These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income.

What is new in the 2020 guidelines update? Key updates ÿ A recommendation for dolutegravir (DTG)-based therapies as the preferred first-line antiretroviral therapy (ART) option (section 11). ÿ Updated guidelines for second-and third-line ART regimens (section 13). ÿ New recommendations on the management of patients on DTG-based therapies who have an elevated viral load (section 12). ÿ A lowering of the threshold for virological failure from 1000 copies/mL to 50 copies/mL (section 8). ÿ A recommendation against routine cluster of differentiation 4 (CD4 + ) monitoring in patients who are clinically well once the CD4 + count is > 200 cells/μL (section 9). ÿ Updated recommendations for isoniazid preventive therapy (IPT) in human immunodeficiency virus (HIV)-positive patients (section 27). ÿ A recommendation for the use of low-dose prednisone as prophylaxis for paradoxical tuberculosis (TB) immune reconstitution inflammatory syndrome (IRIS) in TB/HIV co-infected patients commencing ART within 1 month of TB therapy (section 26).

BackgroundAs South Africa’s (SA) HIV programme increases in size, HIV/TB cases occur that are often beyond the clinical scope of primary healthcare clinicians. In SA’s Eastern Cape (EC) province, health facilities are geographically widespread, with a discrepancy in specialist availability outside of academic institutions. The aim of this study is to describe WhatsApp and its use as an alternative learning tool to improve clinicians’ access to specialised management of complicated HIV/TB cases.ObjectivesTo analyse clinicians’ use of the WhatsApp chat group as a learning tool; to assess clinicians’ confidence in managing complicated HIV and TB patients after participating in the WhatsApp case discussion group; to describe the perceived usefulness of the chat group as a learning tool; to understand clinicians’ knowledge and use of informed consent when sharing patient case details on a public platform such as WhatsApp.MethodAn observational, cross-sectional study was conducted among a group of clinicians from the EC that formed part of a WhatsApp HIV/TB clinical discussion group. Data were collected using a structured anonymous Internet questionnaire and analysed with Epi Info, using descriptive and analytic statistics.ResultsThe analysis found the majority of participants had gained new clinical confidence from group participation. This was associated with the increased group engagement in group follow-up (odds ratio [OR] 48.13 [95% confidence interval [CI] 4.99–464.49]); in posting questions (OR 3.81 [95% CI 1.02–18.48]); in reports of ‘new’ clinical insights (OR 23.75 [95% CI 3.95–142.88]); in referencing old case material (OR 21.42 [95% CI 4.39–104.84]) and in the use of peer guidance to manage cases (OR 48.13 [95% CI 4.99–464.49]). However, there was a discrepancy in participants’ knowledge and actual use of informed consent when posting patient details on social media.ConclusionsOur study findings support the use of WhatsApp in a medical setting as an effective means of communication, long distance learning and support between peers and specialists.

No abstract

In the ADVANCE study of first-line treatment, there were 48 participants with HIV RNA at least 50 copies/ml in the week 48 window who had subsequent follow-up data available with no change in randomized treatment. More participants achieved virological re-suppression in the TAF/FTC+DTG and TDF/FTC+DTG arms (26/34, 76%) than on TDF/FTC/EFV (6/14 = 43%; P = 0.0421). It is unclear whether participants with HIV RNA at least 50 copies/ml at week 48 should be termed ‘virological failures’ on integrase inhibitor-based treatment.