Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach

2003 revision

These treatment guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by proposing a public health approach to achieve these goals. The key tenets of this approach are:

  • Scaling up of antiretroviral treatment programmes , with the objective of ‘universal access’, i.e. that all those who need it will have access to it;
  • Standardization and simplification of ARV regimens to support the efficient implementation of treatment programmes in resource-limited settings;
  • Ensuring that ARV treatment programmes are based on scientific evidence, in order to avoid the use of substandard treatment protocols which compromise the treatment outcome of individual clients and create the potential for emergence of drug resistant virus. However it is also important to consider the realities in terms of availability of human resources, health system infrastructure and the socio-economic context, in order to elaborate clear and realistic recommendations.

The topics addressed in these treatment guidelines include when to start ART, which antiretroviral regimens to start, reasons for changing ART, and what regimens to continue if treatment needs to be changed. It also addresses how treatment should be monitored, with specific reference to the side effects of ART, and makes specific recommendations for certain patient subgroups.