“Treat all” policy to ensure universal access to ARVs in Belarus
Following the approval of new HIV clinical protocols by the Ministry of Health of Belarus in June 2017, the “Treat all” policy will be implemented from 1 January 2018, ensuring access to antiretrovirals (ARVs) for all people living with HIV (PLHIV) in Belarus. All ARV regimens are aligned with the WHO consolidated guidelines issued in 2016, including the use of Efavirenz (EFV) during pregnancy, around which there was major discussion throughout the process.
In recent years, Belarus has made tangible progress in ensuring availability and quality of treatment for PLHIV. To increase coverage with antiretroviral therapy (ART), secure a sustainable supply of medications and prevent stocks-outs, the government has gradually been increasing its share in procurement of ARVs, reaching 72% in 2016. It established local production, including of a fixed dose combination of the WHO preferred first-line regimen (TDF/FTC/EFV) in 2016.
While these efforts led to a significant increase in the number of PLHIV who receive ART, as of 1 January 2017 this figure only reached 50% of the 17 260 PLHIV with known diagnosis. The WHO 2015 recommendations to treat all PLHIV regardless of their CD4 cell count, and the ambitious global, regional and country targets on achieving high coverage with HIV testing and successful treatment accelerated the optimization of ART regimens and the revision of national clinical protocols. Key elements of this achievement include a strong political commitment of the Belarus government to fight the HIV epidemic; continuous cooperation between Belarus and WHO in the field of HIV prevention; continued support from the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the United Nations Environment Programme (UNDP) and other international partners; and active civil society engagement. The Ministry of Health signed the decision to ensure universal access to ARVs for PLHIV in Belarus on 1 June 2017.