Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries

Thomas C Scheier; Nabila Youssouf; Mosepele Mosepele; Cecilia Kanyama; Olukemi Adekanmbi; Sulaiman Lakoh; Conrad K Muzoora; Graeme Meintjes; Dominik Mertz; John W Eikelboom; Sean Wasserman

doi:10.1186/s12981-023-00581-5

Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries

AIDS Res Ther. 2023 Nov 23;20(1):83. doi: 10.1186/s12981-023-00581-5.

Authors

Thomas C Scheier¹, Nabila Youssouf², Mosepele Mosepele², Cecilia Kanyama³, Olukemi Adekanmbi⁴, Sulaiman Lakoh⁵, Conrad K Muzoora⁶, Graeme Meintjes^{7

8}, Dominik Mertz^{1

9

10}, John W Eikelboom¹, Sean Wasserman^{11

12}

Affiliations

¹ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
² Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
³ University of North Carolina Project-Malawi, Lilongwe, Malawi.
⁴ Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁵ College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
⁶ Department of Internal Medicine Faculty of Medicine Mbarara, University of Science and Technology Mbarara, Mbarara, Uganda.
⁷ Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
⁸ Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁹ Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹¹ Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. swasserm@sgul.ac.uk.
¹² Institute for Infection and Immunity, St George's, University of London, London, UK. swasserm@sgul.ac.uk.

Abstract

Background: The World Health Organization (WHO) recommends an evidence-based package of care to reduce mortality and morbidity among people with advanced HIV disease (AHD). Adoption of these recommendations by national guidelines in sub-Saharan Africa is poorly documented. We aimed to review national guidelines for AHD management across six selected countries in sub-Saharan Africa for benchmarking against the 2021 WHO recommendations.

Methods: We reviewed national guidelines from six countries participating in an ongoing randomized controlled trial recruiting people with AHD. We extracted information addressing 18 items of AHD diagnosis and management across the following domains: [1] Definition of AHD, [2] Screening, [3] Prophylaxis, [4] Supportive care, and [5] HIV treatment. Data from national guideline documents were compared to the 2021 WHO consolidated guidelines on HIV and an agreement score was produced to evaluate extent of guideline adoption.

Results: The distribution of categories of agreement varied for the national documents. Four of the six countries addressed all 18 items (Malawi, Nigeria, Sierra Leone, Uganda). Overall agreement with the WHO 2021 guidelines ranged from 9 to 15.5 out of 18 possible points: Malawi 15.5 points, Nigeria, and Sierra Leone 14.5 points, South Africa 13.5 points, Uganda 13.0 points and Botswana with 9.0 points. Most inconsistencies were reported for the delay of antiretroviral therapy (ART) in presence of opportunistic diseases. None of the six national guidelines aligned with WHO recommendations around ART timing in patients with tuberculosis. Agreement correlated with the year of publication of the national guideline.

Conclusion: National guidelines addressing the care of advanced HIV disease in sub-Saharan Africa are available. Besides optimal timing for start of ART in presence of tuberculosis, most national recommendations are in line with the 2021 WHO standards.

Keywords: Advanced HIV disease; REVIVE trial; Standard of care; Sub-Saharan Africa; WHO.

Publication types

Review
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Longitudinal Studies
South Africa
Standard of Care
Tuberculosis* / drug therapy
Tuberculosis* / epidemiology
Tuberculosis* / prevention & control

Abstract

Publication types

MeSH terms

Grants and funding