ArticleSouthern African journal of HIV medicine2020
The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review.
Article in Southern African journal of HIV medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- HIV care cascade of adolescents and young adults in sub-Saharan Africa: a systematic review and meta-analysis.BMJ open · 2026Pooled it
- Lingering sex and age disparities in dolutegravir uptake among adults with HIV: a multicountry observational cohort study.BMJ global health · 2026Observational
- Impact of increasing CD4 count threshold eligibility for antiretroviral therapy initiation on advanced HIV disease and tuberculosis prevalence and incidence in South Africa: an interrupted time series analysis.BMJ global health · 2025Article
- Prediction of visceral leishmaniasis development in a highly exposed HIV cohort in Ethiopia based on Leishmania infection markers: results from the PreLeisH study.EBioMedicine · 2024Article
- Improving WHO's understanding of WHO guideline uptake and use in Member States: a scoping review.Health research policy and systems · 2022Article
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Abstract
backgroundDespite past and present global interventions, the human immunodeficiency virus (HIV) pandemic remains a public health problem in low- and middle-income countries (LMICs). The World Health Organization (WHO) has assisted these countries by providing antiretroviral therapy (ART) policies for adoption and adaptation to local needs.
objectivesThis article describes the response of countries in sub-Saharan Africa (SSA), to the WHO's changing CD4-threshold ART-initiation recommendations of the past two decades.
methodsRelevant articles published in international peer-reviewed journals were accessed via the following search engines: PubMed, Google Scholar, Cochrane, Embase and EBSCOhost. The study's inclusion criteria were articles published in the English language between 2000 and 2019 that highlighted changes to the CD4 ART-initiation threshold and that focused on the WHO's 'commencement of ART' policy guidelines. Sixteen studies (
resultsFour themes emerged: (1) adoption of the WHO CD4-ART-initiation policy by SSA countries, (2) timely implementation of the changing guideline initiation policy in the region, (3) barriers and facilitators encountered in the implementation of the changing guidelines and (4) description of similarities in policy implementation at country level from 2002 to 2019. Regional studies - cross-sectional, observational, retrospective, cost-effectiveness and randomised have described greater access to ART in SSA. However, barriers remain. The most common barriers to the timely implementation of 'new' ART-initiation guidelines were economic constraints, drug stock-outs, delays in obtaining baseline blood-test results and staff shortages.
conclusionAlthough countries in SSA have adopted the WHO-ART-CD4 initiation-threshold policy guidelines, implementation has seldom occurred in a timely manner. Barriers have been identified. Whilst a small number of countries have implemented recommendations promptly, for many, the barriers still require to be overcome.
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