New guidelines widen eligibility for HIV treatment

New guidelines for Human Immunodeficiency Virus (HIV) prevention, treatment and care have recommended placing anyone testing positive to the virus on treatment.

Called “test and treat”, they replace former guidelines which required persons testing positive for HIV to reach a threshold count for CD4 before they are placed on treatment.

Speaking at the North-West dissemination of the guidelines in Kaduna, health minister Isaac Adewole said everyone testing positive is “automatically eligible for treatment and this applies to everyone with equal emphasis—child, man and woman, pregnant or not.”

The document had been available since last year but was officially launched this March—and is being disseminated region by region across the country with support from the Management Sciences for Health (MSH).

The guidelines also make health workers duty bound to offer antiretroviral drugs as prevention to all persons who are at a high risk of contracting the virus, and anyone on treatment is entitled to a least one test of viral load a year.

Under it, approval is given for use of two alternative drugs—Dolutegravir and 400mg Efavirenz—as first-line medication in antiretroviral therapy.

In addition, it rules out a saga that is brewed concerning treatment of pregnant women with HIV—starting and stopping HIV medication in pregnant women (known as Option B) or continuing life-long medication (known as Option B+).

Araoye Segilola, a special adviser speaking on behalf of the health minister, said, “These guidelines couldn’t have come at a less opportunity moment; they will serve as the necessary catalyst for the attainment of the UNAIDS 90-90-90 initiative.”

The initiative aims to ensure every nine in 10 people know their HIV status, 90% of them are put on treatment, and viral load is suppressed among nine in 10 of them by 2020.

Experts say Nigeria’s previous protocol of using a CD4 count as threshold to initiate treatment was insufficient to meet the initiative, and was responsible for many dropping out of treatment or not following up.

Around 3.1 million are estimated to be HIV positive, and only some 860,000 are on treatment.

The US signed up to invest up to $469 million in HIV response in Nigeria for 2017, which could put additional 260,000 people on treatment.