Reflections from IPPF

By Anupam Pathni, Programme Officer – HIV and AIDS (IPPF South Asia Regional Office)

The World Health Organization (WHO) regularly releases updated clinical guidelines on the use of antiretroviral (ARV) drugs for adults and adolescents, and for maternal and child health. For the first time ever, WHO undertook a process of developing a set of consolidated guidelines that go beyond incorporating updated clinical guidance (‘what to do’), to include operational (‘how to do’) and programmatic (‘how to decide what to do, where and when’) guidance to help each country make the best decisions on the use of ARVs in their own context.

IPPF was involved as a civil society representative in the operational and service delivery guideline development group (GDG), and participated in the GDG meeting on 6-8 November 2012 in Geneva. Systematic and GRADE reviews of the operational issues being considered were presented. Participants reviewed risk/benefit tables and discussed various recommendations, covering the following topics: community based HIV testing and counselling, task shifting for ART, decentralization of HIV treatment, strategies for improving treatment adherence, integration of ART and HIV in TB treatment settings and vice versa, and integration of ART and HIV care in MNCH and opiate maintenance treatment settings. Based on the deliberations at this meeting and other similar meetings, the guidelines were updated and were launched at the end of June 2013.

These new guidelines have the potential to transform HIV responses in countries and to boost efforts to achieve ‘Universal Access’ targets. Though none of the IPPF Member Associations (MAs) in the South Asia Region are currently providing ART to their clients, all of the MAs play a very important role in supporting the efforts of their national governments in this area. While implementing community HIV testing and counselling strategies, it will be important for MAs to ensure adherence to rights-based principles beyond ensuring linkages with the continuum of care for those who are diagnosed HIV-positive. In tandem with the promotion of community-based HIV testing and counselling, IPPF needs to continue advocating for enabling environments to help treatment adherence, for example by advocating against punitive laws.

Provision of services cannot happen in isolation and needs to be balanced with community mobilization and context-specific demand creation strategies, which is one of the strengths of our MAs. The new WHO guidelines recommend task shifting and decentralization of HIV treatment and our MAs could leverage opportunities under their national programmes to ensure ART provision within their own facilities, or at the community level. A cross-cutting issue that needs to be addressed would be the implementation of efficient referral systems and linkages to support community-based HIV testing and counselling, decentralization, and integration of services.

Provision of services related to antiretroviral therapy by IPPF Member Associations

A total of 22 IPPF Member Associations reported providing ART-related services in 2012. In 2012, there was a large increase in the number of services provided, as well as facilitated referrals. This increase was largely due to increased ART service provision in Cambodia, Dominican Republic, Ethiopia, Indonesia, Sierra Leone, Sudan, and Togo; and referrals in India and Tanzania.

Download the full issue of the IPPF HIV Update newsletter: http://ippf.org/resource/HIV-Update-Antiretroviral-therapy