HIV Management Guidelines Launched

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The Ministry of Health has for the first time developed local guidelines aimed at providing comprehensive clinical guidance for physicians and other health care providers in the prevention and treatment of HIV in Barbados.

In the past, physicians and health care providers relied on regional and international guidance for the clinical management of HIV.

The new document, officially launched on Friday, January 22, while based on guidance from the World Health Organization (WHO), is built on experience at the country level.

Its focus is the management of HIV in children, adolescents and adults; management of common opportunistic infections; management of HIV infection in pregnant women; and management of HIV post-exposure prophylaxis.

Health Minister John Boyce, speaking at the launch of the publication, reported that studies conducted by the Ministry and The University of the West Indies, revealed that there had been dramatic declines in HIV-related deaths in Barbados, as well as declining rates of new cases. This was largely due, he said, to antiretroviral therapy (ART), introduced in Barbados in 2002.

The Ministry of Health is currently in the process of expanding the use of ART, adopting the 2013 World Health Organization criteria for the initiation of treatment. This change will see the criteria to start ART in a person with HIV moving from a CD4 count of 350 or less to a CD4 count of 500 or less.

The Ministry of Health notes that recent findings from clinical trials have confirmed that the early and expanded use of antiretroviral treatment saves lives by keeping people with HIV healthier, and by reducing the risk that they will transmit the virus to partners. Last September, this confirmation led the WHO to recommend that all people living with HIV start ART as soon as possible after diagnosis.

Mr. Boyce disclosed that during 2016, the Ministry will eventually move towards the new WHO ???treat all??? approach, in which all persons with HIV should be offered lifelong therapy, irrespective of their CD4 count.

Meanwhile, the Ministry is encouraging all clinicians in Barbados to utilise the new guidelines as a point of reference for the provision of high quality treatment and care.

The Health Minister noted: ???These guidelines seek to standardise HIV care; expand access to treatment; and enhance the efficiency and effectiveness of our efforts, while allowing for sustainability of our national HIV response.???

He said the guidelines will be critical in helping Barbados to achieve the UNAIDS 90-90-90 targets by 2030. These targets are that 90 per cent of all people living with HIV know their HIV status; that 90 per cent of all people with diagnosed HIV infection receive sustained antiretroviral therapy; and that 90 per cent of all people receiving antiretroviral therapy are virally suppressed.

The guidelines represent the current state of knowledge regarding the use of antiretroviral therapy. The Ministry notes however that because medical and public health science of HIV is rapidly evolving, the availability of new drugs and new evidence may change therapeutic options and interventions based on the public health approach to HIV.

The guidelines were developed through extensive stakeholder collaboration, including many of the persons involved in the national HIV programme, as well as key partners such as the Pan American Health Organization.

An important contribution was made by the United States Government through the President???s Emergency Plan for AIDS Relief (PEPFAR), which provided technical and financial assistance towards the publication of the guidelines.

Charge d???Affaires at the United States Embassy, Laura Griesmer, who was presented with a copy of the guidelines by Mr. Boyce, said the US Government was thrilled to contribute to the publication, and she hoped the guidelines would be a model for other countries in the region.

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