HIV Treatment: New ‘Treat All’ Standards in Use Worldwide

A survey of HIV treatment sites worldwide shows that 93% have implemented the “Treat All” guidelines recommended in 2015 by the World Health Organization. “Treat All” standards provide antiretroviral medication to anyone with an HIV diagnosis regardless of immune status or clinical disease stage.

Prior to the Treat All recommendation, antiretroviral treatment often depended on patients’ white blood cell counts. WHO changed the standard to promote patient health and to stem transmission of the disease.

The study analyzed survey responses from 201 adult HIV treatment sites in 41 countries. Of these, 187 or 93% reported implementing the Treat All guidelines. Most had done so by mid-2017. These sites that were surveyed participate in a global research consortium called IeDEA (International epidemiology Databases to Evaluate AIDS).

The study was published in the Journal of the International AIDS Society. Lead author Ellen Brazier is a Ph.D. student at the Graduate School of Public Health & Health Policy and senior research scientist at the Institute for Implementation Science in Population Health. Professor Denis Nash was senior author on the study.

Interestingly, the survey found that starting patients on antiretroviral treatment took longer in high-income countries than in less affluent countries. Sites in lower-income countries typically started patients on treatment within 14 days of diagnosis, compared to two to four weeks in more affluent locales. The researchers theorized that treatment may be delayed in higher-income settings due to more testing or coordination of “multiple stakeholders” like insurance providers. In contrast, the Treat All guidelines simplified treatment in rural and low-resource settings where cell counts and other tests are harder to do.

Sites adopting the Treat All approach included all IeDEA sites in the Caribbean, Central and South America, and in East Africa, along with the “vast majority” of sites in Southern Africa, North America, Central Africa, and Asia-Pacific. This near-universal implementation correlates with the list of countries that incorporated WHO’s Treat All recommendation into national treatment guidelines. The survey also found that the median time from national adoption of the guidelines to site-level implementation was just one month.

West Africa was the one region where Treat All implementation lagged, carried out at only 63% of sites. National policies in that region at the time the survey was conducted did not reflect the Treat All recommendations.

Beyond SUM

Work By

Ellen Brazier (Senior Research Scientist, Institute for Implementation Science in Population Health, Epidemiology) | Profile 1
Denis Nash (Distinguished Professor, Epidemiology) | Profile 1