On behalf of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), I would like to congratulate the World Health Organization (WHO) on the launch of the Consolidated ARV Guidelines. WHO has been a critical partner in the global AIDS response since PEPFAR’s launch 10 years ago, providing evidence based normative guidance to countries around the globe and allowing countries to take the bold steps needed to dramatically scale and improve the quality of HIV treatment programs.
On June 18, at PEPFAR’s 10th anniversary commemoration, Secretary of State John Kerry noted that 13 countries have reached the programmatic tipping point in their epidemics, with the annual number of new adult HIV infections falling below the annual increase in adults on ART. We also hit a historic milestone: In June, the millionth baby was born HIV –free thanks to PEPFAR support.
Without WHO guidelines holding the bar high, pushing for early initiation of treatment and better, less toxic regimens, we could not have come this far. The new consolidated guidelines will continue to propel us even closer to achieving an AIDS-free generation.
The guidelines are visionary as they close gaps between north and south, and promote quality and equity. We endorse the bold direction of the new guidelines and want to underscore the importance they hold for helping us address some of the most significant challenges we face in treatment and prevention.
First, we are all too familiar with the challenge of getting treatment to those in need while also retaining quality. Harmonizing ART regimens across different populations and age groups and moving towards a single preferred first-line regimen with a safer and more robust fixed-dose combination pill will simplify treatment and enable further decentralization of service delivery. This will result in increased efficiencies and, ultimately, major cost savings over time.
Second, we are not living up to high standards when it comes to pediatric treatment. Expanding ART eligibility to all children <5 years will simplify pediatric treatment and will help to address very low coverage of ART in children.
Third, we must stop the fall-out in the cascade of pregnant women seeking treatment, but not sticking with a regimen. Providing life-long ART to all pregnant and breastfeeding women irrespective of their immune status is critical for achieving the goal of eliminating HIV infection in children and saving the lives of mothers with HIV.
Fourth, it is critical that we strengthen durable viral suppression. Rational expansion of viral load monitoring will improve the quality of treatment for people living with HIV, prevent the development of HIV drug resistance and maximize efforts to prevent HIV transmission.
Finally, starting people on ART earlier (≤500 cells/mm³) will benefit their own health by preventing progression of disease and more advanced immune deficiency, and prevent end-organ damage. With effective viral suppression, this will also protect their partners and children from becoming infected.
PEPFAR looks forward to working with WHO, countries and other partners to ensure the rapid uptake and implementation of these game-changing recommendations.
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