Original Research

When will sub-Saharan Africa adopt HIV treatment for all?

Somya Gupta, Reuben Granich
Southern African Journal of HIV Medicine | Vol 17, No 1 | a459 | DOI: https://doi.org/10.4102/sajhivmed.v17i1.459 | © 2016 Somya Gupta, Reuben Granich | This work is licensed under CC Attribution 4.0
Submitted: 14 January 2016 | Published: 31 August 2016

About the author(s)

Somya Gupta, International Association of Providers of AIDS Care, New Delhi, India
Reuben Granich, International Association of Providers of AIDS Care, Washington DC, United States


Background: The World Health Organization (WHO) HIV treatment guidelines have been used by various countries to revise their national guidelines. Our study discusses the national policy response to the HIV epidemic in sub-Saharan Africa and quantifies delays in adopting the WHO guidelines published in 2009, 2013 and 2015.

Methods: From the Internet, health authorities and experts, and community members, we collected 59 published HIV guidelines from 33 countries in the sub-Saharan African region, and abstracted dates of publication and antiretroviral therapy (ART) eligibility criteria. For these 33 countries, representing 97% regional HIV burden in 2015, the number of months taken to adopt the WHO 2009, 2013 and/or 2015 guidelines were calculated to determine the average delay in months needed to publish revised national guidelines.

Findings: Of the 33 countries, 3 (6% regional burden) are recommending ART according to the WHO 2015 guidelines (irrespective of CD4 count); 19 (65% regional burden) are recommending ART according to the WHO 2013 guidelines (CD4 count ≤ 500 cells/mm3); and 11 (26% regional burden) according to the WHO 2009 guidelines (CD4 count ≤ 350 cells/mm3). The average time lag to WHO 2009 guidelines adoption in 33 countries was 24 (range 3–56) months. The 22 that have adopted the WHO 2013 guidelines took an average of 10 (range 0–36) months, whilst the three countries that adopted the WHO 2015 guidelines took an average of 8 (range 7–9) months.

Conclusion: There is an urgent need to shorten the time lag in adopting and implementing the new WHO guidelines recommending ‘treatment for all’ to achieve the 90-90-90 targets.


Treatment for all; time lag; WHO guidelines; policy adoption


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Crossref Citations

1. HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries
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PLOS Medicine  vol: 15  issue: 3  first page: e1002534  year: 2018  
doi: 10.1371/journal.pmed.1002534