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Global Policy Review of Antiretroviral Therapy Eligibility Criteria for Treatment and Prevention of HIV and Tuberculosis in Adults, Pregnant Women, and Serodiscordant Couples

Gupta, Somya MA*; Granich, Reuben MD, MPH*; Suthar, Amitabh B. PharmD, MPH*; Smyth, Caoimhe MA, MSc*; Baggaley, Rachel MBBS, MSc*; Sculier, Delphine MD, MPH; Date, Anand MD, MBBS; Desai, Mitesh A. MD, MPH; Lule, Frank MD§; Raizes, Elliot MD; Blanc, Leopold MD, MPH; Hirnschall, Gottfried MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2013 - Volume 62 - Issue 3 - p e87–e97
doi: 10.1097/QAI.0b013e31827e4992
Implementation and Operational Research: Epidemiology and Prevention

Objective: This article reviews the antiretroviral therapy (ART) initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current World Health Organization (WHO) recommendations.

Methods: Published ART guidelines were collected from the Internet, databases, and WHO staff. ART eligibility criteria for asymptomatic people, pregnant women, people with HIV-associated tuberculosis, serodiscordant couples, injecting drug users, men who have sex with men, and sex workers were abstracted from them. Multiple regression analysis was used to determine the relation between ART eligibility criteria, ART coverage, and various population characteristics and policy interventions.

Results: Of the 70 countries, 42 (60%) follow WHO’s ART guidelines for asymptomatic people and 31 (44%) for pregnant women, recommending ART at CD4 count of ≤350 cells/mm3. Twenty-three (33%) countries recommend ART for people with HIV-associated tuberculosis irrespective of CD4 count. Nineteen countries are also recommending or considering earlier ART above CD4 count ≤350 cell/mm3 for asymptomatic people, pregnant women, and/or serodiscordant couples. Multiple linear regression analysis shows that HIV prevalence, year of publication of guidelines, and HIV expenditure are significantly associated with published ART eligibility criteria. On average, the ART coverage is similar irrespective of published guidelines being consistent with the WHO recommendation (P < 0.53).

Conclusions: Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART.

*Department of HIV/AIDS, World Health Organization, Geneva, Switzerland

Stop TB Department, World Health Organization, Geneva, Switzerland

Division for Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA

§HIV Treatment and Care, World Health Organization, Brazzaville, Congo.

Presented at XIX International AIDS Conference, July 25, 2012, Washington, DC, and at Second Annual HIV Treatment as Prevention Workshop, April 23, 2012, Vancouver.

The opinions and statements in this article are those of the authors and do not represent the official policy, endorsement or views of the World Health Organization.

The authors have no conflicts of interest to declare.

Development of conceptual framework: R.G., A.S., and C.S.; Data abstraction: S.G., C.S., and A.S.; Data and statistical analysis: S.G.; Contribution of reagents/materials: C.S., A.D., M.D., F.L., and E.R.; Drafting and writing the paper: S.G., R.G., A.S., C.S., R.B., D.S., L.B., and G.H.; Review of the final version: R.G., A.S., G.H., R.B., D.S., A.D., M.D., E.R., F.L., and L.B.

Correspondence to: Somya Gupta, MA, Antiretroviral Treatment and HIV Care, Department of HIV/AIDS, Building D, 1st Floor, Room 1005, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland (e-mail:

Received August 06, 2012

Accepted October 04, 2012

© 2013 Lippincott Williams & Wilkins, Inc.