WHO consultation on technical and operational recommendations for scale-up of laboratory services and monitoring HIV antiretroviral therapy in resource-limited settings

ISBN 92 4 159368 7

Despite the progressive increase in access to HIV antiretroviral (ARV) drugs in countries with limited resources promoted by the 3 by 5 initiative, WHO recognizes that the current limitations on laboratory capacity in resource poor settings can be an important barrier in the way of reaching the planned treatment target. WHO, as stated in its global HIV ART guidelines for resource-limited settings, will work together with the international community and countries to improve the laboratory infrastructure at local and regional levels so as to permit uniform availability of HIV and CD4 testing, wider availability of automated haemoglobin and chemistry testing, and national availability of viral load (VL) testing, while the capacity for HIV drug resistance testing (HIVDR) should be available at regional level. Given current local realities and future scenarios, this will require choosing uniform, simplified and cost-effective methodologies at the country level and ensuring supplies of reagents and the maintenance of equipment.

The aim of the consultation was to obtain clear and realistic guidelines as to which diagnostic and monitoring schedules were optimal and how they could be delivered in order to assist decision-making on treatment and facilitate the implementation of strategies and necessary actions for scaling up diagnosis and monitoring at the local, regional and global levels, with particular emphasis on resource-constrained settings. It was required that the resulting recommendations would provide useful tools for the rational implementation of scaling-up processes, taking into consideration variations between developing countries in human resources, health structures and socioeconomic contexts.