Gupta Somya, Granich Reuben
International Association of Providers of AIDS Care, New Delhi, India.
International Association of Providers of AIDS Care, Washington DC, United States.
South Afr J HIV Med. 2016 Aug 31;17(1):459. doi: 10.4102/sajhivmed.v17i1.459. eCollection 2016.
The World Health Organization (WHO) HIV treatment guidelines have been used by various countries to revise their national guidelines. Our study discusses the national policy response to the HIV epidemic in sub-Saharan Africa and quantifies delays in adopting the WHO guidelines published in 2009, 2013 and 2015.
From the Internet, health authorities and experts, and community members, we collected 59 published HIV guidelines from 33 countries in the sub-Saharan African region, and abstracted dates of publication and antiretroviral therapy (ART) eligibility criteria. For these 33 countries, representing 97% regional HIV burden in 2015, the number of months taken to adopt the WHO 2009, 2013 and/or 2015 guidelines were calculated to determine the average delay in months needed to publish revised national guidelines.
Of the 33 countries, 3 (6% regional burden) are recommending ART according to the WHO 2015 guidelines (irrespective of CD4 count); 19 (65% regional burden) are recommending ART according to the WHO 2013 guidelines (CD4 count ≤ 500 cells/mm); and 11 (26% regional burden) according to the WHO 2009 guidelines (CD4 count ≤ 350 cells/mm). The average time lag to WHO 2009 guidelines adoption in 33 countries was 24 (range 3-56) months. The 22 that have adopted the WHO 2013 guidelines took an average of 10 (range 0-36) months, whilst the three countries that adopted the WHO 2015 guidelines took an average of 8 (range 7-9) months.
There is an urgent need to shorten the time lag in adopting and implementing the new WHO guidelines recommending 'treatment for all' to achieve the 90-90-90 targets.
世界卫生组织（WHO）的艾滋病毒治疗指南已被各国用于修订其国家指南。我们的研究探讨了撒哈拉以南非洲地区针对艾滋病毒疫情的国家政策应对措施，并对采用2009年、2013年和2015年发布的WHO指南的延迟情况进行了量化。
我们从互联网、卫生当局和专家以及社区成员那里收集了撒哈拉以南非洲地区33个国家的59份已发布的艾滋病毒指南，并提取了发布日期和抗逆转录病毒疗法（ART）资格标准。对于这33个国家（占2015年该地区艾滋病毒负担的97%），计算采用WHO 2009年、2013年和/或2015年指南所需的月数，以确定发布修订后的国家指南所需的平均延迟月数。
在这33个国家中，3个国家（占地区负担的6%）根据WHO 2015年指南（无论CD4细胞计数如何）推荐ART；19个国家（占地区负担的65%）根据WHO 2013年指南（CD4细胞计数≤500个细胞/mm³）推荐ART；11个国家（占地区负担的26%）根据WHO 2009年指南（CD4细胞计数≤350个细胞/mm³）推荐ART。33个国家采用WHO 2009年指南的平均时间滞后为24个月（范围为3 - 56个月）。采用WHO 2013年指南的22个国家平均用时10个月（范围为0 - 36个月），而采用WHO 2015年指南的3个国家平均用时8个月（范围为7 - 9个月）。
迫切需要缩短采用和实施新的WHO“全面治疗”指南的时间滞后，以实现90 - 90 - 90目标。
