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2013 WHO Consolidated ARV Guidelines Summary of Major Recommendations and Estimated Impact

GSG Briefing July 19, 2013. 2013 WHO Consolidated ARV Guidelines Summary of Major Recommendations and Estimated Impact. Gottfried Hirnschall, Director HIV Department, WHO. ART Scale up : Progress Towards Global Targets. WHO Global ART report, 2013.

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2013 WHO Consolidated ARV Guidelines Summary of Major Recommendations and Estimated Impact

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  1. GSG Briefing July 19, 2013 2013 WHO Consolidated ARV GuidelinesSummary of Major Recommendations and Estimated Impact Gottfried Hirnschall, Director HIV Department, WHO

  2. ART Scale up : Progress Towards Global Targets WHO Global ART report, 2013

  3. Number of pregnant women living with HIV needing and receiving ARVs for PMTCT, 2005-2011 HIV+ pregnant women receiving ARVs for PMTCT HIV+ pregnant women needing ARVs for PMTCT 1,570,000 1,470,000 56% 14% (WHO, Global Report 2013)

  4. Number of children acquiring HIV infection in low- and middle-income countries, 1996-2012 No ARV prophylaxis for PMTCT Current ARV prophylaxis coverage for PMTCT 800,000 pediatric infections averted ~290,000 new pediatric infections 2012 2015 goal: 40,000 new pediatric infections 2015 (WHO, Global Report 2013)

  5. 01 | Results: The gap between adult and child ART coverage in 20 high burden countries is widening Source: Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS) and 2013 UNAIDS estimates.

  6. WHO 2013 Consolidated ARV Guidelines HOW TO DO IT? • Service delivery • Diagnostics • Drug supply WHAT TO DO? • When to start or switch • Which regimen to use • How to monitor • Co-infections & • co-morbidities Clinical Operational Simplification and consolidation across:- Continuum of HIV care- Ages and populations- Clinical, operational and programmatic guidance- Existing and new recommendations Guidance for Programme Managers HOW TO DECIDE? • Prioritization • Equity and ethics • Monitoring & Evaluation

  7. Treatment 2.0

  8. Key New Recommendations in 2013 WHO Guidelines Clinically relevant • Earlier initiation of ART (CD4 ≤ 500) • Immediate ART for children < 5 years • ART initiation for all pregnant and breastfeeding women (Option B/B+) and lifelong ART (Option B+) • Harmonization of ART across populations (e.g., adults and pregnant women) and age groups • Simplified, fewer, and less toxic 1st-line regimens (TDF/XTC/EFV) Operationally relevant • Use of Fixed Dose Combinations as a preferred approach • Improved patient monitoring to support better adherence and detect earlier treatment failure (increased use of VL) • Recommend task shifting, decentralization, and integration • Community based testing to complement broader HTC

  9. Summary of Changes in Recommendations When to Start in Adults

  10. Recommendations: CD4 Independent Conditions

  11. Rationale: Shift from Option A to B+ or B • Major issue now is not “when to start” or “what to start” but “whether to stop”

  12. Estimated impact on ART eligibility of implementing the new recommendations 2010 = 16.7 CD4 <350* 2013 = 25.9 on ART CD4 <500* <5y ** ** Number of people eligible for ART in low- and middle-income countries in million per WHO 2010 and 2013 ARV guidelines, based on end of 2012 epidemic situation ** only CD4>500, others included in adults * incl. co-infected with TB or HBV

  13. Estimated impact on incidence and deaths of implementing the new recommendations WHO Global ART report, 2013

  14. Estimated cost of implementing the new recommendations 10% increase of the 22-24 billion USD annually for full HIV response WHO Global ART report, 2013

  15. Global Update on HIV Treatment 2013: Key Findings and Messages 9.7 million on ART, 1.6 more than in 2011 15 by 15 is within reach In high burden countries, ART coverage varies from 30% to 90% Many countries do well, but some need intensified support 630 000 children on ART, only 64 000 more than in 2011 Child – adult coverage gap is widening, other key populations lag behind ARVs saved 4.2 million lives and prevented 800 000 child infections HIV treatment scale-up is paying off Eligibility increase from 17 to 26 m Mortality/ incidence decline by 1/3 Switching from 2010 to 2013 guidelines will enhance impact on lives & epidemic

  16. Next Steps • Global level • Launch of guidelines at IAS KL (30 June 2013) • Full guidelines • Short summaries in 6 UN languages + Portuguese • Regional level • Regional dissemination workshops • All regions planned for the next 3-6 months • UN and implementing partners support • Country level • Country adaptation • Policy and national guidelines updates • Implementation roll out

  17. Find the New 2013 WHO Consolidated ARV Guidelines on www.who.int/hiv

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