Table 1

Overview of advanced HIV disease care package

InterventionCD4 cell count
Screening and diagnosisCD4 cell count
Four symptom screen, chest X-ray, C-reactive protein
Molecular rapid diagnostic if TB screening positive*Any
LF-LAM screening≤200 cells/µL (inpatient)/≤100 cells/µL (outpatient)/ any if TB symptoms or seriously ill†
CrAg screening≤100 cells/µL/considered if ≤200 cells/µL
Prophylaxis/pre-emptive treatmentCo-trimoxazole prophylaxis<350 cells/µL/ WHO stage 3 or 4/any if high prevalence of malaria or SBI
TB preventive treatmentAny
Fluconazole pre-emptive therapy for CrAg-positive people without evidence of meningitis≤100 cells/µL
ART initiationRapid ART initiationAny
Defer initiation if clinical symptoms suggest meningitis (TB or cryptococcal)Any
Adherence supportTailored counselling to support optimal adherence to the AHD care package, including home visits if feasibleCD4 <200 cells/µL
  • Adapted from WHO.13

  • *WHO TB symptom screen includes presence of fever, weight loss or any cough. People living with HIV may present with signs or symptoms of extrapulmonary TB also including lymphadenopathy, meningitis or other atypical presentations warranting evaluation.

  • †Seriously ill is defined based on four danger signs: respiratory rate >30/min, temperature >39°C, heart rate >120/min and unable to walk unaided.

  • AHD, advanced HIV disease; ART, antiretroviral therapy; CrAg, cryptococcal antigen; LF-LAM, lateral flow lipoarabinomannan assay; SBI, severe bacterial infections (including bloodstream, respiratory, central nervous system and gastrointestinal infections); TB, tuberculosis; WHO, World Health Organization.