African and global researchers are looking for ways to achieve universal HIV/AIDS treatment on the African continent through effective implementation of the World Health Organisation’s 2016 "treat all” recommendation.

The researchers are meeting in Kigali for the International Epidemiology Databases to Evaluate AIDS (IeDEA), a two-day all-Africa regional meeting on HIV universal testing and treatment.

Hosted by Rwanda Military Hospital, Kanombe, the meeting attracted at least 150 investigators from sub-Saharan Africa, the US, France, and Switzerland to share knowledge and experience, and strengthen collaborations to develop research approaches to optimise the implementation of universal testing and treatment for HIV in the region.

Published in June 2016 by the World Health Organisation (WHO), the "treat all” recommendation states that ‘anyone infected with HIV should begin antiretroviral treatment as soon as possible.’

The WHO guideline includes service delivery recommendations on how to expand coverage of HIV treatment to reach all HIV-positive persons.

According to the experts, while many African countries have adopted some form of the recommendation, rigorous research to assess outcomes of this global effort, including its uptake and impact, is critical at this stage, along with research to identify and address major bottlenecks holding back effective implementation.

"Universal test-and-treat is critically important in ending the disease by reducing transmission and improving the lives of people living with HIV,” said Dr Diane Gashumba, the minister for health.

Research

Noting that there are challenges in implementing the model, she said there is a "critical need” for research as well as close collaboration between policy-makers, programme implementers, and affected communities to optimise the its implementation.

"Research on implementation strategies is key to our ability to optimise outcomes of decrease in transmission, improved health and ending the epidemic both in general communities and among more vulnerable populations,” Dr Gashumba said.

Mary-Ann Davies, an expert from IeDEA Southern Africa, said for the universal treatment to be effective, there needs to be strategies for retention of the patients that come into the treatment system. She also hinted on the importance of good drugs that are better at viral suppression.

Viral suppression is when ARVs reduce the viral load of HIV in a person’s body.

According to Dr Muhayimpundu Ribakare, the director of HIV/AIDS care and treatment at Rwandan Biomedical Centre, when a person’s viral load is reduced, the risk of spreading HIV to others is also reduced.

Challenge to treat-all strategy

Sharing Rwanda’s experience, Dr Ribakare told visiting experts that implementation of the treat-all recommendation calls for taking good decision on the strategies to use to implement it depending on the resources a country has.

Rwanda started the programme in June 2016 countrywide and now almost 83 per cent of the infected persons are on the anti-retro viral treatment. HIV prevalence in the country stands at around 3 per cent.

Praising the system’s achievements in reducing new infections as well as deaths, Ribakare warned fellow experts that there may be a challenge of identifying those who are infected to make them start on the treatment. For this, she called for new identification strategies.

"If you don’t put a really good strategy in place, at the end of the day, you will not treat all. This is because people will remain in their houses untested, and you will be at the clinic waiting for them. If they don’t come, of course, you will have a treat-all strategy but you will not have people to treat,” she said.

Lucy Wanjiku, an HIV-positive woman and the leader of the Positive Young Women Voices, from Kenya, urged the researchers and leaders to always involve the young people in policy making, as well as putting the documents in the language they understand as a way of taking forward the treat-all initiative.

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