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Table 1 Summary of PEPFAR supports for interventions to identify advanced HIV disease; prevent, diagnose, and treat opportunistic infections; and conduct surveillance of mortality among PLHIV

From: Addressing advanced HIV disease and mortality in global HIV programming

Category Intervention How PEPFAR supports the intervention
Identifying advanced HIV disease (AHD) Use of a point-of-care test that differentiates CD4 cell count as binary greater than or less than 200 cells/µL Once test is WHO pre-qualified, PEPFAR plans to support use of this test to target PLHIV at increased risk of AHD
Preventing AHD-related mortality and associated opportunistic infections (OIs) Rapid ART initiation using optimized ART Rapid ART initiation as cornerstone of HIV programming, scaling up integrase-based ART regimens
TB preventive treatment Commitment to ensure all eligible PLHIV on ART receive TPT by 2022
Cryptococcal antigen (CrAg) testing and cryptococcal meningitis preventive interventions Recognition of importance of CrAg testing and cryptococcal meningitis preventive interventions in PEPFAR guidance
Prevention of severe bacterial infections (SBI) using co-trimoxazole Co-trimoxazole is mainstay of PEPFAR guidance and programming
Diagnosing OIs Use of Xpert MTB/RIF testing among PLHIV with presumptive TB Improving implementation of Xpert MTB/RIF, through optimizing distribution of machines, improving specimen transfer networks, and scaling up Xpert MTB/RIF Ultra
Use of urine lateral flow lipoarabinomannan (LF-LAM) to diagnose and screen for active TB among PLHIV with AHD1 PEPFAR guidelines recommend use of LF-LAM among PLHIV with a CD4 cell count < 200 cells/µL
Treating OIs Integration of HIV and TB services PEPFAR programming emphasizes co-location of HIV and TB services and timely return of TB testing results to inform ART initiation
Option of all-oral induction therapy for cryptococcal meningitis Working with other global HIV programmers in scaling up clinical implementation of this all-oral option
Surveillance of mortality among PLHIV Conduct systematic surveillance of mortality Use of an indicator TX_ML in its data reporting systems to track loss to follow up, including loss from mortality, allowing routine reporting on mortality
  1. 1WHO 2019 guidelines for the use of LF-LAM in the diagnosis of active TB among PLHIV include the following: among inpatients with signs and symptoms of TB, with AHD, or with CD4 cell count < 200 cells/μL; and among outpatients with signs and symptoms of TB or with CD4 cell count < 100 cells/μL