Establishing targets for advanced HIV disease: A call to action

Southern African Journal of HIV Medicine

Field Value
Title Establishing targets for advanced HIV disease: A call to action
Creator Meya, David B. Tugume, Lillian Nabitaka, Vennie Namuwenge, Proscovia Phiri, Sam Oladele, Rita Jibrin, Bilkisu Mobolaji-Bello, Mojisola Kanyama, Cecilia Maokola, Werner Mfinanga, Sayoki Katureebe, Cordelia Amamilo, Ikechukwu Ngwatu, Brian Jarvis, Joseph N. Harrison, Thomas S. Shroufi, Amir Rajasingham, Radha Boulware, David Govender, Nelesh P. Loyse, Angela
Subject — advanced HIV disease; cryptococcal antigen; tuberculosis; TB-LAM; targets
Description The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease.
Publisher AOSIS
Date 2021-08-10
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajhivmed.v22i1.1266
Source Southern African Journal of HIV Medicine; Vol 22, No 1 (2021); 5 pages 2078-6751 1608-9693
Language eng
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Rights Copyright (c) 2021 David B. Meya, Lillian Tugume, Vennie Nabitaka, Proscovia Namuwenge, Sam Phiri, Rita Oladele, Bilkisu Jibrin, Mojisola Mobolaji-Bello, Cecilia Kanyama, Werner Maokola, Sayoki Mfinanga, Cordelia Katureebe, Ikechukwu Amamilo, Brian Ngwatu, Joseph N. Jarvis,