Realizing the potential of treatment as prevention: global ART policy and treatment coverage.

Abstract

This article reviews the antiretroviral therapy (ART) initiation criteria from published national guidelines for 94 countries (representing 86 % of global HIV burden) and compares them with the 2013 World Health Organization (WHO) ART guidelines. As of 31st of July 2014, 19 countries have adopted the WHO-recommended CD4 eligibility criteria of ≤500cells/mm(3), while seven have opted to treat irrespective of CD4 cell count ("test and treat"). Together, these 26 countries represent 27% of 2013 global HIV burden. Additionally, test and treat is recommended for selected groups of HIV-positive individuals, namely, (a) people with tuberculosis in 58 countries, (b) pregnant women in 42 countries, (c) people with liver disease due to hepatitis B co-infection in 52 countries, (d) serodiscordant couples in 35 countries and (e) children below 5years in nine countries. Global access to treatment has improved; however in 2013, ART coverage was 12.9 million or 37% of people living with HIV. Rapidly translating new science into policy is a critical component of the HIV response. Adapting and implementing the 2013 WHO treatment recommendations are necessary to prevent unnecessary illness, death, HIV transmission and costs.