deshola The World Health Organization’s latest update to its HIV clinical management guidelines arrives at a critical moment for Africa, where progress against the epidemic has slowed even as treatment options have become more sophisticated. The recommendations, released in early January, reflect years of accumulated evidence and are aimed less at scientific novelty than at practical gains: better adherence, fewer deaths and health systems that work for patients rather than against them.
Sub-Saharan Africa remains the epicentre of the global HIV epidemic, accounting for roughly two-thirds of people living with the virus. While antiretroviral therapy has transformed HIV from a fatal diagnosis into a manageable condition, gaps persist ,missed doses, clinic congestion, drug stock-outs and the stubborn toll of tuberculosis among people with compromised immunity. The updated WHO guidance is designed to address precisely these pressure points.
At the core of the recommendations is a renewed emphasis on simpler, more durable treatment regimens. Dolutegravir-based therapies are reaffirmed as the preferred first-line option, but the guidance goes further by expanding the circumstances under which simplified two-drug combinations can be used safely. For health systems that struggle to keep patients on lifelong daily medication, this is not a marginal adjustment. Fewer pills and clearer treatment pathways can translate into higher retention rates and sustained viral suppression, particularly in rural and underserved communities.
Perhaps the most consequential shift is the cautious endorsement of long-acting injectable antiretroviral therapy for people who find daily oral treatment difficult. In African settings where stigma, travel costs and unstable housing disrupt adherence, injections given monthly or every two months could change the rhythm of care. The promise, however, comes with conditions. Countries will need to invest in cold-chain storage, train health workers and ensure that injectable treatments do not become the preserve of urban elites while rural patients are left behind.
The guidance also sharpens the focus on preventing mother-to-child transmission, an area where Africa has made progress but not yet closed the gap. New paediatric infections continue to occur, particularly during breastfeeding. WHO’s recommendations reaffirm breastfeeding alongside effective maternal treatment and enhanced infant prophylaxis, recognising the nutritional realities facing many African families. For countries struggling with high rates of infant infection, the message is clear: prevention must be continuous, not confined to delivery rooms.
Tuberculosis, long the leading cause of death among people living with HIV in Africa, features prominently in the updated advice. Shorter TB preventive regimens, such as three-month courses combining isoniazid and rifapentine, are promoted as practical alternatives to longer treatments that patients often abandon. In regions where HIV-TB co-infection remains endemic, wider uptake of these regimens could save thousands of lives each year.
The real test, however, lies beyond the pages of WHO documents. African governments have no shortage of guidelines; what they often lack is the fiscal and administrative space to implement them fully. Updating national treatment protocols, retraining clinicians and securing reliable drug supplies all carry costs. So does integrating HIV and TB services, a reform that requires coordination across programmes that have historically operated in silos.
There is also the question of access. Newer therapies, particularly long-acting injectables, risk arriving late and at high prices unless countries act collectively. Pooled procurement, tougher price negotiations and regional regulatory cooperation will be essential if African patients are not to wait years for treatments already available elsewhere.
From a policy perspective, the updated guidance offers governments a chance to reset their HIV response around practicality rather than aspiration. Decentralising care, expanding community-based delivery and using data to track patients more effectively are not radical ideas, but they remain unevenly applied. Where countries have invested in these approaches, gains have followed.
The WHO’s recommendations do not promise a dramatic breakthrough. What they offer instead is something arguably more valuable: a set of tools better aligned with the realities of African health systems and the lives of those who depend on them. If governments move decisively, the guidance could help revive momentum toward ending AIDS as a public health threat. If they do not, it risks becoming another well-intentioned blueprint that outpaced the political will required to make it real.
