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 |