Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries
Abstract Introduction The World Health Organization (WHO) has published guidelines for the management of patients with advanced HIV disease (AHD) but mortality remains high. Adoption of WHO recommendations by national guidelines is poorly documented. We aimed to extend our prior review of six nation...
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2025-03-01
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| Online Access: | https://doi.org/10.1186/s12981-025-00733-9 |
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| author | Thomas C. Scheier Tafese Beyene Tufa Torsten Feldt Yasmine Hardy Albert Minga Raoul Moh Albertino Damasceno Lucia Chambal Francine Ntoumi Carine Kades Leopold Bitunguhari Osee R. Sebatunzi Marco Missanga Katanekwa Njekwa Monde Muyoyeta Sumathy Rangarajan Graeme Meintjes Dominik Mertz John W. Eikelboom Sean Wasserman |
| author_facet | Thomas C. Scheier Tafese Beyene Tufa Torsten Feldt Yasmine Hardy Albert Minga Raoul Moh Albertino Damasceno Lucia Chambal Francine Ntoumi Carine Kades Leopold Bitunguhari Osee R. Sebatunzi Marco Missanga Katanekwa Njekwa Monde Muyoyeta Sumathy Rangarajan Graeme Meintjes Dominik Mertz John W. Eikelboom Sean Wasserman |
| author_sort | Thomas C. Scheier |
| collection | DOAJ |
| description | Abstract Introduction The World Health Organization (WHO) has published guidelines for the management of patients with advanced HIV disease (AHD) but mortality remains high. Adoption of WHO recommendations by national guidelines is poorly documented. We aimed to extend our prior review of six national management guidelines by including additional countries from sub-Saharan Africa. Methods We identified guidelines of eight additional countries participating in a multicountry trial of azithromycin prophylaxis for AHD. Data was extracted in five domains including definition of AHD (1 item), screening (6 items), prophylaxis (6 items), supportive care (1 items), and HIV treatment (4 items) and scored agreement of each national guideline with the WHO guidelines. Results Six of the eight national guidelines had a designated section for AHD. Compared with the WHO guideline, the agreement score for national guidelines was between 7 and 17 out of 18, whereby disagreement is mainly driven by missing information. None of the national guidelines had more than three items not in agreement with the WHO guidelines, and the maximum number of items not addressed by any one guideline was eight. Main areas of disagreement were the targeted population for start of ART in presence of tuberculosis meningitis (1/8 in agreement) and urine lipoarabinomannan screening (2/8 in agreement). The targeted population group for cotrimoxazole prophylaxis and its discontinuation was in line with the WHO recommendations in 3/8 national guidelines. Except one guideline, all documents showed similar overall agreement, irrespectively of publication date. Conclusion National guidelines for the management of people with AHD are broadly in agreement with WHO guidelines. Main areas of disagreement are recommendations regarding urine lipoarabinomannan screening, cotrimoxazole prophylaxis and start of antiretroviral therapy in presence of tuberculosis. |
| format | Article |
| id | doaj-art-0a2d6e78e2ba4add80582ab07c1be25b |
| institution | Kabale University |
| issn | 1742-6405 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
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| series | AIDS Research and Therapy |
| spelling | doaj-art-0a2d6e78e2ba4add80582ab07c1be25b2025-08-20T03:40:50ZengBMCAIDS Research and Therapy1742-64052025-03-0122111010.1186/s12981-025-00733-9Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countriesThomas C. Scheier0Tafese Beyene Tufa1Torsten Feldt2Yasmine Hardy3Albert Minga4Raoul Moh5Albertino Damasceno6Lucia Chambal7Francine Ntoumi8Carine Kades9Leopold Bitunguhari10Osee R. Sebatunzi11Marco Missanga12Katanekwa Njekwa13Monde Muyoyeta14Sumathy Rangarajan15Graeme Meintjes16Dominik Mertz17John W. Eikelboom18Sean Wasserman19Population Health Research Institute, McMaster University and Hamilton Health SciencesAsella Referral and Teaching Hospital, College of Health Sciences, Arsi UniversityHirsch Institute of Tropical Medicine (HITM), Heinrich-Heine UniversityDirectorate of Medicine, Komfo Anokye Teaching HospitalCentre Médical de Suivi des Donneurs de Sang (CMSDS-CNTSCI)Programme PAC-CI, Site ANRS de Côte d’IvoireFaculty of Medicine, Eduardo Mondlane UniversityFaculty of Medicine, Eduardo Mondlane UniversityFondation Congolaise pour la Recherche MédicaleFondation Congolaise pour la Recherche MédicaleDepartment of Internal Medicine, University Teaching Hospital of KigaliDepartment of Internal Medicine, University Teaching Hospital of KigaliNIMR-Mbeya Medical Research CenterCenter for Infectious Disease Research in Zambia (CIDRZ)Center for Infectious Disease Research in Zambia (CIDRZ)Population Health Research Institute, McMaster University and Hamilton Health SciencesWellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, ObservatoryPopulation Health Research Institute, McMaster University and Hamilton Health SciencesPopulation Health Research Institute, McMaster University and Hamilton Health SciencesWellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, ObservatoryAbstract Introduction The World Health Organization (WHO) has published guidelines for the management of patients with advanced HIV disease (AHD) but mortality remains high. Adoption of WHO recommendations by national guidelines is poorly documented. We aimed to extend our prior review of six national management guidelines by including additional countries from sub-Saharan Africa. Methods We identified guidelines of eight additional countries participating in a multicountry trial of azithromycin prophylaxis for AHD. Data was extracted in five domains including definition of AHD (1 item), screening (6 items), prophylaxis (6 items), supportive care (1 items), and HIV treatment (4 items) and scored agreement of each national guideline with the WHO guidelines. Results Six of the eight national guidelines had a designated section for AHD. Compared with the WHO guideline, the agreement score for national guidelines was between 7 and 17 out of 18, whereby disagreement is mainly driven by missing information. None of the national guidelines had more than three items not in agreement with the WHO guidelines, and the maximum number of items not addressed by any one guideline was eight. Main areas of disagreement were the targeted population for start of ART in presence of tuberculosis meningitis (1/8 in agreement) and urine lipoarabinomannan screening (2/8 in agreement). The targeted population group for cotrimoxazole prophylaxis and its discontinuation was in line with the WHO recommendations in 3/8 national guidelines. Except one guideline, all documents showed similar overall agreement, irrespectively of publication date. Conclusion National guidelines for the management of people with AHD are broadly in agreement with WHO guidelines. Main areas of disagreement are recommendations regarding urine lipoarabinomannan screening, cotrimoxazole prophylaxis and start of antiretroviral therapy in presence of tuberculosis.https://doi.org/10.1186/s12981-025-00733-9Advanced HIV diseaseGuidelinesSub-Saharan AfricaAntiretroviral therapy |
| spellingShingle | Thomas C. Scheier Tafese Beyene Tufa Torsten Feldt Yasmine Hardy Albert Minga Raoul Moh Albertino Damasceno Lucia Chambal Francine Ntoumi Carine Kades Leopold Bitunguhari Osee R. Sebatunzi Marco Missanga Katanekwa Njekwa Monde Muyoyeta Sumathy Rangarajan Graeme Meintjes Dominik Mertz John W. Eikelboom Sean Wasserman Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries AIDS Research and Therapy Advanced HIV disease Guidelines Sub-Saharan Africa Antiretroviral therapy |
| title | Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries |
| title_full | Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries |
| title_fullStr | Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries |
| title_full_unstemmed | Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries |
| title_short | Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries—an extension study of eight countries |
| title_sort | standard of care in advanced hiv disease review of hiv treatment guidelines in sub saharan african countries an extension study of eight countries |
| topic | Advanced HIV disease Guidelines Sub-Saharan Africa Antiretroviral therapy |
| url | https://doi.org/10.1186/s12981-025-00733-9 |
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