Implications of new WHO HIV treatment recommendations on treatment coverage in Latin America (LA)
L. Martin1, O. Sued2, B. Gomez2, M.D. Perez-Rosales2, M. Vila2, R. Mazin2, H. Gottfried2
1PAHO. Carlo Schmid Program Fellow, Washington, United States, 2Pan American Health Organization, FCH-HI, Washington, United States
Background: The 2009 WHO guidelines recommend earlier initiation of antiretroviral therapy (ART) by raising the threshold for initiating ART from < 200 CD4/mm3 to < 350 CD4/mm3. In addition, the delivery of more patient-friendly antiretroviral drugs (ARVs) is advised. While in other regions of the world (e.g. Sub Saharan Africa) these changes will have dramatic effects on the number of people needing treatment, health service capacities and drug procurement, the impact on Latin America is less clear.
Methods: An assessment of the implications of the WHO recommendations in LA was conducted analyzing the current national guidelines (NG) in 16 countries. Additional information was collected through a survey completed by 15 PAHO-HIV-Country representatives and stakeholder groups.
Results: Ten out of 16 NG (Argentina, Bolivia, Brazil, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama and Paraguay) already recommend the new CD4 criteria (< 350/mm3); 3/16 NG consider, without strictly indicating, ART with CD4 counts < 350/mm3 (Venezuela, Ecuador, Peru). In 2/16 NG ART eligibility is defined as CD4 < 200 cells/mm3 (Colombia, Chile) and 1/16 (Uruguay) uses CD4 counts < 250/mm3. Due to its high costs tenofovir and tenofovir fixed dose combinations are not considered as first line drugs in 10/16 NG. Protease inhibitors are considered as first line option in 9/16 countries. No monitoring mechanisms of NG implementations were defined in 8/15 countries. Low adherence to the recommended regimens was reported in some countries.
Conclusions: In comparison to other regions, the new WHO guidelines will not have a significant impact on treatment eligibility in Latin America as the majority of countries already adopted the threshold < 350 CD4/mm3. However, costing implications and capacity building issues could arise as tenofovir based backbones become increasingly part of standard first-line regimens in LA. Mechanisms need to be defined to monitor guideline implementations.
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