Yesterday, WHO issued an “early release guideline” on when to start antiretroviral therapy (ART) and on pre-exposure prophylaxis (PrEP) for HIV prevention. This document, titled “Consolidated Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a Public Health Approach,” is seminal, in that it recommends the provision of treatment to all people living with HIV (PLHIV) irrespective of their CD4 status. These recommendations not only simplify ART provision, but also revolutionize prevention by recommending PrEP for those at substantial risk of HIV infection.
All the estimated 37 million PLHIV are now eligible for treatment. Current treatment rates are estimated at just 41% for adults and 32% for children; universal ART is a substantial undertaking, which, if successfully implemented, has the potential to achieve the goal of ending the AIDS epidemic by 2030.
The major gap is knowledge of HIV status; an estimated 46% of PLHIV globally not to know their HIV status. This is a big barrier to treatment access and an impediment to achieving the UNAIDS 90-90-90 goal of ensuring that by 2020, 90% of all PLHIV know their HIV status; 90% of PLHIV are receiving ART; and of these, 90% are virologically suppressed. New WHO guidelines on HIV testing services released in July 2015 suggest ways in which testing can be scaled up.
If the most recent WHO guidance is adopted by the most affected countries, the major challenge to ending the AIDS epidemic will primarily be logistical. There will be a need to ensure that adequate drugs are available to treat PLHIV and that the supply chain management system minimizes stock outs for both HIV test kits and drugs. The major battleground will still remain sub-Saharan Africa, which bears the burden of almost 70% of the global HIV epidemic, and where adolescent girls and young women are especially disproportionately infected. HIV funding for this region needs to be scaled up if the 2030 goals are to be met.
We have come a long way from having only 3 million people on ART in 2008 to exceeding our 2015 target of 15 million on treatment. The time to double our efforts is now and get at least 90% of the 37 million PLHIV on treatment by 2020 as we continue promoting proven HIV prevention interventions. Only then can we really be on the road to making an AIDS-free generation a reality in our time!