In July 2019, the World Health Organization released the policy brief on HIV treatment building up on the July 2018 technical update.
This version of the Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection provides simplified guidance on the
country’s transition plan, the continued approach that positively affects the continuum of HIV care, while adding to innovative
methods that will reduce transmission rates and increase life span for those on treatment. This is all to further accelerate efforts to
meet the ambitious 2020 Fast-Track 90–90–90 treatment target: ensuring that 90% of the people living with HIV know their HIV status;
90% of the people living with HIV who know their HIV status are accessing treatment; and 90% of people living with HIV who are
receiving treatment have suppressed viral load, thereby achieving major reductions in the number of people dying from HIV-related
causes and the reducing the number of newly HIV infected people.
Besides the recommendation to provide lifelong antiretroviral therapy to all HIV infected populations regardless of CD4 cell count and
WHO clinical staging, these guidelines present several recommendations, including Universal routine HIV Testing, counselling and
treatment in all public and private health facilities in Zambia. This approach gives a window to provide prioritized HIV testing and
immediate treatment and care to all of those at substantial risk of HIV acquisition but do not leave out those who never had an HIV
test done recently. Furthermore, individuals who are tested HIV positive will have their sample tested for recency HIV in order to
determine whether they are recently infected or long-term HIV. This will accelerate our strides towards HIV epidemic control.
Additionally, these guidelines provide the use of better and safer antiretroviral agents such as Darunavir-ritonavir (DRV-r) as part of
second line HIV treatment whilst emphasizing the use of newer agents like Dolutegravir (DTG), Tenofovir alafenamide (TAF), and
Efavirenz-400mg (EFV), and how to transition patients who are on the older regimens.
Our 2020 guidelines have also adopted the use of a fixed dose combination of Tenofovir alafenamide, Emtricitabine and Dolutegravir
(TafED) to treat HIV positive children aged 6 years and above, and weighing 25kg or more. In order to manage our patients better,
these guidelines also recommend resistance testing after Enhanced Adherence Counselling (EAC) in those who are unsuppressed.
Importantly, there has been introduction of Darunavir-ritonavir (DRV-r) dosed as 800mg/100mg, as a part of the Second-Line regimen
for adults. These guidelines also highlight the management of patients failing Second-Line ART with third-line ART, who should be
managed at higher-level health facilities called Advanced Treatment Centres (ATCs). All of the recommendations have been adopted
because of their anticipated public health effect.
Several significant recommendations from the previous guidelines remain a priority, namely providing lifelong ART regardless of CD4
cell count and WHO clinical staging, to all populations, and moving toward viral load testing as the preferred means of monitoring
people on ART. Newer developments aim to complement and improve the service delivery of HIV services to our population.
Importantly, in the guidance WHO emphasizes the need for differentiated approaches to care for people who are stable on ART, such
as reducing the frequency of clinic visits and community ART distribution. Such efficiencies are essential if countries with a high
burden of HIV infection are to manage their growing numbers of people receiving ART and reduce the burden on people receiving
treatment and on health facilities.
There will be continued concerted efforts required toward implementing these guidelines at district and health facility levels; the 2020
Consolidated Guidelines represent an important step toward achieving the goal of universal access to ARV drugs, treating and
preventing HIV, and ultimately ending the HIV epidemic by 2030.