Despite great progress in making treatment available globally, HIV continues to take a devastating toll on health, with 37 million people infected and 1.2 million deaths worldwide in 2015.
Now, a team of researchers from Boston University School of Public Health (BUSPH) is on the forefront of a policy change that could save more lives by demonstrating that immediate initiation of antiretroviral therapy (ART), on the day of HIV diagnosis, results in better health outcomes.
“With so many more people eligible for ART under the World Health Organization’s (WHO’s) 2015 guidelines, which recommended that all people with HIV be on treatment, regardless of disease stage, finding ways to get them started on medications quickly, without long waits or multiple clinic visits, is essential,” said Dr. Sydney Rosen, a research professor of global health at BUSPH whose study in South Africa influenced the July 2017 WHO recommendation for same-day initiation.
In releasing the recommendations this summer for rapid initiation of HIV treatment, WHO cited the study led by BUSPH, dubbed “RapIT” for Rapid Initiation of Treatment, as one of the main sources of evidence in favor of immediate initiation of ART.
In September 2016, South Africa followed the WHO’s guidelines to “treat all” — removing the CD4-count thresholds that dictated who could receive ART. However, based on experiences of patients in rural South Africa, researchers have predicted that fewer than one in four newly eligible patients will initiate ART within six months of testing positive.
Merely eliminating CD4 count treatment thresholds for all HIV patients without expanding HIV testing and care, however, is unlikely to lead to a critical mass of people with HIV starting ART, according to a recent analysis in South Africa. BUSPH researchers have recommended additional interventions and improvements to initiation strategies.