Addressing advanced HIV disease and mortality in global HIV programming.

Area of Science:

• Global Health
• Infectious Diseases
• Public Health Policy

Background:

• The US President's Emergency Plan for AIDS Relief (PEPFAR) has historically focused on increasing access to antiretroviral treatment (ART) and preventing new HIV infections.
• With declining new infections, PEPFAR is shifting focus to reducing mortality among people living with HIV (PLHIV).
• Advanced HIV disease (AHD) and opportunistic infections (OIs) are significant contributors to mortality among PLHIV.

Purpose of the Study:

• To outline PEPFAR's evolving strategy to address HIV-related mortality.
• To detail interventions for identifying, preventing, diagnosing, and treating AHD and associated OIs.
• To highlight PEPFAR's enhanced support for mortality surveillance among PLHIV.

Main Methods:

• Supporting expanded CD4 testing, including point-of-care assays, to identify PLHIV with low CD4 counts.
• Promoting rapid ART initiation with integrase inhibitor-based regimens and tuberculosis preventive treatment.
• Implementing urine lateral flow lipoarabinomannan assays for TB diagnosis in PLHIV with CD4 < 200 cells/µL.
• Scaling up new drug regimens for cryptococcal meningitis and improving TB/HIV co-infection services.
• Introducing the TX_ML indicator for systematic tracking of mortality outcomes among PLHIV on ART.

Main Results:

• PEPFAR is actively increasing efforts in identifying AHD and managing OIs.
• Implementation of new diagnostic tools and treatment regimens for OIs is underway.
• Enhanced mortality surveillance through the TX_ML indicator is being established.

Conclusions:

• PEPFAR is strategically enhancing its programs to combat HIV-related mortality.
• Collaborative efforts focus on identifying AHD, managing OIs, and improving mortality tracking.
• These integrated strategies aim to significantly decrease mortality among people living with HIV.