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Local guidelines frequently predate the release of the WHO’s Acknowledgements
guidelines as local bodies require less administration/
bureaucracy and can respond to new data in real time, for Competing interests
example, UTT and the Insight-Start and the Temprano The authors declare no conflict of interest. The funders had
Studies, dolutegravir in first-line ART and the ADVANCE no role in the design of the study; in the collection, analyses
27
Trial, etc. Mehraj et al. noted that Canada implemented the or interpretation of data; in the writing of the manuscript or
2002 WHO and ART guidelines 2 months before its general in the decision to publish the results.
28
release. Canada had all the required capacity with regard to
resources and regular staff trainings as well as mentoring in Authors’ contributions
implementing the guidelines. Within a space of 1 month after
the release of the 2015 WHO and ART initiation guidelines, S.M.G. and M.J.C. conceptualised the study. S.M.G. did
60% of the facilities in Spain were already implementing literature searches, analysis, writing and compilation of
29
rapid ART initiation. This suggests that Spain had already manuscript. M.J.C. supervised the processes, reading all
started preparing for the changes based on EACS guidelines. versions. Both authors have read and approved the final article.
Larsen et al. revealed that despite significant funding from
PEPFAR, the South African National Department of Health Funding information
is still failing to implement rapid ART initiation. Indeed This research was funded by the University of KwaZulu-
most SSA countries have experienced fundings cuts in the Natal through a PhD studentship bursary awarded to SMG
past few years. 30 by the College of Health Sciences.

There is a worrisome trend in SSA countries concerning the
national adoption of the WHO-ART initiation guidelines. Data availability statement
This may explain why countries in SSA are still struggling Data sharing is not applicable to this article as no new data
to achieve the 90-90-90 target. Despite the increase in HIV were created or analysed in this study.
testing, rapid ART initiation based on the 2015 WHO
guidelines are yet to be achieved in SSA. Furthermore, Disclaimer
there is need for African governments to seriously consider
local situations and experiences when embracing global The views and opinions expressed in this article are those of
guidelines. the authors and do not necessarily reflect the official policy or
position of any affiliated agency of the authors.
Limitations References
One of the limitations of our study is that we reviewed
data from SSA and possibly excluded some important 1. Pell C, Reis R, Dlamini N, Moyer E, Vernooij E. ‘Then her neighbour will not know
her status’: How health providers advocate antiretroviral therapy under
articles published in languages other than English. The universal test and treat. Int Health. 2019;11(1):36–41. https://doi.org/10.1093/
study included only articles focusing on CD4 threshold inthealth/ihy058
changes on ART initiation. More articles might have been 2. World Health Organization. Consolidated guidelines on the use of antiretroviral
drugs for treating and preventing HIV infection: Recommendations for a public
captured if language and the CD4 threshold had not been health approach. Geneva: World Health Organization; 2016.
a filter. 3. Beck EJ, Vitoria M, Mandalia S, Crowley S, Gilks CF, Souteyrand Y. National adult
antiretroviral therapy guidelines in resource-limited countries: Concordance with
2003 WHO guidelines? AIDS (London, England). 2006;20(11):1497–1502. https://
doi.org/10.1097/01.aids.0000237365.18747.13
Conclusion 4. WHO Guidelines Approved by the Guidelines Review Committee. WHO
recommendations on the diagnosis of HIV infection in infants and children.
We conclude that although countries in SSA have generally Geneva: World Health Organization; 2010.
adopted the WHO-ART guidelines, implementation has 5. Walensky RP, Wood R, Ciaranello AL, et al. Scaling up the 2010 World Health
Organization HIV treatment guidelines in resource-limited settings: A model-
frequently been delayed. We noted that the changes based analysis. PLoS Med. 2010;7(12):e1000382. https://doi.org/10.1371/journal.
in guidelines were fraught with many challenges like pmed.1000382
3
switching from treating at a CD4 count of 200 cells/mm in 6. Hsieh AC, Mburu G, Garner AB, et al. Community and service provider views to
inform the 2013 WHO consolidated antiretroviral guidelines: Key findings and
2002 to rapid ART initiation in 2015 regardless of the CD4 lessons learnt. AIDS (London, England). 2014;28(Suppl 2):S205–S216. https://doi.
org/10.1097/QAD.0000000000000251
level. Implementation has been variable across the countries 7. Kuznik A, Iliyasu G, Habib AG, Musa BM, Kambugu A, Lamorde M. Initiation of
of SSA because of differences in the health systems and the antiretroviral therapy based on the 2015 WHO guidelines. AIDS (London, England).
2016;30(18):2865–2873. https://doi.org/10.1097/QAD.0000000000001251
availability of resources. Because of the financial burden on 8. Danel C, Moh R, Gabillard D, et al. A trial of early antiretrovirals and isoniazid
governments, the reduction in donor funding, the rising preventive therapy in Africa. N Engl J Med. 2015;373(9):808–822. https://doi.
incidence and prevalence of HIV and sometimes and org/10.1056/NEJMoa1507198
the attitudes of healthcare workers, the majority of SSA 9. Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early
asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807. https://doi.
countries have experienced a delay in the implementation org/10.1056/NEJMoa1506816
of the guidelines. A comprehensive approach to reduce 10. Perriat D, Balzer L, Hayes R, et al. Comparative assessment of five trials of universal
HIV testing and treatment in sub-Saharan Africa. J Int AIDS Soc. 2018;21(1):e25048.
barriers whilst enhancing facilitators may improve the https://doi.org/10.1002/jia2.25048
situation of adopting and implementing timely ART initiation 11. Nash D, Yotebieng M, Sohn AH. Treating all people living with HIV in sub-Saharan
Africa: A new era calling for new approaches. J Virus Eradic. 2018;4(Suppl 2):1–4.
guidelines. https://doi.org/10.1016/S2055-6640(20)30340-X
http://www.sajhivmed.org.za 229 Open Access