Rapid antiretroviral therapy initiation in low- and middle-income countries: A resource-based approach

Major progress has been made, but late entry to care remains common in the HIV "treat all" era Current strategies are inadequate for identifying and preventing OIs and related deaths in late presentersIn the "treat all" era, the challenge is targeting effective prophylaxis against the bacterial, mycobacterial, and fungal pathogens that are the major causes of death in these late presenters.Such prophylaxis saves lives (see below) but also costs money and raises the potential risk of antimicrobial resistance if used indiscriminately.Further, when prophylaxis is provided conditional on a diagnostic test result, unless truly point-of-care, there is the potential for delays in ART initiation, which may substantially increase mortality risk.Specific tests that have evidence supporting their use in reducing mortality and are recommended to target treatment/prophylaxis to patients with HIV and low CD4 cell counts include tuberculosis (TB) smear, Xpert MTB/RIF and urinary lipoarabinomannan (LAM) for TB, and