Routine urine LAM and serum CrAg screening

Clinical description

• Routinely test ALL children 5 years and above and adults who meet the definition of advanced HIV

disease using:

o Urine LAM for disseminated TB and o CrAG for cryptococcal meningitis (CM) / subclinical cryptococcaemia (serum or whole blood).

• Patient groups with advanced HIV disease include:

o All children <5 years old are considered to have advanced HIV disease until they are clinically stable with a suppressed VL on ART o CD4 < 200 cells/ml before ART initiation / while on ART.

Note that a CD4 test result is not required to conduct urine LAM and CrAg testing if other criteria (see below) are met.

o WHO stage 3 or 4 o Every ART experienced patient with viral load 1000+ (on ART for > 1 year)

o “Seriously ill” PLHIV:

• All PLHIV admitted as in-patient
• HIV infected patients with any of the following danger signs:
• Adults: ≥30 breaths/min; heart rate ≥120 beats/min; unable to walk unaided; ≥39°C
• Children: lethargy; unconsciousness; convulsions; unable to drink or breastfeed;

repeated vomiting; fever ≥39°C; tachycardia; tachypnoea

• Document TB urine LAM and CrAg results in patient health passport and on ART patient card.

HIV-related diseases

• Urine LAM result

o Positive: treat for TB, regardless of other TB diagnostics (see section 8.2.6 on page 27)

o Negative: does not rule out TB. Continue with TB investigations in symptomatic patients according to TB guidelines.

• Serum/Blood CrAg

o Positive: Confirms Cryptococcocaemia but require CSF sample to confirm meningitis, assess for active meningitis signs, do lumbar puncture and CrAg on CSF, treat for active meningitis or give pre-emptive antifungal therapy (see sections 8.2.1 and 8.2.2 on page 23).

o Negative: does not rule out CM. Continue with CSF testing (CrAg, India ink, GXpert) and other investigations for patient with meningitis signs.