Establishing targets for advanced HIV disease: A call to action

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, Thomas S. Harrison, Amir Shroufi, Radha Rajasingham, David Boulware, Nelesh P. GovenderAngela Loyse

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article numbera1266
JournalSouthern African Journal of HIV Medicine
Volume22
Issue number1
DOIs
StatePublished - 2021

Bibliographical note

Funding Information:
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors D.B.M., R.R., D.R.B. and N.P.G. are supported by the National Institute of Allergy and Infectious Diseases (K23AI138851, R01AI118511 and U01AI125003).

Publisher Copyright:
Copyright © 2021. The Authors.

Keywords

  • Advanced HIV disease
  • Cryptococcal antigen
  • TB-LAM
  • Targets
  • Tuberculosis

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