Diagnosis & Treatment

Accessing Care for Advanced HIV Disease (AHD)

When someone has Advanced HIV Disease, time matters. This page guides you through the key steps to screen, diagnose, treat, and prevent life-threatening infections. Follow the care pathway below.

The STOP AIDS Toolkit: A Lifesaving Package for Advanced HIV Disease

When someone has advanced HIV disease (AHD), they are at high risk of serious infections and death. The STOP AIDS toolkit helps health workers deliver a package of care that can save lives. STOP = Screen. Treat. Optimise. Prevent.

1. S = SCREEN

Find out what’s going on.

Do a CD4 test to check immune system strength

Use TB LAM test to check for tuberculosis

Use CrAg test to screen for cryptococcal meningitis (CD4 <100)

Why it matters: Many people have serious infections that are not visible. These quick tests can catch them early.

2. T = TREAT

Start the right treatment fast.

For TB: Start appropriate TB therapy

For cryptococcal meningitis: Use antifungal treatment (liposomal amphotericin B + fluconazole if available)

For bacterial infections: Use antibiotics like ceftriaxone as needed

Why it matters: Delays in treatment can be deadly. Treat the infection immediately based on what’s found.

3. O = OPTIMISE ART

Start or restart HIV treatment quickly.

Begin antiretroviral therapy (ART) within 7 days

Offer same-day ART if no contraindications (e.g. no meningitis)

Monitor side effects and support adherence

Why it matters: ART helps rebuild the immune system and prevent more infections but timing matters.

4. P = PREVENT

Stop future infections before they start.

Give cotrimoxazole to prevent bacterial infections

Start TB Preventive Therapy (e.g. 3HP or 6H)

Provide fluconazole prophylaxis (if CrAg+ without symptoms)

Offer adherence support and counselling

Why it matters: Prevention saves lives. These simple meds can keep people from getting sick again.

The STOP AIDS Toolkit is endorsed by the World Health Organization and partners. When used together, these steps can reduce deaths from AHD by more than 25%.

AHD Care Pathway

A quick-reference view of the STOP AIDS toolkit. Follow this pathway from screening through to ongoing prevention and support.

Step 1: Screen

CD4 testing
TB symptom screening

Step 2: Diagnose

TB LAM for very ill patients
Xpert for TB
CrAg if CD4 <100
Suspected CrM: LP + rapid CrAg

Step 3: Treat

Begin ART within 7 days
Treat opportunistic infections
Delay ART 4–6 wks in meningitis

Step 4: Prevent & Support

Start CTX
TB preventive treatment
Follow-up & adherence support

Screening for Advanced HIV

Tool	Purpose	Target Group
CD4 Cell Count Testing	Identifies severe immune suppression and supports AHD diagnosis	Adults, adolescents with HIV presenting to care- naiive , re-engaging in care, or failing on treatment ( in some countries, includes children)
Point of Care CD4 Testing	Rapid identification of AHD at the point of care	Adults and adolescents living with HIV
WHO Clinical Staging	Identifies advanced disease when CD4 testing is unavailable	All people living with HIV

Diagnostic Tools

Tool	Purpose	Target Group
TB Symptom Screening	Identifies individuals who require further TB investigation	All people living with HIV
TB LAM Test	Rapid diagnosis of tuberculosis among people with advanced HIV disease	People with CD4 <200 cells/mm³ or WHO Stage 3/4 disease
CrAg Screening	Detects cryptococcal infection before meningitis develops	People with CD4 <100 cells/mm³
Histoplasma Antigen Testing	Detects disseminated histoplasmosis and supports early diagnosis and treatment	People with AHD in endemic settings, particularly those with symptoms suggestive of histoplasmosis

Treatment Medicines

Effective treatment for opportunistic infections and immune recovery.

Medicine	Used For
Amphotericin B Liposomal	First-line treatment for cryptococcal meningitis
Flucytosine	Combined with Amphotericin B for fungal infections
Fluconazole	Maintenance therapy for cryptococcal meningitis
Cotrimoxazole (CTX)	Prevents and treats bacterial infections
Isoniazid + Rifapentine (3HP / 1HP)	Short-course TB preventive treatment
Antiretroviral Therapy (ART)	Restores immune function and stops disease progression

Preventive Care

Keep infections from happening in the first place.

Tool	Purpose	Target Group
Cotrimoxazole (CTX)	Prevents pneumonia, toxoplasmosis, bacterial infections	All PLHIV with AHD
Isoniazid Preventive Therapy (IPT)	Prevents latent TB from becoming active	HIV-positive, no active TB
Fluconazole Prophylaxis	Prevents cryptococcal disease	CD4 <100
Pre-Exposure / Post-Exposure Prophylaxis (PrEP / PEP)	Prevents HIV acquisition	At-risk populations
Male / Female Condoms	Prevent HIV and STI transmission	Sexually active individuals
Harm Reduction (e.g., clean needles, opioid substitution)	Prevent HIV in people who inject drugs	PWID

Supportive Vaccines

While not core AHD tools, these vaccines support long-term health for people living with HIV.

Vaccine	Who It’s For
Pneumococcal (PCV-10)	Children to prevent pneumonia
HPV Vaccine (4-valent)	Adolescent girls and boys
Measles Vaccine	All children
BCG (for TB)	Neonates in high TB-burden areas

Supply Planning Recommendations

Buffer Stock: Maintain a 2–3 month buffer to prevent stockouts.
Shelf-Life Consideration: Plan orders considering product shelf life to minimise expiries.
Integrated Forecasting: Coordinate across programs (e.g., HIV, TB, immunisation) to integrate AHD commodities into national supply chains.
Data-Driven Decisions: Utilise tools like the AHD Commodity Calculator for accurate quantification.

For a more detailed guide, you can refer to the full document: Quantification and Supply Planning for Commodities Needed to Deliver the WHO-Recommended Advanced HIV Disease Package of Care.

Opportunistic Infections