WHO 'Treat All' Recommendation for HIV Widely Implemented

The World Health Organization "Treat All" strategy for antiretroviral treatment (ART) initiation among patients living with HIV was the standard of care at almost all International epidemiology Databases to Evaluate AIDS (IeDEA) sites by mid-2017, according to a study published in the July issue of the Journal of the International AIDS Society.

Ellen Brazier, from City University of New York in New York City, and colleagues surveyed 201 of 221 adult HIV treatment sites (June and December 2017) that participate in the global IeDEA research consortium to assess the status of the Treat All implementation across regions, countries, and levels of the health care delivery system.

The researchers found that the vast majority of sites (93 percent) reported that they had begun implementing Treat All. There were no statistically significant differences observed in site-level Treat All introduction by health facility type, urban or rural location, public or private sector, or country income level. A median time of one month was noted between national policy adoption and site-level introduction. Even in countries where Treat All was not yet adopted in national guidelines, 69 percent of sites reported initiating all patients on ART, regardless of clinical criteria. More than three-quarters of sites (77 percent) reported typically initiating patients on ART within 14 days of confirming diagnosis. In East, Southern, and West Africa, 60 to 62 percent of sites reported same-day ART initiation for most patients.

"Many of the sites that are initiating patients on antiretroviral therapy do not have adequate resources to monitor key patient outcomes through viral load testing, including treatment failure or the development of drug resistance," a coauthor said in a statement. "This is an issue that requires urgent attention, as it is critical to assess and optimize longer term HIV care outcomes in the Treat All era."

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