Abstract
BackgroundDespite past and present global interventions, the human immunodeficiency virus (HIV) pandemic remains a public health problem in low- and middle-income countries (LMICs). The World Health Organization (WHO) has assisted these countries by providing antiretroviral therapy (ART) policies for adoption and adaptation to local needs.ObjectivesThis article describes the response of countries in sub-Saharan Africa (SSA), to the WHO’s changing CD4-threshold ART-initiation recommendations of the past two decades.MethodsRelevant articles published in international peer-reviewed journals were accessed via the following search engines: PubMed, Google Scholar, Cochrane, Embase and EBSCOhost. The study’s inclusion criteria were articles published in the English language between 2000 and 2019 that highlighted changes to the CD4 ART-initiation threshold and that focused on the WHO’s ‘commencement of ART’ policy guidelines. Sixteen studies (n = 16) from SSA were identified and included in this review: four are cross-sectional, four deal with cost-effectiveness, four are retrospective, one is a randomised trial and three are observational studies. Only studies conducted in SSA were assessed.ResultsFour themes emerged: (1) adoption of the WHO CD4-ART-initiation policy by SSA countries, (2) timely implementation of the changing guideline initiation policy in the region, (3) barriers and facilitators encountered in the implementation of the changing guidelines and (4) description of similarities in policy implementation at country level from 2002 to 2019. Regional studies – cross-sectional, observational, retrospective, cost-effectiveness and randomised have described greater access to ART in SSA. However, barriers remain. The most common barriers to the timely implementation of ‘new’ ART-initiation guidelines were economic constraints, drug stock-outs, delays in obtaining baseline blood-test results and staff shortages.ConclusionAlthough countries in SSA have adopted the WHO-ART-CD4 initiation-threshold policy guidelines, implementation has seldom occurred in a timely manner. Barriers have been identified. Whilst a small number of countries have implemented recommendations promptly, for many, the barriers still require to be overcome.
Highlights
Despite past and present global interventions, the human immunodeficiency virus (HIV) pandemic remains a public health problem in low- and middle-income countries (LMICs)
Conclusion: countries in sub-Saharan Africa (SSA) have adopted the World Health Organization (WHO)-antiretroviral therapy (ART)-CD4 initiation-threshold policy guidelines, implementation has seldom occurred in a timely manner
We only reviewed studies that examined how different SSA countries adopted changes in WHO and ART initiation guidelines based on CD4 threshold and how the guidelines have impacted ART programmes in SSA
Summary
Despite past and present global interventions, the human immunodeficiency virus (HIV) pandemic remains a public health problem in low- and middle-income countries (LMICs). Infection with human immunodeficiency virus (HIV) has spread globally and caused an estimated 74.9 million infections and 32 million AIDS-related illnesses.[1] In its first 15 years no treatment could control the infection or halt its spread.[2] By 2018, the African region was home to approximately 25.7 million people living with HIV (PLWH)[1] and in that year alone, Africa experienced approximately 1.1 million new infections.[1] Almost two-thirds of all new global infections occur in sub-Saharan Africa (SSA).[1]. The World Health Organization’s (WHO’s) antiretroviral therapy (ART) initiation-guidelines have changed substantially over the last two decades.[2] The guidelines were first published in 2002.3 These (2002/2003) recommended starting ART in those with AIDS-related conditions and/or at a CD4 of ≤ 200 cells/mm. Continued deaths from AIDS and success with ART prompted a CD4 increase in 2006 http://www.sajhivmed.org.za
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
