The WHO public health approach to HIV treatment and care: looking back and looking ahead In 2006, WHO set forth its vision for a public health approach to delivering antiretroviral therapy. This approach has been broadly adopted in resource-poor settings and has provided the foundation for scaling up treatment to over 19·5 million people.
Full Answer
What is the current gold standard approach to combating HIV?
[4, 5] Randomized controlled trials (RCTs) are generally considered the gold standard to define the evidence base for HIV prevention programs and policies.
What does the World health Organization consider HIV?
The human immunodeficiency virus (HIV) targets the immune system and weakens people's defense against many infections and some types of cancer that people with healthy immune systems can fight off. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient.Nov 30, 2021
What is one of the greatest barriers to HIV prevention care and treatment?
Barriers to care for HIVFewer financial resources.Fewer health care resources available in the area.Worry about violent reactions from partners, for women in abusive relationships.Less access to transportation.Lack of housing. ... Lack of emotional or physical support.More items...•Nov 21, 2018
How have HIV treatments changed over the years?
Treatment of HIV has evolved from gruelling regimens with high pill burden, inconvenient dosing, treatment-limiting toxicities, food and drug interactions, incomplete viral suppression and emergence of drug resistance to manageable one or two pill once daily regimens that can be initiated in early HIV disease and ...
What is antiretroviral therapy?
Antiretroviral therapy (ART) is treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs. The standard treatment consists of a combination of drugs (often called "highly active antiretroviral therapy" or HAART) that suppress HIV replication.
What is the 90 90 90 strategy?
UNAIDS “90-90-90” strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. Reaching these targets by 2020 will reduce the HIV epidemic to a low-level endemic disease by 2030.Jun 30, 2016
When was antiretroviral therapy introduced?
In 1987 the US Food and Drug Administration approved the use of azidothymidine (AZT), the first antiretroviral drug for treatment of HIV/AIDS.Jul 1, 2019
Who discovered AZT?
We learn this week of the death of a medical researcher whose work had a profound impact on the treatment of the AIDS virus. Jerome Horwitz invented the drug AZT. It was approved in 1987, the first drug that significantly helped decrease the devastating death toll of AIDS.Sep 21, 2012
How does WHO approach HIV testing?
The WHO public health approach of HIV care requires expanded HIV testing through community-based services and integration of HIV and viral hepatitis services in chronic disease care in settings where rates of co-infection are high. 1 Innovative strategies for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV)testing are thus becoming necessary to expand both their prevention and treatment services. 2 We pioneered the use of mobile units for mass HIV testing throughout Cameroon. 3 The development of a new multiplex rapid diagnostic test (RDT) for simultaneous detection of HIV, and HCV-specific antibodies, and HBV surface antigen (HBsAg) 4 prompted us to assess its usefulness in mobile units for mass HIV, HBV, and HCV screening.
What is WHO's public health approach?
WHO's public health approach aimed to promote standardisation and simplification of ART regimens to support efficient implementation and to accelerate access. The key principles of this public health approach were articulated by WHO in the first guidelines for antiretroviral therapy in 2002. 2.
How did ART help HIV?
In the initial phase of the HIV response, ART was mainly provided through vertical programmes to rapidly respond to high mortality. The shift towards treating more people earlier in their HIV infection with less clinical care requirements than before, together with the growing burden of co-infections and non-communicable diseases,
How many people are aware of HIV?
Globally, only around 70% (range 51–84) of people who are HIV-infected are aware of their status,
Why is public health important?
The public health approach was conceived so that as many people with advanced HIV disease as possible were on ART, to reduce acute mortality. Nowadays, HIV programmes are faced with a dual challenge of continuing to enrol patients onto ART while ensuring long-term retention for the growing cohort of people on ART. Although the immunological status of patients presenting to care has improved, advanced disease management remains a challenge.
What are the four Ss of clinical decision making?
The original public health approach framework emphasised the so-called Four Ss of simplified clinical decision making: when to start, when to substitute for toxicity, when to switch treatment after failure, and when to stop (ie, move to end-of-life care).
Where is public health approach to ART delivery aimed?
The public health approach to ART delivery was aimed primarily at countries with a high burden of HIV, and much of the evidence supporting the key approaches has come from sub-Saharan Africa. Not all approaches are universally applicable: in concentrated epidemics, decentralising HIV testing and treatment across the entire health-care system might not be efficient, and strategic assessments are needed to ensure optimal efficiency according to where the burden of disease is greatest. Nevertheless, most strategies can be universally applied: task shifting, which is supported by high-quality evidence from a range of settings, has the potential to improve service efficiency in all settings, and differentiating service delivery to reduce clinic visits for stable, adherent patients, also makes sense everywhere.
How is HIV ART provided?
In the initial phase of the HIV response, ART was mainly provided through vertical programmes to rapidly respond to high mortality. The shift towards treating more people earlier in their HIV infection with less clinical care requirements than before, together with the growing burden of co-infections and non-communicable diseases,94 requires HIV treatment and care services to be more fully integrated into health-care services. WHO recom-mendations have developed towards recommending integration of care for HIV-related health services. These services include not only tuberculosis, as the leading cause of death among people with HIV, but also maternal and child health-care services, settings providing opioid substitution therapy and other services related to drug use disorders, sexually transmitted infection services, and family planning services.62 The increasing contribution of viral hepatitis to mortality and morbidity worldwide95 means that integration of HIV and viral hepatitis services requires particular attention in settings and populations in which rates of co-infection are high. There is a growing body of evidence supporting the integration or linkage of HIV and chronic non-communicable disease care, including cardiovascular diseases, hypertension, and diabetes,96 which will become an increasingly important approach as the life expectancy of people with HIV approaches that of the general population.18,19
What is the public health approach to ART?
The initial design of the public health approach to ART expansion was premised on the fact that routine laboratory monitoring was inadequate in most resource-poor settings with a high burden of HIV,1 and successive WHO guidelines have emphasised that insucient laboratory monitoring should not be a barrier to starting ART.39 As the global cohort of people on ART has grown, management of treatment failure has become increasingly important and viral load monitoring, the standard way to monitor ART effectiveness in high-income settings, is being expanded across most low-income and middle-income countries.25 New technologies (such as point-of-care devices) and strategies (such as sample transport and electronic communication of results) are needed to further improve access to viral load monitoring and action on the subsequent results.The development of point-of-care technologies has shown a strong potential for improving quality of care, including CD4 cell count, viral load monitoring, and diagnosis of tuberculosis.75–77 Future opportunities include qualitative CD4 cell count tests to diagnose patients presenting with advanced HIV disease, simplified tools to measure adherence and drug resistance, multiplex point-of-care platforms capable of performing a range of assessments (for example tuberculosis diagnosis and HIV and hepatitis C viral load monitoring), and the use of electronic technology to reduce turnaround time for receipt of results.
What are the four Ss of clinical decision making?
The original public health approach framework emphasised the so-called Four Ss of simplified clinical decision making: when to start, when to substitute for toxicity, when to switch treatment after failure, and when to stop (ie, move to end-of-life care).
Where does the public health approach to ART delivery come from?
The public health approach to ART delivery was aimed primarily at countries with a high burden of HIV, and much of the evidence supporting the key approaches has come from sub-Saharan Africa. Not all approaches are universally applicable: in concentrated epidemics, decentralising HIV testing and treatment across the entire health-care system might not be ecient, and strategic assessments are needed to ensure optimal eciency according to where the burden of disease is greatest. Nevertheless, most strategies can be universally applied: task shifting, which is supported by high-quality evidence from a range of settings, has the potential to improve service eciency in all settings, and differentiating service delivery to reduce clinic visits for stable, adherent patients, also makes sense everywhere.
Is ending AIDS a public health concern?
There is broad agreement that the available knowledge and tools make ending AIDS as a major public health concern a feasible goal. However, despite enormous progress, crucial shortfalls remain in ensuring adequate access to prevention, treatment, and chronic care services, in particular for key at-risk populations and other marginalised groups.118Universal health coverage is the aspirational and practical goal that all people have access to the health services they need, of sucient quality to be effective, and without experiencing financial hardship. The emphasis is on providing holistic care, in which the scope of services is expanded to cover the health-care needs of individuals and populations. The chronic care needs of people with HIV illustrate the importance of strengthening health systems to deliver integrated and person-centred care across the full life course, from pregnancy to an ageing population. The response to HIV has promoted innovation in the delivery and funding of health services, including defining comprehensive intervention and service delivery packages funded through the public system; strengthening quality assurance and quality improvement systems; developing and applying multisector costing approaches; promoting strategies to reduce costs, improve access, and maximise patient and programme outcomes; pioneering innovative financing models; and addressing health inequities.119There are further opportunities to use the universal health coverage framework to strengthen and accelerate HIV programmes. These opportunities include ensuring that financial protection schemes cover the full range of HIV interventions, integrating HIV into broader health planning, identifying new approaches for sustainable financing, removing financial and other structural barriers to enable equitable access to services, and promoting greater service eciencies.
Abstract
In 2006, WHO set forth its vision for a public health approach to delivering antiretroviral therapy. This approach has been broadly adopted in resource-poor settings and has provided the foundation for scaling up treatment to over 19·5 million people.
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