Policy and guidance documents

Southern Africa Treatment Access Movement (SATAMo)
Treatment Barometer. A survey of treatment provision to People Living with HIV in Southern Africa.2008

As part of efforts to hold SADC governments accountable to the commitments they have made towards universal access to treatment, the Southern African Treatment Access Movement (SATAMo) conducted a survey of progress in the provision of ARV and OI treatment programmes in the region. Findings from the audit will be used for advocacy at national and regional levels. This project was initiated during the SATAMo strategic planning workshop, which took place in South Africa from 28 April to 02 May 2008. Activists realised that despite numerous promises made by national and regional leaders, there was insufficient progress towards universal access to treatment in most countries in Southern Africa. Further, there were few coordinated efforts to monitor and press governments to fulfil their pledges. The Treatment Barometer was developed as a tool to monitor implementation of HIV-related treatment programs.

According to this report issued by WHO, UNAIDS and UNICEF, some 3 million people now have access to antiretroviral therapy. The report notes that one million people started on treatment last year alone, which represents an increase of around 46.5% from the previous year. Its findings also show that 2007 saw improved access to drugs to prevent mother to child transmission of HIV, expanded testing and counselling, and greater commitment to male circumcision in some of the more heavily affected regions of sub-Saharan Africa.

This publication is intended to serve as a reference tool for countries with limited resources as they develop or revise national guidelines for the use of ART in adults and postpubertal adolescents. The material presented takes updated evidence into account, including new ART treatment options, and draws on the experience of established ART scale-up programmes.

This document responds to growing need at country level for basic operational guidance on provider-initiated HIV testing and counselling in health facilities. It is intended for a wide audience including policy-makers, HIV/AIDS programme planners and coordinators, health-care providers, non-governmental organizations providing HIV/AIDS services and civil society groups.

Best Practice and Guidelines

WHO
Use of antiretroviral drugs for treating pregnant women and preventing HIV Infection in infants. 2009

The availability of a significant amount of new evidence on ARV prophylaxis to prevent MTCT, as well as new information on optimal timing for ART initiation (treatment eligibility) warrants development of revised 2009 guidelines. Particularly important is the evidence indicating the benefits of starting ARV prophylaxis for PMTCT earlier during pregnancy, and new data indicating that extended ARV prophylaxis to mothers or infants is effective in substantially decreasing the risk of HIV transmission through breastfeeding. Revision of the  guidelines provides an important
opportunity to simplify and standardize current recommendations, and to provide updated normative guidance for more effective PMTCT interventions in both resource-limited settings and globally.

WHO
Antiretroviral therapy for HIV infection in adults and adolescents. 2009

The guideline continues to follow the principles of a public health approach, aiming to optimize outcomes, including
the quality of life and survival, of people living with HIV and to act as a reference tool for countries to adopt and adapt according to their national circumstances. WHO recommendations on infant feeding and HIV were last revised in 2006. Significant programmatic experience and research evidence regarding HIV and infant feeding have accumulated since then. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This has major implications for how women living with HIV might choose to feed their infants, and how health workers should counsel mothers when making these choices WHO has now reviewed newevidence around safety and efficacy of antiretroviral therapy (ARV) for pregnat women eligible for treatment and ARV prophylactic regimens.

WHO
HIV and infant feeding. Revised principles and recommendations. 2009

WHO recommendations on infant feeding and HIV were last revised in 2006. Significant programmatic experience and research evidence regarding HIV and infant feeding have accumulated since then. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This has major implications for how women living with HIV might choose to feed their infants, and how health workers should counsel mothers when making these choices.

WHO
New WHO Guidelines on Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infections in Infants. 2006

This document is one of a trilogy of guidelines published at the same time which provide recommendations developed by WHO and its partners in support of the public health approach to antiretroviral therapy (ART) in resource  constrained settings It contains recommendations for the use of ARV drugs in pregnant women for their own health and for preventing HIV infection in infants and young children, and a summary of the scientific rationale for the recommendations. In particular, the publication aims to provide guidance to assist national ministries of health in the provision of ART for pregnant women with indications for treatment, and in the selection of ARV prophylaxis regimens to be included in programmes to prevent mother-to-child transmission (MTCT), taking into account the needs and constraints on health systems in various settings.

WHO
New WHO Guidelines on Antiretroviral Therapy of HIV Infection in Infants and Children. 2006

Important aspects highlighted in the revised guidelines include the following:

• how to establish diagnosis of HIV in infants and children
• when to commence ART
• ARV drug toxicity
• strategies when first- and secondline treatments fail considerations for nutrition/ malnutrition and ART
• clinical and laboratory monitor
• ART adherence and drug resistance

WHO convened an expert meeting to review the scientific evidence and programmatic data available, in order to develop guidance for national programmes, regulatory authorities and implementing partners on selection, prioritization and planning for second-line ARV drugs.

USAID/The Acquire Knowledge
Acquiring Knowledge. Applying Lessons Learned to Strengthen FP/RH Services. Integrating Family Planning with AntiretroviralTherapy Services in Uganda. 2007

In Sub-Saharan Africa, HIV affects women disproportionately, particularly young women. In many of the worst-hit countries of the region, 10% to 30% of pregnant women are HIV-positive (UNAIDS). Family planning (FP) can help ease the burden of HIV and limit new occurrences of HIV infection by decreasing unintended and unwanted pregnancies in HIV-positive women, thereby preventing the transmission of HIV from mother to child.