The impact and cost of the 2013 WHO recommendations on eligibility for antiretroviral therapy.

OBJECTIVES: The present study presents estimates of the number of people who would become newly eligible for antiretroviral therapy if all countries adopted the 2013 WHO treatment guidelines. It also shows the cost and impact that would result if coverage expanded to 80% of those eligible. METHODS: The AIDS Impact Model (AIM) and the Goals model within the Spectrum modelling system were used for these estimates. Projections of costs and AIDS deaths are based on estimates for 116 low-income and middle-income countries. Projections of impact on HIV incidence are based on simulation modelling for 24 high burden countries, with the results scaled up to represent all low-income and middle-income countries. RESULTS: If the 2013 guidelines were adopted universally, the number eligible for treatment would rise to 28.6 million in 2013. Achieving 80% coverage would mean 28 million on antiretroviral therapy by 2025, and would avert 2.9 million deaths and 3.9 million new infections from 2013 to 2025 compared with the 2010 guidelines. CONCLUSION: The 2013 guidelines significantly expand the number eligible for treatment. Reaching those newly eligible will require additional resources, but is likely to produce significant benefits.

The 2013 WHO guidelines for antiretroviral therapy: evidence-based recommendations to face new epidemic realities.

PURPOSE OF REVIEW: The review summarizes the key new recommendations of the WHO 2013 guidelines for antiretroviral therapy and describes the potential impact of these recommendations on the HIV epidemic. RECENT FINDINGS: The 2013 WHO guidelines recommend earlier initiation of antiretroviral therapy (ART) at CD4 500 cells/µl or less for all adults and children above 5 years. Further recommendations include initiation of ART irrespective of CD4 cell count or clinical stage for people co-infected with active tuberculosis disease or hepatitis B virus with severe liver disease, pregnant women, people in serodiscordant partnerships, and children under 5 years of age. The ART regimen comprising a once daily fixed-dose combination of tenofovir + lamivudine (or emtricitabine) + efavirenz is recommended as the preferred first-line therapy. Several approaches are also recommended to reach more people and increase health service capacity, including community and self-testing, and task shifting, decentralization, and integration of ART care. SUMMARY: If fully implemented, the 2013 WHO ART guidelines could avert at least an additional 3 million deaths and prevent close to an additional 3.5 million new infections between 2012 and 2025 in low- and middle-income countries, compared with previous treatment guidelines.

Feasibility of buprenorphine and methadone maintenance programmes among users of home made opioids in Ukraine.

BACKGROUND: Opioid substitution therapy (OST) in the Ukraine was not provided until 2004. Methadone maintenance therapy only became available in May 2008. Injecting drug users in Ukraine are predominantly injecting self-made opioid solution ('Shirka'). A feasibility study on buprenorphine and methadone maintenance treatment was conducted in 2008. METHODS: A total of 331 opioid dependent patients were given buprenorphine (n=191) or methadone (n=140) as a substitute, and a survey of substance use, HIV transmission risks, and legal and social status was conducted at baseline and at six months follow-up. RESULTS: Illegal substance use, illegal activities, incomes and HIV related transmission risks were highly reduced, whereas employment rates and psychiatric problems improved. Retention was comparatively high among the patients in buprenorphine (84.8%) and in methadone maintenance treatment (85.0%) after six months of treatment. CONCLUSION: These data show the successful implementation of OST in the Ukraine among drug users who were predominantly injectors of self-made opioid solutions. Continuing scale-up of OST in the Ukraine is therefore both feasible and highly recommended.

Feasibility of buprenorphine maintenance therapy programs in the Ukraine: first promising treatment outcomes.

BACKGROUND: Opiate substitution therapy (OST) in the Ukraine was not provided until 2004. As part of the introduction of OST, the first feasibility study was conducted in 2007. Six clinics in 6 cities were involved in providing OST and collecting data. METHODS: A total of 151 opiate-dependent patients were given buprenorphine as a substitute, and a survey of substance use, HIV transmission risks, and legal and social status was conducted at baseline and at 6 and 12-month follow-up. RESULTS: Illegal substance use and illegal activities and incomes were highly reduced, whereas employment rates and psychiatric problems improved. Retention was comparatively high (79.5%) after 12 months. No significant adverse events were reported. CONCLUSION: A successful implementation of OST in the Ukraine is feasible.