Review of Global HIV Treatment Guidelines from 149 countries Please note that this is “under construction” and is a dynamic area — policies are changing and we do not have written policies for some countries — let us know if you see errors and/or there are newly published policies for the database

Objectives and methodology: “wiki strategy” Compare national ART guidelines for 149 countries with WHO 2013 guidelines Published guidelines from 110 countries and recommendations from 52 countries AIDSTAR-One database UNAIDS regional support team Web search Ministry of Health officials Recommendation on ART initiation criteria and monitoring for different target population abstracted Search end date: July 2015

ART initiation criteria ART initiation for asymptomatic people ART initiation criteria No. of Countries People with HIV (2014) Countries Irrespective of CD4 count 10 640,000 (2%) Australia, Brazil, British Columbia (Canada), France, Korea, Maldives, Mexico, the Netherlands, Papua (Indonesia), Spain, Thailand, US Consider for >500 7 136,000 (1%) Argentina, Austria, Germany, Greece, Guyana, Hong Kong, Italy ≤500 WHO recommendation 42 19,484,000 (53%) Algeria, Bangladesh, Bhutan, Bolivia, Burundi, Cambodia, Cameroon, Chile, Colombia, Democratic Republic of Congo, Ecuador, El Salvador, Fiji, Ethiopia, Gabon, Haiti, Honduras, Kenya, Lesotho, Mali, Madagascar, Malawi, Mauritania, Myanmar, Namibia, Nepal, Oman, Poland, Rwanda, South Africa, South Sudan, Sri Lanka, Sudan, Swaziland, Tanzania, Tunisia, Uganda, Uruguay, Venezuela, Viet Nam, Zambia, Zimbabwe ≤350 (consider for CD4 ≤ 500) 4 129,000 (<1%) Belize, Costa Rica, Finland, Guinea ≤350 34 8,072,000 (22%) Angola, Benin, Botswana, Britain, Burkina Faso, Canada, China, Cote d’Ivoire, Croatia,Djibouti, Dominican Republic, Ghana, Guatemala, India, Indonesia, Jamaica, Kazakhstan, Malaysia, Moldova, Morocco, Mozambique, Nicaragua, Niger, Nigeria, Norway, Panama, Papua New Guinea, Paraguay, Peru, Sierra Leone, Sweden, Switzerland, Ukraine ≤300 1 200 (<1%) Macedonia ≤200 (consider for CD4 ≤ 350) 6 56,500 (<1%) Afghanistan, Belarus, Cape Verde, Cuba, Estonia, Russia ≤200 218,000 (1%) Comoros, Lao PDR, Liberia, Pakistan, Philippines, Senegal 14 countries in red have reported new recommendations. Percentage represents proportion of 37 million people living with HIV (78% burden) Source: published policy

2003-05 2006-09 2010 2011 2012 2013 2014 2015 Source: published policy Consider at ≤500 and >500 Guyana Irrespective of CD4 count US Netherlands Irrespective of CD4 count Spain Thailand Papua (Indonesia) Mexico Irrespective of CD4 count Australia France Brazil Korea Irrespective of CD4 count Maldives Irrespective of CD4 count BC Canada Consider for >500 Italy ≤350 Burkina Faso Sweden Djibouti, Croatia Moldova, Niger, PNG, Nicaragua Portugal Sierra Leone Consider at >500 Argentina Austria Germany ≤500 Algeria Consider at ≤500 Guinea Consider at ≤500 Belize Consider at >500 Hong Kong Consider at >500 Greece 2003-05 2006-09 2010 2011 2012 2013 2014 2015 ≤ 200 ≤ 200 (200-350) ≤ 350 ≤ 500 ≤350 Ghana Morocco Nigeria Ukraine ≤500 Bolivia Chile Colombia DRC, Fiji Haiti Ecuador Ethiopia Honduras Madagascar Mali, Oman Rwanda Tunisia Uganda Zambia Zimbabwe ≤500 Bangladesh, Bhutan, Burundi, Cameroon, El Salvador, Gabon, Kenya, Malawi, Nepal, Lesotho, Sudan, Uruguay Mauritania, Poland, Myanmar Namibia, South Africa, South Sudan, Sri Lanka, Tanzania Venezuela ≤ 350 Angola Jamaica Kazakhstan Malaysia Panama Switzerland ≤200 (200-350) Cape Verde Estonia ≤200 (200-350) Afghanistan Belarus Cuba Russia ≤350 Botswana Benin China Guatemala Peru ≤500 Cambodia Swaziland Viet Nam ≤200 Pakistan Senegal ≤300 Macedonia US and Netherlands adopted ART for all in 2012 ≤200 Comoros Lao PDR Liberia Philippines Consider at ≤500 Costa Rica Finland ≤350 Britain, India Dominican Republic, Paraguay, Canada Cote d’Ivoire ≤350 Mozambique Indonesia Norway Source: published policy

ART initiation for asymptomatic people 2013 WHO Recommendation : CD4 count ≤ 500 cells/mm3 <200, <250 or <300 <350 <500 >500 Irrespective of CD4 count Source: published policy

ART initiation criteria in Africa 2013 WHO Recommendation : CD4 count ≤ 500 cells/mm3 <200 <350 <500 >500 Irrespective of CD4 count Source: published policy

ART initiation criteria Reported ART initiation criteria in 53 countries (missing written policy document) ART initiation criteria No. of Countries Countries Irrespective of CD4 count 3 Argentina, Belgium, Panama >500 2 Montenegro, New Zealand ≤500 21 Afghanistan, Angola, Antigua and Barbuda, Belize, Central African Republic, Chad, Costa Rica, Cuba, Dominica, Grenada, Guatemala, India, Liberia, Morocco, Romania, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Timor-Leste, Trinidad and Tobago, Yemen ≤350 25 Albania, Armenia, Bahamas, Barbados, British Virgin Islands, Bulgaria, Comoros, Cape Verde, Congo, Egypt, Equatorial Guinea, Eritrea, Gambia, Guinea- Bissau, Iran, Kyrgyzstan, Mauritius, Sao Tome, Senegal, Serbia, Seychelles, Somalia, Tajikistan, Togo, Turkmenistan ≤300 1 Uzbekistan ≤200 Suriname

ART initiation for asymptomatic people ART criteria Countries PLHIV (2014) Irrespective of CD4 count 13 783,000 (2%) Argentina, Australia, Belgium, Brazil, British Columbia (Canada), France, Korea, Maldives, Mexico, the Netherlands, Panama, Spain, Thailand, United States Consider for CD4 >500 8 10,000 (<0.1%) Austria, Germany, Greece, Guyana, Hong Kong, Italy, Montenegro, New Zealand, Europe ≤500 63 20,292,000 (55%) Afghanistan, Angola, Antigua and Barbuda, Algeria, Bangladesh, Belize, Bhutan, Bolivia, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Chile, Colombia, Costa Rica, Cuba, Democratic Republic of Congo, Dominica, Ecuador, El Salvador, Ethiopia, Fiji, Gabon, Grenada, Guatemala, Haiti, Honduras, India, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Morocco, Myanmar, Namibia, Nepal, Oman, Poland, Romania, Rwanda, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Timor-Leste, Trinidad and Tobago, Tunisia, Uganda, Uruguay, Venezuela, Yemen, Zambia, Zimbabwe ≤350 (consider for CD4 ≤ 500) 2 118,000 (0.3%) Finland, Guinea ≤350 54 8,182,000 (22%) Albania, Armenia, Bahamas, Barbados, Benin, Botswana, Britain, British Virgin Islands, Bulgaria, Burkina Faso, Canada, Cape Verde, China, Comoros, Congo, Cote d’Ivoire, Croatia, Djibouti, Dominican Republic, Egypt, Equatorial Guinea, Eritrea, Gambia, Ghana, Guinea- Bissau, Indonesia, Iran, Jamaica, Kazakhstan, Kyrgyzstan, Malaysia, Mauritius, Moldova, Niger, Mozambique, Nicaragua, Nigeria, Norway, Papua New Guinea, Paraguay, Peru, Portugal, Serbia, Sao Tome, Senegal, Seychelles, Sierra Leone, Somalia, Sweden, Switzerland, Tajikistan, Togo, Turkmenistan, Ukraine, Viet Nam ≤300 32,000 (0.1%) Macedonia, Uzbekistan ≤200 (consider for CD4 ≤ 350) 3 29,000 (0.1%) Belarus, Estonia, Russia ≤200 4 144,000 (0.4%) Lao PDR, Pakistan, Philippines, Suriname Countries in red are reported (80% burden) Source: published policy + reported

ART initiation for asymptomatic people 2013 WHO Recommendation : CD4 count ≤ 500 cells/mm3 <200, <250 or <300 <350 <500 >500 Irrespective of CD4 count Source: published policy + reported

ART initiation criteria in Africa 2013 WHO Recommendation : CD4 count ≤ 500 cells/mm3 <200 <350 <500 >500 Irrespective of CD4 count Source: published and reported policy

ART INITIATION CRITERIA Changes in ART policy following June 2013 WHO guidelines ART INITIATION CRITERIA NO. OF COUNTRIES COUNTRIES Irrespective of CD4 count 9 Australia, Brazil, France, Korea, Maldives, Panama, Spain, Thailand, Mexico <500 CD4 count 39 (40) Bangladesh, Bhutan, Bolivia, Burundi, Cambodia, Cameroon, Chile, Colombia, Democratic Republic of Congo, El Salvador, Ethiopia, Fiji, Gabon, Haiti, Honduras, Hong Kong, Kenya, Lesotho, Madagascar, Mali, Malawi, Mauritania, Myanmar, Namibia, Nepal, Oman, Poland, Rwanda, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Uganda, Uruguay, Venezuela, Zambia, Zimbabwe, (Tunisia) Reported move to <500 CD4 count 9 (11) Afghanistan, Angola, Belize, Central African Republic, India, Liberia, Morocco, Timor-Leste, Yemen, (Chad, Gabon) Planning to move to <500 CD4 count Botswana, British Virgin Islands, Comoros, El Salvador, Mauritius, Moldova, Nicaragua, Peru, Seychelles

ART eligibility criteria: before 2010 <500 <350 <250 <200 Not available In 24 countries Source: published policy + reported

ART : mid-2013 eligibility criteria <500 <350 <250 <200 Not available Source: published policy + reported

ART eligibility criteria: After July, 2013 <500 <350 <250 <200 Not available Reported (Angola) Source: published policy + reported

GDP per capita and ART coverage Low and middle-income countries Positive but low correlation between GDP per capita and ART coverage

National policy on task shifting Nurses can initiate ART and lay workers can provide ART adherence counselling Nurses can initiate ART Lay workers can provide ART adherence counselling Neither nurses can initiate ART nor lay workers can provide ART adherence counselling Source: MSF UNAIDS. Speed up scale-up: Strategies, tools and policies to get the best HIV treatment to more people, sooner

National policy on ARV drug dispensing Nurses can initiate ART and lay workers can provide ART adherence counselling Neither nurses can initiate ART nor lay workers can provide ART adherence counselling Lay workers can provide ART adherence counselling Nurses can initiate ART Source: MSF UNAIDS. Speed up scale-up: Strategies, tools and policies to get the best HIV treatment to more people, sooner

Task shifting and ARV drug dispensing Countries Nurses can initiate ART Lay workers can provide adherence counseling 2-3 month routine ARV refills for people in stable condition ARV dispensing at community level Zambia YES Kenya, Malawi, South Africa, Swaziland x Botswana, Central African Republic, Lesotho, Uganda, Zimbabwe Ethiopia Mozambique India, Tanzania Guinea Brazil, Cameroon, China, Democratic Republic of Congo, Namibia, Nigeria, Ukraine Myanmar Source: MSF UNAIDS. Speed up scale-up: Strategies, tools and policies to get the best HIV treatment to more people, sooner

ART eligibility criteria for children below age of 5 2013 WHO Recommendation : Irrespective of CD4 count Of the 110 countries with guidelines, 79 countries (96% burden) have recommendations on paediatric ART ART initiation criteria for children <5 vary considerably Of the 79 countries, 33 (57% global paediatric burden) are consistent with WHO 2013 guidelines Afghanistan, Angola and India reported guideline change to provide ART to all children below 5

ART INITIATION CRITERIA ART eligibility criteria for children <5 years WHO 2013 Guidelines: ART irrespective of CD4 count ART INITIATION CRITERIA NUMBER CHILDREN WITH HIV COUNTRIES Irrespective of CD4 count for children <5 33 1,491,000 (57%) Bangladesh, Bhutan, Burundi, Cambodia, Cameroon, China, Colombia, Democratic Republic of Congo, El Salvador, Fiji, Gabon, Honduras, Indonesia, Kenya, Lesotho, Mali, Malawi, Maldives, Mauritania, Mozambique, Myanmar, Namibia, Nepal, Oman, Rwanda, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe Irrespective of CD4 count for children <2 16 489,000 (19%) Algeria, Argentina, Benin, Botswana, Cote d’Ivoire, Ghana, Guyana, Haiti, India, Kazakhstan, Morocco, Nigeria, Panama, Papua New Guinea, Venezuela, Viet Nam Irrespective of CD4 count for children <1 19 166,000 (7%) Angola, Brazil, Burkina Faso, Chile, Costa Rica, Dominican Republic, Ethiopia, Finland, Guatemala, Hong Kong, Madagascar, Mexico, Paraguay, Sri Lanka, Sweden, Thailand, Tunisia, United States, Uruguay Conditional (clinical prerequisites) 11 20,200 (1%) Afghanistan, Cape Verde, Comoros, Djibouti, Guinea, Lao PDR, Liberia, Malaysia, Peru, Sierra Leone, Ukraine Source: published policy

ART eligibility criteria for children <5 years WHO 2013 Guidelines: ART irrespective of CD4 count Clinical prerequisites ART for all children <1 ART for all children <2 ART for all children <5 ART for all children <10 ART for all children <15 Source: published policy

Cote d’Ivoire, Haiti, India ART eligibility criteria for children <5 years Children <2 Guyana Children <15 Zambia Uganda Children <15 Namibia Children <15 Tanzania Children <1 Brazil Burkina Faso Sweden Children <5 Rwanda Children <5 China Children <10 Kenya 2004-05 2006-09 2010 2011 2012 2013 2014 2015 Pre-requisites <2 years <5 years Pre-requisites Cape Verde Pre-requisites Afghanistan Comoros Djibouti Lao PDR Liberia Malaysia Peru Sierra Leone Ukraine Children <2 Algeria Ghana Morocco Nigeria Children <2 Kazakhstan Panama Viet Nam Children <2 Argentina Benin Botswana Papua New Guinea Tanzania Children <5 Bangladesh Bhutan, Sudan Burundi Cameroon El Salvador Indonesia Gabon, Malawi Lesotho, Nepal Mauritania Mozambique Myanmar South Sudan Children <5 Colombia DRC Fiji Honduras Mali Oman South Africa Zimbabwe Children <5 Cambodia Maldives Swaziland Children <2 Cote d’Ivoire, Haiti, India Children <1 Angola Paraguay Children <1 Ethiopia Guatemala Children <2 Venezuela Children <1 Costa Rica Finland Mexico Sri Lanka Thailand US, Uruguay Children <1 Chile Dominican Republic Hong Kong Madagascar Tunisia Pre-requisites Guinea Source: published policy

ART INITIATION CRITERIA ART initiation for people with HIV and TB 2013 WHO Recommendation : Irrespective of CD4 count ART INITIATION CRITERIA COUNTRIES Irrespective of CD4 count 83 Argentina, Algeria, Australia, Bangladesh, Belize, Benin, Bhutan, Bolivia, Botswana, Brazil, Britain, Burundi, Cambodia, Cameroon, Canada, Chile, China, Colombia, Costa Rica, Croatia, Democratic Republic of Congo, Dominican Republic, Ecuador, El Salvador, Ethiopia, France, Fiji, Finland, Gabon, Ghana, Greece, Guatemala, Guyana, Haiti, Honduras, Hong Kong, India, Indonesia, Italy, Jamaica, Kenya, Korea, Lesotho, Madagascar, Malawi, Maldives, Mali, Mauritania, Mexico, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, Nigeria, Norway, Oman, Panama, Papua New Guinea, Paraguay, Peru, Poland, Portugal, Rwanda, South Africa, Spain, Sri Lanka, South Sudan, Sudan, Swaziland, Switzerland, Tanzania, Thailand, Tunisia, Uganda, United States, Ukraine, Uruguay, Venezuela, Viet Nam, Zambia, Zimbabwe ≤350 20 Afghanistan, Angola, Austria, Burkina Faso, Cote d’Ivoire, Cuba, Djibouti, Germany, Guinea, Kazakhstan, Lao PDR, Liberia, Malaysia, Moldova, Nicaragua, Niger, Pakistan, Philippines, Sierra Leone, Sweden ≤300 1 Macedonia ≤200 6 Belarus, Cape Verde, Comoros, Estonia, Russia, Senegal Source: published policy

ART INITIATION CRITERIA ART initiation for pregnant women 2013 WHO Recommendation : Irrespective of CD4 count ART INITIATION CRITERIA NO. OF COUNTRIES COUNTRIES Option B+ 71 Algeria, Argentina, Australia, Austria, Bangladesh, Benin, Bhutan, Bolivia, Brazil, Burundi, Cambodia, Cameroon, Chile, Costa Rica, Croatia, Democratic Republic of Congo, Dominican Republic, Ecuador, El Salvador, Ethiopia, France, Fiji, Finland, Gabon, Germany, Greece, Ghana, Guatemala, Haiti, Honduras, India, Indonesia, Italy, Kenya, Korea, Lesotho, Madagascar, Malawi, Maldives, Mali, Mauritania, Mexico, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, Nicaragua, Norway, Papua New Guinea, Paraguay, Peru, Poland, Rwanda, Spain, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Switzerland, Uganda, United States, Uruguay, Venezuela, Tanzania, Thailand, Tunisia, Zambia, Zimbabwe ≤500 3 Colombia, Hong Kong (China), Oman ≤350 25 Angola, Afghanistan, Belize, Botswana, Britain, Burkina Faso, Canada, China, Cote d’Ivoire, Djibouti, Guinea, Guyana, Jamaica, Kazakhstan, Liberia, Malaysia, Moldova, Niger, Nigeria, Panama, Portugal, Sierra Leone, Sweden, Ukraine, Viet Nam ≤300 1 Macedonia ≤200 (consider for ≤350) 4 Belarus, Cape Verde, Estonia, Russia ≤200 6 Comoros, Cuba, Lao PDR, Pakistan, Philippines, Senegal Source: published policy

ART INITIATION CRITERIA ART initiation for serodiscordant couples 2013 WHO Recommendation : Irrespective of CD4 count ART INITIATION CRITERIA NO. OF COUNTRIES COUNTRIES Irrespective of CD4 count 56 Algeria, Australia, Austria, Bangladesh, Benin, Bhutan, Bolivia, Brazil, Burundi, Cambodia, Cameroon, Canada, Chile, China, Costa Rica, Democratic Republic of Congo, Ecuador, El Salvador, France, Fiji, Gabon, Germany, Haiti, Honduras, Hong Kong, Indonesia, Italy, Kenya, Korea, Lesotho, Madagascar, Maldives, Mali, Mauritania, Mexico, Myanmar, Namibia, Nepal, Netherlands, Oman, Poland, Rwanda, Spain, Sri Lanka, South Sudan, Sudan, Swaziland, United States, Uganda, Uruguay, Tanzania, Thailand, Tunisia, Venezuela, Zambia, Zimbabwe >500 1 Argentina >350 3 Britain, Nigeria, Norway HIV+ partner of pregnant or breastfeeding women Mozambique Source: published policy

ART INITIATION CRITERIA ART initiation for people with Hepatitis B 2013 WHO Recommendation : Irrespective of CD4 count ART INITIATION CRITERIA NO. OF COUNTRIES COUNTRIES Irrespective of CD4 count 75 Algeria, Angola, Argentina, Australia, Austria, Bangladesh, Belize, Bhutan, Brazil, Burundi, Cambodia, Cameroon, Chile, China, Costa Rica, Croatia, Cuba, Democratic Republic of Congo, Dominican Republic, Ecuador, El Salvador, France, Fiji, Finland, Gabon, Germany, Greece, Guatemala, Haiti, Honduras, Hong Kong, India, Indonesia, Italy, Jamaica, Kenya, Lesotho, Madagascar, Malawi, Maldives, Mali, Malaysia, Mauritania, Mexico, Morocco, Mozambique, Myanmar, Namibia, Nepal, Netherlands, Nicaragua, Nigeria, Norway, Papua New Guinea, Paraguay, Peru, Poland, Rwanda, South Korea, Spain, Sri Lanka, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Thailand, Tunisia, Uganda, Ukraine, United States, Uruguay, Venezuela, Zambia, Zimbabwe <500 3 Britain, Portugal, Switzerland Same as eligibility 32 Afghanistan, Belarus, Benin, Bolivia, Botswana, Burkina Faso, Canada, Cape Verde, Colombia, Comoros, Cote d’Ivoire, Djibouti, Ethiopia, Ghana, Guinea, Guyana, Kazakhstan, Lao PDR, Liberia, Macedonia, Moldova, Niger, Oman, Pakistan, Panama, Philippines, Russia, Senegal, Sierra Leone, Sweden, Viet Nam Source: published policy

TEST AND TREAT (ART IRRESPECTIVE OF CD4 COUNT) FOR KEY POPULATIONS ART initiation criteria for key populations 2013 WHO Recommendation : CD4 count <500 cells/mm3 COUNTRY TEST AND TREAT (ART IRRESPECTIVE OF CD4 COUNT) FOR KEY POPULATIONS Austria and Germany Men who have sex with men (MSM) Burundi MSM, sex workers Cameroon MSM, sex workers, injecting drug users Indonesia Myanmar MSM, female sex workers, injecting drug users, transgender Rwanda Tanzania MSM, sex workers, injecting drug users, prisoners Sri Lanka MSM, female sex workers, injecting drug users, drug users, beach boys, prisoners Uganda Fisher folks, sex workers, truckers Source: published policy

ART initiation criteria for key populations No recommendation specific for KP Irrespective of CD4 count for KP Irrespective of CD4 count for all, including KP Source: published policy KP: Key populations

Frequency of CD4 monitoring (55 countries) NUMBER COUNTRIES Month 1; 3-monthly thereafter 1 Madagascar Every 3 months Ukraine Every 3-monthly for 1 year; 6-monthly thereafter China Every 3-4 months 2 Malaysia, Sierra Leone Every 3-6 months 4 Angola, Argentina, Colombia, Pakistan Month 3 and 6; 6-monthly thereafter Botswana, Burkina Faso Month 3; 6-monthly thereafter Nigeria Month 3; every 4-6 months thereafter Chile Every 4-6 months Dominican Republic, Mexico 6-monthly (WHO recommendation) 28 Benin, Brazil, Burundi, Cambodia, Cote d'Ivoire, Democratic Republic of Congo, Ecuador, Ethiopia, Guatemala, Guinea, Haiti, India, Indonesia, Lesotho, Mali, Mozambique, Nepal, Myanmar, Niger, Papua New Guinea, Peru, Rwanda, South Sudan, Sudan, Tanzania, Viet Nam, Zambia, Zimbabwe Every 6-12 months Venezuela Month 6; yearly thereafter Ghana No routine CD4 ART monitoring 8 Cameroon, Kenya, Malawi, Namibia, South Africa, Swaziland, Thailand, Uganda No recommendation Morocco, Senegal Source: MSF Issue Brief: Achieving undetectable: what questions remain in scaling-up HIV virologic treatment monitoring?

Viral Load for ART monitoring (55 countries) RECOMMENDATION NUMBER COUNTRIES Routine viral load for ART monitoring (WHO recommendation) 47 Angola, Argentina, Benin, Botswana, Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, Chile, China, Colombia, Cote d'Ivoire, Democratic Republic of Congo, Dominican Republic, Ecuador, Ghana, Guatemala, Guinea, Indonesia, Kenya, Lesotho, Madagascar, Malawi, Malaysia, Mali, Mexico, Mozambique, Namibia, Nepal, Niger, Nigeria, Pakistan, Papua New Guinea, Peru, Rwanda, Sierra Leone, South Africa, Sudan, Swaziland, Tanzania, Thailand, Uganda, Ukraine, Venezuela, Viet Nam, Zambia Targeted viral load monitoring 6 Haiti, India, Morocco, Myanmar, South Sudan, Zimbabwe Not recommended 1 Ethiopia No recommendation Senegal Source: MSF Issue Brief: Achieving undetectable: what questions remain in scaling-up HIV virologic treatment monitoring?

MONTH AFTER ART INITIATION Frequency of VL monitoring (47 countries) MONTH AFTER ART INITIATION Month 1 Month 3 Month 6 Month 9 Month 12 Month 18 Month 24 Post the last VL test Angola, Burundi, Dominican Republic, Ecuador, Guatemala, Malaysia, Mali, Niger, Nigeria, Pakistan, Papua New Guinea, Venezuela, Viet Nam ✔ 6-monthly Argentina, Colombia 3-6 monthly Ukraine Botswana, Brazil, Chile, Mexico, Peru, Sierra Leone Thailand Yearly Benin, Burkina Faso, Cameroon, China, Cote d’Ivoire, Democratic Republic of Congo, Ghana, Kenya, Indonesia, Lesotho, Madagascar, Mozambique, Namibia, Nepal, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia Guinea, Rwanda Malawi Biennially Cambodia VL – viral load Source: MSF Issue Brief: Achieving undetectable: what questions remain in scaling-up HIV virologic treatment monitoring?

Viral Load for ART monitoring (55 countries) Recommended and widely available Recommended (availability unknown) Recommended with limited availability Recommended only for monitoring treatment failure Not recommended No recommendation (limited availability) Source: MSF Issue Brief: Achieving undetectable: what questions remain in scaling-up HIV virologic treatment monitoring?

Early Infant Diagnosis (within 2 months of birth) Colombia, South Africa Mexico Chile Morocco Argentina, Malaysia Guatemala, Ukraine, Thailand Rwanda, Swaziland, Zambia Angola, Botswana, Cambodia, Democratic Republic of Congo, Indonesia, Mali, Myanmar, Peru, Tanzania, South Sudan, Viet Nam (WHO recommendation) Brazil, Haiti, Mozambique, Venezuela Benin, Burkina Faso, Burundi, Cameroon, China, Dominican Republic, Ethiopia, Ghana, Guinea, India, Kenya, Lesotho, Malawi, Namibia, Nepal, Papua New Guinea, Uganda, Zimbabwe Weeks 1 2 3 4 5 6 7 8 In 2013, the % of HIV-exposed infants receiving a virological test within 2 months of birth was <30% in countries in red and >70% in countries in bold (source: UNAIDS GARPR 2014).

Limitations Guidelines may be outdated and/or in the process of being updated Written policies may not reflect programme implementation or clinical practice Other guidelines covering ART, task shifting, drug dispensing may exist

Conclusion Guidelines from 6 countries released before 2013 recommend ART for asymptomatic people at CD4 ≤ 500 or earlier USA, Netherlands, France, Brazil, Australia, Korea, Spain, Maldives, Mexico and Thailand recommend test and treat Only 33 countries are consistent with WHO paediatric ART recommendation Post 2013 WHO guidelines, countries are revising/ planning to revise national guidelines

IAPAC Global ART guidelines database Link: http://www.hivpolicywatch.org/ http://www.globalhivpolicywatch.org/ Please send new and/or updated guidelines to: Reuben Granich MD MPH Vice President and Chief Technical Advisor, IAPAC E-mail: rgranich@iapac.org