Table 1 Extracted data country specific guidelines

Guideline information

 Country specific guideline

N/A

Yes

Yes

Yes

Yes

Yes

Yes

 Year of publication

2021

2016

2022

2020

2020

2023

2018

 Specific section for AHD

Yes

No

No

Yes

No

No

Yes

Definition of AHD

 Definition

 < 200 CD 4 + cells/mm³ or WHO clinical stage 3 or 4

 ≤ 100 CD 4 + cells/mL³ or WHO clinical stage 3 & 4

 < 200 CD 4 + cells/mm³ or WHO clinical stage 3 or 4 or additional criteria*

 < 200 CD 4 + cells/mm³ or WHO clinical stage 3 or 4

 ≤ 200 CD 4 + cells/mm³ or WHO clinical stage 3 or 4

Not addressed

 < 200 CD 4 + cells/mm³ or WHO clinical stage 3 or 4

Screening

 CD4 testing at baseline

Yes

Yes

Yes

Yes

Yes

Yes

Yes

 Cryptococcal antigen

Yes

Yes

Yes

Yes

Yes

Yes

Yes

  - Population group

- Recommended: < 100 CD 4 + cells/mm³

- Considered: < 200 CD 4 + cells/mm³

 < 100 CD 4 + cells/mm³

AHD

 < 200 CD 4 + cells/mm³

- < 100 CD 4 + cells/mm³

All PLHIV on ART suspected or

- confirmed to have treatment failure

 < 100 CD 4 + cells/mm³

- Positive symptom screen or

- Danger sign

- or ≤ 100 CD 4 + cells/mm³

 Routine TB screening

Yes

Yes

Yes

Yes

Yes

Yes

Yes

  - Urine LAM

Yes

Not addressed

Yes

Yes

Yes

Yes

Yes

○ Population group

- Inpatients ≤ 200 CD 4 + cells/mm³

- Outpatients ≤ 100 CD 4 + cells/mm³

- Any CD 4 + count

with symptoms or if seriously ill^#

Not addressed

AHD

 < 200 CD 4 + cells/mm³

 < 100 CD 4 + cells/mm³

- CD4 count < 200 within the last 6 months, or

- Advanced HIV disease, or

- Current serious illness

- TB symptoms and ≤ 100 CD 4 + cells/mm3

- Danger signs at any CD 4 + count

Prophylaxis

 Cotrimoxazole

Yes

Yes

Yes

Yes

Yes

Yes

Yes

  - Population group

- < 350 CD 4 + cells/mm³ or clinical stage 3 or 4

- Any CD4 count in settings with high prevalence of malaria or severe bacterial infection

 < 200 CD 4 + cells/mm³

All HIV infected adults

Any CD 4 + cell or WHO stage, due to high prevalence of malaria and severe bacterial infections

All HIV infected adults

CD 4 + count ≤ 200 cells/mm³,

WHO Stage 2, 3 and 4

- All PLHIV newly initiating on ART

- Patients suspected to have treatment failure

  - Discontinuation

- Clinically stable on ART⁺, with evidence of immune recovery and/or viral suppression^$,&

- Malaria and /or severe bacterial infections are highly prevalent: co-trimoxazole prophylaxis should be continued regardless of CD4 cell count or WHO clinical stage

 > 200 CD 4 + cells/mm³ for three months

For life

May be discontinued in adults who are clinically stable on ART with evidence of immune recovery and virological suppression

For life

CD 4 + count > 200 cells/mm³

- Patient should be older than 15 years of age

- Patient should not be pregnant

- Patient should have been on ART for at least one year

- Patient’s last VL should be suppressed

- Patient should not have a treatment WHO stage 3 or 4 event at the time of stopping CPT or other symptoms of Advanced Disease

 Pre-emptive therapy for cryptococcal antigenaemia

Yes

Yes

Yes

Yes

Yes

Yes

Yes

 TB preventive therapy

Yes

Not addressed

Yes

Yes

Yes

Yes

Yes

  - Population group

Any

Not addressed

HIV infected adults

Any CD4 cell count

All HIV patients

Any CD4 count

Negative symptom screen and any CD 4 + count

Supportive care

 Specified adherence information

Yes

Yes

Yes

Yes

Yes

Yes

Yes

HIV treatment

 Recommended 1st line ART

DTG/3TC/TDF OR DTG/FTC/TDF

DTG/FTC/TDF

TDF/3TC/DTG

DTG/3TC/TDF OR DTG/FTC/TDF

DTG/3TC/TDF

DTG/3TC/TDF

DTG/3TC/TDF

 Delayed/Deferred ART start after start of TB/cryptococcal treatment

  - TB at non-neurological site

within 2 weeks

ART naïve

- < 100 CD 4 + cells/mm3 as soon as possible, no later than 8 weeks

- > 100 CD 4 + cells/mm3 within 8 weeks

Within 2 weeks

- if < 50 CD 4 + cells/mm³ 2 weeks

- if > 50 CD 4 + cells/mm³ 4 weeks

2–8 weeks

DS-TB:

- < 50 CD 4 + cells/mm³ within 2 weeks

- ≥ 50 CD 4 + cells/mm³ after 8 weeks

DR-TB:

- 2 weeks

- if < 50 CD 4 + cells/mm³ within 2 weeks

- if > 50 CD 4 + cells/mm³ 2 weeks

  - TB meningitis

4– 8 weeks

- < 50 CD 4 + cells/mm³ ART within first two weeks

- < 100 CD 4 + cells/mm³ as soon as possible, no later than 8 weeks

- > 100 CD 4 + cells/mm³ within 8 weeks

5 weeks

4 weeks

2–8 weeks

4–8 weeks

- if < 50 CD 4 + cells/mm³ within 2 weeks

if > 50 CD 4 + cells/mm³ 2 weeks

  - Cryptococcal meningitis

4–6 weeks

4–6 weeks

5 weeks

4–6 weeks

4–6 weeks

4–6 weeks

4–6 weeks