Currently, fewer than 5% of persons needing ARV drugs in resource-limited settings have access to these medicines. WHO believes that at least three million people needing care should be able to obtain them by 2005. This would represent an increase of more than tenfold.
These guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by means of a public health approach, the key tenets of which are:
1) scaling up antiretroviral treatment programmes to meet the needs of people living with HIV/AIDS in resource-limited settings;
2) standardization and simplification of ARV regimens to support the efficient implementation of treatment programmes;
3) ensuring that ARV treatment programmes are based on the best scientific evidence, in order to avoid the use of substandard treatment protocols that compromise the outcome of treatment in individual clients and create the potential for the emergence of drug-resistant virus.
While it is hoped that this document will be useful to clinicians in resource-limited settings, it is intended primarily for use by treatment advisory boards, national AIDS programme managers and other senior policy-makers involved in the planning of national and international HIV care strategies in these settings. The guidelines serve as a framework for selecting the most potent and feasible antiretroviral regimens as part of expanded national responses. The framework aims to standardize and simplify ART, as has happened with TB treatment in national TB control programmes, while acknowledging the relative complexity of HIV treatment. Accordingly, options for first-line and second-line regimens are presented, bearing in mind the needs of health systems that often lack sophisticated manpower and monitoring facilities, without compromising the quality and outcomes of the treatments offered.
The topics addressed in these guidelines include ART, which ARV regimens to start, reasons for changing ART, and which regimens to continue if treatment needs to be changed. Also considered is the way in which treatment should be monitored, with particular reference to the side-effects of ART, and specific recommendations are made for certain subgroups of patients