When to start ART

Clinical description

• Start ART as soon as possible:

o For all children and adults with confirmed HIV infection o For infants with presumed AIDS (following definition of PSHD).

• All patients need a confirmatory HIV test before starting ART. The standard (blood-based) HIV

testing algorithm, performed by a trained HTS provider at the same health facility where ART is started, counts as the confirmatory HIV test. A new confirmatory test is only needed for patients who were initially diagnosed elsewhere (community, another health facility).

• Explain the benefits of immediate ART for the patient’s own health, and for prevention of

onward transmission to sexual partners and from mother to child. This understanding is key for patient motivation and good adherence.

• Patients may not be ready to start ART immediately.

o Allow for reflection time if the patient is unsure and/or wants to discuss with family.

o Schedule a follow-up appointment not further than 2 weeks.

o Delay ART initiation by 5 weeks for patients treated for cryptococcal or TB meningitis (see section 14.2 on page 71) due to the risk of IRIS (see section 18.12 on page 102).

• Initiate / transition all children from 3kg+ to a DTG-based regimen.

o 15PP (paed ABC/3TC + paed DTG) for 3 – 19.9 kg o 15PA (paed ABC/3TC + adult DTG) for 20 – 24.9kg o 15A (adult ABC/3TC + adult DTG) for 25 – 29.9kg

• Do not wait for undetectable VL in the last 6 months before making this

transition.

• Monitor weight and routinely move children to 13A once they have reached 30kg+
• Collect routine VL samples 6-monthly for all children on paediatric regimens (blue patient card)

and for pregnant or breastfeeding women.