The Eurasian Community for Access to Treatment (ECAT) has submitted a comprehensive set of recommendationsto the World Health Organization (WHO) for the upcoming update of the global HIV prevention and treatment guidelines. It is important to note that the previous consolidated guidelines were published in 2022.
The new proposals were collected based on consultations with experts, activists, community representatives, civil society organizations, and NGOs from the Eastern Europe and Central Asia (EECA) region. The full letter in English is attached for review.
Key Recommendations:
Long-acting injectable medications
ECAT urges WHO to prioritize recommendations related to long-acting injectables such as lenacapavir and cabotegravir, which can be used for both HIV treatment and prevention. These medications have the potential to improve adherence by reducing the frequency of drug administration.
Expanding information on alternative treatment regimens
According to feedback from ECAT partners in EECA countries, the widespread rollout of dolutegravir (DTG) in first- and second-line therapy has led to restricted access to other treatment options. Therefore, ECAT recommends that WHO provide more detailed guidance on the use of other integrase inhibitors (raltegravir, bictegravir) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) (doravirine), emphasizing the importance of individualized treatment selection.
DTG/TAF/FTC combination
The use of the dolutegravir/tenofovir alafenamide/emtricitabine (DTG/TAF/FTC) combination is increasing in the EECA region, despite its higher cost compared to alternative regimens. In light of clinical data indicating significant weight gain associated with DTG and TAF, ECAT requests that WHO develop a position statement assessing the clinical relevance of DTG/TAF/FTC compared to other regimens and summarizing its advantages and disadvantages.
Dolutegravir/Lamivudine dual therapy
Given the widespread use of the dolutegravir/lamivudine (DTG/3TC) dual therapy in clinical practice across several EECA countries, ECAT recommends that WHO either include it in the updated guidelines or clarify which additional data are needed for its formal inclusion.
Mental health
ECAT calls on WHO to expand and update the mental health section in the HIV guidelines. The proposed revision should incorporate the latest scientific data and address co-management of HIV and mental health conditions. Additionally, it should highlight coordination strategies between HIV services and mental health care providers, considering the specific regional context of EECA countries.
We hope that these recommendations will be taken into account, contributing to improved HIV response outcomes both in the EECA region and on a global scale.
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