Evidence for Improving AHD Programmes
This page brings together research, data, and practical insights to help programmes design, improve, and scale Advanced HIV Disease (AHD) services.
Why Research Matters in Advanced HIV Disease (AHD)
Evidence is the backbone of effective health systems. For people living with advanced HIV disease (AHD), timely diagnosis, appropriate treatment, and simplified care pathways can mean the difference between life and death. Through real-world studies, clinical trials, and operational research, IMPAACT4HIV generates data that informs policies, improves clinical outcomes, and supports the scale-up of lifesaving AHD services in sub-Saharan Africa.
Research and Publications
Use Evidence for Programme Design
- Decentralised AHD care
- SBI assessment
- Service delivery studies
Strengthen Diagnostics & Clinical Care
- Histoplasmosis LFA study
- Clinical evidence
National Guidance & Global Standards
- WHO guidelines
- AHD protocols
Publications
A chronological list of peer-reviewed publications on Advanced HIV Disease (AHD), most recent first. Titles link to the source where available; unlinked citations will be updated as sources are confirmed.
| Year | Title | Author |
|---|---|---|
| 2024 | Prevalence of advanced HIV disease and associated factors among antiretroviral therapy naïve adults enrolling in care at public health facilities in Kampala, Uganda | Ainembabazi B et al. |
| 2024 | Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis | Portilla-Tamarit I et al. |
| 2024 | Advanced HIV disease in East Africa and Nigeria, in The African Cohort Study | Oboho IK et al. |
| 2024 | Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay | Aguilar G et al. |
| 2024 | Understanding health systems challenges in providing Advanced HIV Disease (AHD) care in a hub and spoke model: a qualitative analysis to improve AHD care program in Malawi | Maphosa T et al. |
| 2024 | Tracking cryptococcal meningitis to monitor HIV program success during the Treat-All era: an analysis of national data in Botswana | Milburn J et al. |
| 2024 | Evaluation of factors associated with high advanced HIV disease and mortality in Southwestern China: a retrospective cohort study, 2005-2020 | Li SS et al. |
| 2024 | Antibiotic susceptibility patterns of pathogens isolated from hospitalized patients with advanced HIV disease (AHD) in Bihar, India | Kumar V et al. |
| 2024 | Analysing Early Diagnosis Strategies for HIV Infection: A Retrospective Study of Missed Diagnostic Opportunities | Giménez-Arufe V et al. |
| 2024 | Clinical characteristics, diagnosis, treatment and outcomes of patients living with HIV and co-infected with tuberculosis and histoplasmosis: a 5-y retrospective case series | Castellanos Reynosa ME et al. |
| 2024 | A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar | Raberahona M et al. |
| 2023 | Advanced HIV disease in Homa Bay County, Kenya: Characteristics of newly-diagnosed and antiretroviral therapy-experienced clients | Masaba RO et al. |
| 2023 | Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: A mixed-methods evaluation | Gils T et al. |
| 2023 | Understanding gender differences of people with HIV newly diagnosed or returning to care with advanced HIV disease in Malawi: a qualitative study | Katirayi L et al. |
| 2023 | Pulmonary tuberculosis complicated by pneumothorax, and acute respiratory distress syndrome (ARDS) in the settings of advanced HIV disease: A case report | Haile H et al. |
| 2023 | Factors associated with CD4 + cell count recovery among males and females with advanced HIV disease | Kouamou V et al. |
| 2023 | Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries | Scheier TC et al. |
| 2023 | Clinical characteristics and morbidity among hospitalized adults with advanced HIV disease in Uganda during ‘test and treat’ era | Tugume L et al. |
| 2023 | Rapid antiretroviral therapy initiation in patients with advanced HIV disease: 6-month outcomes of an observational cohort evaluation in Lesotho | Tiam A et al. |
| 2023 | Barriers and facilitators to implementing advanced HIV disease screening at a secondary referral hospital -Malawi: a convergent parallel study | Mithi B et al. |
| 2023 | Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis | Kitenge MK et al. |
| 2023 | Cost-effectiveness evaluation of routine histoplasmosis screening among people living with advanced HIV disease in Latin America and the Caribbean | Rajasingham R et al. |
| 2023 | Contribution des diagnostics au points de service dans l’identification de la maladie à VIH avancée | Ditondo P et al. |
| 2023 | Advanced HIV disease: A review of diagnostic and prophylactic strategies | Lehman A et al. |
| 2023 | Prevalence and Factors Associated With Cryptoccocal Antigenemia Among Patients With Advanced Human Immunodeficiency Virus in Eastern Uganda: A Facility-Based Cross-sectional Study | Eric E et al. |
| 2023 | Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study | Mesic A et al. |
| 2023 | Effects of Gender and Baseline CD4 Count on Post-Treatment CD4 Count Recovery and Outcomes in Patients with Advanced HIV Disease: A Retrospective Cohort Study | Kouamou V et al. |
| 2023 | Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India | Acharya S et al. |
| 2023 | Tackling Histoplasmosis Infection in People Living with HIV from Latin America: From Diagnostic Strategy to Public Health Solutions | Cáceres DH et al. |
| 2023 | Barriers and facilitators to implementing Advanced HIV Disease screening at secondary referral hospital -Malawi: Asequential exploratory mixed method-study | Mithi B et al. |
| 2023 | The hard part we often forget: providing care to children and adolescents with advanced HIV disease | Frigati LJ et al. |
| 2023 | Modelling the impact of CD4 testing on mortality from TB and cryptococcal meningitis among patients with advanced HIV disease in nine countries | Oboho IK et al. |
| 2023 | Advanced HIV disease and engagement in care among patients on antiretroviral therapy in South Africa: results from a multi-state model | Patten GE et al. |
| 2023 | Repeated false-negative HIV rapid test results in a patient presenting to care with advanced HIV disease: A case report | Chuwa F et al. |
| 2023 | A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria | Oladele RO et al. |
| 2023 | Advanced HIV Disease at Antiretroviral Therapy Initiation and Treatment Outcomes Among Children and Adolescents Compared to Adults Living With HIV in Kinshasa, Democratic Republic of the Congo | Chabikuli ON et al. |
| 2022 | Persistent High Burden and Mortality Associated With Advanced HIV Disease in Rural Tanzania Despite Uptake of World Health Organization “Test and Treat” Guidelines | Stöger L et al. |
| 2022 | Laboratory Evaluation of the VISITECT Advanced Disease Semiquantitative Point-of-Care CD4 Test | Lechiile K et al. |
| 2022 | Trends of late HIV presentation and advance HIV disease among newly diagnosed HIV cases in Jiangsu, China: A serial cross-sectional study from 2008 to 2020 | Shi L et al. |
| 2022 | Prevalence of Late Presenters and Advanced HIV Disease in HIV Patients and Their Related Factors in Iran: Results from 19 Years of National Surveillance HIV Data | Sharafi M et al. |
| 2022 | Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria | Oladele RO et al. |
| 2022 | Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women | Nhampossa T et al. |
| 2022 | Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India | Acharya S et al. |
| 2022 | Diagnostic Accuracy of Point of Care Cryptococcal Antigen Lateral Flow Assay in Fingerprick Whole Blood and Urine Samples for the Detection of Asymptomatic Cryptococcal Disease in Patients with Advanced HIV Disease | Boyd K et al. |
| 2022 | Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria | Ekeng BE et al. |
| 2022 | Factors Associated with Baseline CD4 Cell Counts and Advanced HIV Disease among Male and Female HIV-Positive Patients in Iran: A Retrospective Cohort Study | Afrashteh S et al. |
| 2022 | Implementation of WHO guidelines on management of advanced HIV disease and its impact among TB co-infected patients in Tanzania: a retrospective follow-up study | Hassan FE et al. |
| 2022 | Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications | Heller T et al. |
| 2022 | Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review | Mbewe N et al. |
| 2022 | Feasibility of implementing the advanced HIV disease care package as part of community-based HIV/TB activities: a mixed-methods study protocol | Gils T et al. |
| 2021 | Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017 | Ngongo NM et al. |
| 2021 | Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection | Makadzange TA et al. |
| 2021 | Establishing targets for advanced HIV disease: A call to action | Meya DB et al. |
| 2021 | Improved detection and management of advanced HIV disease through a community adult TB-contact tracing intervention with same-day provision of the WHO-recommended package of care including ART initiation in a rural district of Mozambique | Izco S et al. |
| 2021 | A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala | Medina N et al. |
| 2021 | Impact of Advanced HIV Disease on Quality of Life and Mortality in the Era of Combined Antiretroviral Treatment | Portilla-Tamarit J et al. |
| 2020 | Diagnostic Accuracy of the Biosynex CryptoPS Cryptococcal Antigen Semiquantitative Lateral Flow Assay in Patients with Advanced HIV Disease | Tenforde MW et al. |
| 2020 | Prevalence of and factors associated with advanced HIV disease among newly diagnosed people living with HIV in Guangdong Province, China | Jiang H et al. |
| 2020 | Addressing advanced HIV disease and mortality in global HIV programming | Boyd AT et al. |
| 2020 | Diagnostic performance and usability of the VISITECT CD4 semi-quantitative test for advanced HIV disease screening | Ndlovu Z et al. |
| 2019 | Different transmission routes and the risk of advanced HIV disease: A systematic review and network meta-analysis of observational studies | Chen Q et al. |
IMPAACT4HIV: Areas of Research
Decentralized Delivery Models for AHD Care
Study Objective: Assess the feasibility, adoption, sustainability, and clinical outcomes of decentralized AHD care models.
Focus: Adults and children living with AHD
Design: Mixed-method implementation science study
Countries:
- Côte d’Ivoire – Adult AHD
- South Africa, Nigeria – Paediatric AHD
- DRC, Mozambique, Sierra Leone – Both adult and paediatric
Key Outcomes:
- Improved access and retention in care
- Data to support scale-up of decentralized AHD services
Dissemination: Findings to be presented at regional technical meetings and HIV implementation science forums in 2026
Field Evaluation of Histoplasmosis Lateral Flow Assays (LFAs)
Study Objective: Evaluate the performance and utility of LFAs for diagnosing histoplasmosis in AHD populations.
Focus: Fungal OIs in high-burden settings
Design: Prospective observational study
Countries: Côte d’Ivoire, Sierra Leone, DRC
Key Outcomes:
- Estimated burden of histoplasmosis in AHD patients
- Validated LFA performance for use in low-resource settings
Dissemination: Results expected in 2026 via publications in mycology and HIV journals
Situational Assessment of Severe Bacterial Infections (SBIs)
Study Objective: Identify current practices and gaps in SBI detection and management within AHD programs.
Focus: Service delivery improvement
Design: Cross-sectional assessment including interviews, algorithm reviews, and service audits
Countries: Côte d’Ivoire, DRC, Mozambique, Nigeria, Sierra Leone, South Africa
Key Outcomes:
- Country-specific recommendations
- Strengthened protocols for SBI identification and treatment
Dissemination: Summary briefs shared with Ministries of Health and implementing partners
Modelling the Public Health Impact and Cost-Effectiveness of Decentralised AHD Care
Study Objective: Estimate mortality reduction and economic value of scaling decentralised AHD services.
Focus: Investment case for national scale-up
Design: Mathematical modelling using project and national data
Countries: All six IMPAACT4HIV countries
Key Outcomes:
- Projected DALYs averted and deaths reduced
- Cost-effectiveness data to support policy change
Dissemination: Shared with donors, economists, and policy forums to support AHD investment cases
Sharing What We Learn: How Evidence Translates Into Action
These findings will be used to:
- Update national policies and referral systems
- Support scale-up of simplified AHD care models
- Strengthen supply chains and decentralise service delivery
- Build capacity for continuous quality improvement
Together, this work creates a foundation for more responsive, evidence-based HIV care in high-burden settings.