Recently, the World Health Organization (WHO) revised their HIV treatment guidelines and made two new key recommendations:
1. Every person infected with HIV should be given antiretroviral treatment (ART). This is a change from 2013 when the WHO recommended ART to people with compromised immune systems (i.e., a CD4 count of 500 cells/mm3 or less) and vulnerable populations such as children and pregnant women.
2. Pre-exposure prophylaxis or PrEP is recommended as a preventative measure to all persons at substantial risk of acquiring HIV.
This update is based on unequivocal evidence demonstrating that early HIV treatment reduces morbidity, mortality and secondary HIV transmission. Research on the effectiveness of PrEP is also definitive, with many studies having shown that it can reduce the risk of HIV infection by more than 90% when taken as prescribed.
The new guidelines will help to ensure that national standards of HIV prevention and treatment keep pace with important scientific developments. Under the guidelines revision, the number of persons eligible for HIV treatment globally will increase significantly. The new guidelines are an important step towards achieving the ambitious UNAIDS 90-90-90 targets for 2020.
National recommendations for immediate ART initiation have been in place for the last few years in the US. With the launch of Governor Cuomo’s three-point plan to end the epidemic in New York State by the end of 2020, the state has embarked on an ambitious plan to lower the number of new infections and increase uptake of HIV primary care and ART medications, as well as PrEP.
Among persons receiving HIV medical care in 2013, eHIVQual data from 187 clinics in the NYS HIV Quality of Care Program, an average of 91% of patients were prescribed ART1. However, there is a long way to go, since the recently revised statewide HIV care cascades show that only 70,000 of 129,000 persons living with HIV (PLWH) (55%) have achieved viral suppression.
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1Clinic mean score