Updated recommendations on service delivery for the treatment and care of people living with HIV

    Publication year: 2021

    WHO promotes a public health approach to programming and delivering antiretroviral therapy (ART), which has enabled access to treatment and care for people living with HIV to be scaled up in resource-limited settings. The 2016 WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection include a chapter that provides several recommendations for delivering HIV services across the cascade of care from HIV testing to long-term viral suppression.

    These guidelines update provide updated recommendations and good practice statements in the following areas:

    starting ART, including initiating treatment outside the clinic and support for same-day ART start; frequency of clinical visits and ART refills; measuring adherence; tracing and re-engagement in care; psychosocial support for adolescents living with HIV; task sharing for diagnostic services; and service integration. These guidelines were developed in accordance with procedures established by the WHO Guidelines Review Committee. The recommendations in the guidelines are based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to reviewing evidence and formulating recommendations. The primary audience for these guidelines is national HIV programme managers and policy-makers in low- and middle-income countries. These updated guidelines will be a useful resource for clinicians and should help to shape the priorities of policy-makers in development agencies, international organizations, nongovernmental organizations and other implementing partners. These guidelines will also be of value to people living with HIV, communities and civil society organizations that will need to be engaged meaningfully to support their successful implementation. These recommendations are intended to encourage continued improvements in access to ART, simplify care delivery for providers and end users and support return to care for those who have disengaged. Implementing these recommendations within the overall public health approach is anticipated to support further reductions in the number of people acquiring HIV and the number of people getting sick and dying from HIV-associated causes. The recommendations developed for these and other relevant guidelines developed since 2016 will be integrated with the updated consolidated HIV guidelines in 2021. Many individuals contributed to the development of these guidelines including people living with HIV and representatives from affected communities, from ministry of health, researchers, implementers, and health care providers. WHO would like to acknowledge and thank the numerous contributors to these guidelines that were developed during the COVID-19 pandemic and will continue to engage with the global HIV community and Member States to ensure the continuity and quality of care for people living with HIV during and beyond the COVID-19 pandemic.