Evidence-based recommendations for people-centred, integrated HIV service delivery for clinicians and programme managers globally
What this guideline saysGMJ summary
This guideline consolidates all WHO HIV service delivery recommendations from 2013 to 2025, providing comprehensive, evidence-based guidance to support more people-centred, integrated and equitable HIV service delivery. It covers the full continuum of care from linkage after diagnosis through long-term treatment maintenance, with particular attention to reducing structural barriers and improving retention in care.
Key areas include rapid ART initiation (including same-day start), reduced frequency of clinical visits (every 3–6 months) and medication refills (3–6 months) for stable clients, task-sharing to non-physician providers, decentralization of services, and integration of HIV care with TB, noncommunicable diseases (diabetes, hypertension) and mental health services. The guideline emphasizes person-centred care, adolescent-friendly services, and community-based approaches.
Recommendations are classified as new, updated or revalidated, with strength and evidence certainty graded using GRADE methodology. The guideline aims to improve access, strengthen continuity of care and accelerate progress towards ending AIDS as a public health threat.
Key pointsfor clinicians
- Rapid ART initiation should be offered within 7 days of HIV diagnosis, including same-day start for people ready to begin (strong recommendation)
- People established on ART should be offered clinical visits every 3–6 months, preferably every 6 months (strong recommendation)
- ART refills lasting 3–6 months, preferably 6 months, should be offered to people established on ART (strong recommendation)
- Trained non-physician clinicians, midwives and nurses can initiate and maintain first-line ART (strong recommendation)
- Diabetes and hypertension care should be integrated with HIV services (strong recommendation, updated 2025)
- Mental health care for depression, anxiety and alcohol use disorders should be integrated with HIV services (strong recommendation, new 2025)
- Adherence support interventions including counselling, reminders, peer support and education should be provided to people on ART (strong recommendation)
- Psychosocial interventions should be provided to all adolescents and young adults living with HIV (strong recommendation)
HIV service delivery recommendations summaryextracted from the guideline
| Date | Recommendation area | Key recommendation | Strength |
|---|---|---|---|
| 2017 | ART initiation | Rapid ART initiation (within 7 days) should be offered to all people living with HIV | Strong |
| 2021 | Clinical visits | Clinical visits every 3–6 months, preferably every 6 months for established clients | Strong |
| 2021 | Medication refills | ART refills of 3–6 months, preferably 6 months for established clients | Strong |
| 2025 | Adherence support | Adherence support interventions (counselling, reminders, peer support, education) should be provided | Strong |
| 2016 | Task sharing | Trained non-physician clinicians, midwives and nurses can initiate and maintain ART | Strong |
| 2025 | NCD integration | Diabetes and hypertension care should be integrated with HIV services | Strong |
| 2025 | Mental health | Mental health care for depression, anxiety and alcohol use should be integrated with HIV services | Strong |
| 2021 | Adolescent services | Psychosocial interventions should be provided to all adolescents and young adults | Strong |
What changed in this edition
- 2025: New recommendation to integrate mental health care for depression, anxiety and alcohol use disorders with HIV services
- 2025: Updated recommendation strengthening integration of diabetes and hypertension care with HIV services
- 2025: Updated recommendation on adherence support interventions with expanded evidence base
- Consolidates all WHO HIV service delivery recommendations issued from 2013 to 2025 into a single document
- Recommendations now labelled as 'new', 'updated' or 'revalidated' to indicate development status
ApplicabilityGeorgia and the region
Georgia and the South Caucasus region face specific challenges in HIV service delivery including concentrated epidemics among key populations, stigma barriers to care access, and health system capacity constraints. The guideline’s emphasis on task-sharing, decentralization and integration with mental health and NCD services is particularly relevant for strengthening primary care capacity in the region. Countries should assess feasibility of multimonth dispensing given supply chain reliability, consider adaptation of adolescent-friendly services for local contexts, and evaluate opportunities to integrate HIV care within existing chronic disease management platforms. The strong recommendations for people-centred care and reducing frequency of clinical visits can help address retention challenges, while task-sharing provisions may help overcome health workforce limitations. National programmes should review legal and regulatory frameworks to enable expanded roles for non-physician providers and community health workers in HIV care delivery.
Questions this guideline answers
What is considered 'established on ART' for differentiated service delivery?
A person is established on ART if they have been receiving ART for at least 6 months, have no current illness (excluding well-controlled chronic conditions), demonstrate understanding of lifelong adherence, and have evidence of treatment success (suppressed viral load within past 6 months, or CD4 >200 cells/mm³, or weight gain with no symptoms).
Can ART be initiated outside health facilities?
Yes, ART initiation may be offered outside the health facility (conditional recommendation). However, confirmatory HIV testing, baseline assessments including CD4 count, ART literacy education, and systems for linkage to ongoing facility-based ART services must be ensured. This approach can increase treatment access for populations facing structural barriers to facility-based care.
What types of adherence support interventions are recommended?
Four types of adherence interventions have demonstrated benefit: counselling (moderate-certainty evidence), reminders including SMS (moderate-certainty evidence), peer and other supporter-based strategies (moderate-certainty evidence), and education (low-certainty evidence). These can be combined or sequenced based on individual needs and preferences.
Related on GMJinterconnected resources
Conditions A–Z
Dictionary of Public Health
GMJ News coverage
- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2026
- Replaces
- Updated recommendations on service delivery for the treatment and care of people living with HIV, 2021; Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection (2nd edition), 2016
- Status
- Current
- Published
- 2026-07-22
- Languages
- English
- Scope
- Service delivery models for HIV testing, linkage, ART initiation, clinical follow-up, adherence support, task-sharing, decentralization, and integration with TB, NCDs and mental health services
- Audience
- Health professionals developing national/local HIV guidelines and protocols; hospital administrators; nursing managers; infectious disease and chronic care providers; primary care leaders; health information managers; pharmacists; professional societies; NGOs; community-based organizations
- Pages
- 50
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-012423-3
- Evidence
- GRADE-rated systematic reviews and meta-analyses; recommendations classified as strong or conditional based on certainty of evidence (high, moderate, low, very low); good practice statements where appropriate
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