Towards consolidated guidelines to prevent and treat HIV for release in 2013
WHO HIV/AIDS Department is working to publish the first consolidated guidelines on antiretroviral treatment (ART) in 2013. Since the release of our set of 2010 ART guidelines (adult ART, pediatric ART, PMTCT), a series of landmark study results have been announced leading to much wider opportunities in using ART to both treat patients for their own health but also to prevent new infections.
Countries also require more comprehensive information on the full menu of options for ART use in different population groups and epidemiological settings along with guidance on responding to varying policy and financial requirements.
WHO has been at the forefront of the response to these developments and aims to reflect these advances in developing sound policy recommendations to enable countries to successfully scale up efficiency and impact of their HIV/AIDS programmes.
Key features of the new guidelines
Based on the country experiences of implementing previous WHO HIV guidelines, and adapted to incorporate the latest advancements in HIV science, the new 2013 guidelines will have the following key features:
Expanding the scope
Unlike previous WHO HIV guidelines, the new update will move beyond clinical recommendations (What to do?) to include operational (How to do?) and programmatic (How to decide what to do and where?) recommendations to provide comprehensive guidance to national programme managers and policymakers.
Addressing all age groups and populations
Countries will be able to access a full menu of recommendations for different populations in one guideline (adults, pregnant women, adolescents, children, and key populations, such as men-who-have-sex-with-men, people who inject drugs, sex workers, and prisoners) to facilitate easier adaptation and use in various epidemiological contexts.
Providing guidance across the Continuum of HIV care
Countries will be able to access a comprehensive list of recommendations across the continuum of HIV care and entry-points for services from HIV testing, linkages with care, pre-ART management, when and what to start, including use of ART for treatment and prevention, monitoring of treatment response and toxicities, management of co-infections and co-morbidities with HIV.
Expanding the evidence-base to support recommendations
Consistent with the high standards set by the WHO guidelines development and review process, WHO will use systematic reviews of the literature and the GRADE system for assessing the quality of evidence and development of recommendations. This process will be further complemented by strategic modelling and cost-effectiveness analyses, country best practice case studies and grey literature reviews.
A public health approach
WHO published its first ART guidelines for adults and adolescents in 2002, and subsequently revised them in 2003, 2006 and 2010. Since 2006, additional but separate guidelines for ART in children and prevention of mother-to-child transmission (PMTCT) were developed. These guidelines provided key policy and programmatic instruments to countries to achieve dramatic results in saving lives and improving the health and wellbeing of people living with HIV. The 2013 WHO HIV consolidated guidelines will be based on the same public health principles prioritizing the people who are sicker and most at risk to HIV mortality and morbidity and aiming to accelerate progress towards universal access of HIV diagnostics, treatment, care and support to all people in need.
Roadmap to 2013 guidelines
To start, the WHO HIV department organized a series of technical consultations with global partners and stakeholders on the fuller and more strategic use of antiretroviral drugs following the announcements of major clinical trials in 2011. Meetings held in November 2011 and March 2012 were instrumental in defining the scope of the policy guidance the countries need in using the scientific findings in real-life national programmes.
In 2012, a series of new guidance and programmatic updates was released: In March 2012, the first guidance on couples HIV testing and counselling, including ART for treatment and prevention in serodiscordant couples. In April, Programmatic update on antiretrovirals for pregnant women and preventing HIV infection in infants. It is planned to release recommendations on the use of ART in pre-exposure prophylaxis (PrEP) in serodiscordant couples and men who have sex with men, and guidance on the use of ART for prevention in sex workers, in July 2012.
At the upcoming XIXth International AIDS Conference, 22-27 July in Washington DC, we will engage with global partners to maximize the impact of more strategic ART and to review progress achieved under the “Treatment 2.0” initiative.
While the publication of the full set of comprehensive guidelines is planned for July 2013, WHO will continue to publish specific recommendations ahead of time to facilitate timely decision making in countries, and provide a full update at the end of 2012 including an outlook on major recommendations of the 2013 guidelines.
Key milestones in the roadmap towards the completion of the consolidated guidelines to be released in July 2013 are:
- May 2012: Constitution of the Guidelines Development Groups (GDGs)
- June 2012: Finalization of PICOT questions and contracting of reviews
- October/November 2012: Guidelines Development Groups meeting to prepared draft recommendations
- December 2012: Publication of comprehensive update including on anticipated recommendations
- January 2013: Preparation of the final draft
- February 2013: Peer review of Consolidate Guidelines and revisions
- April 2013: Submission to Guidelines Review Committee
- July 2013: Publication and dissemination
For more information
Major milestones and progress in the 2013 WHO HIV guidelines development process will be communicated through our website: http://www.who.int/hiv/
For more detailed information on the process, please write to firstname.lastname@example.org with subject line: "2013 WHO HIV guidelines".