accessed 6 October 2015).
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