New HIV Guideline: Universal Test and Treat (UTT)

07 Sep 2016
07 Sep 2016

New HIV Guideline: Universal Test and Treat (UTT)

From 1st September 2016, in the public sector, the following criteria to start patients on lifelong ART apply:

  • All HIV-positive children, adolescents and adults, regardless of CD4 count, will be offered ART treatment, prioritizing those with CD4 ≤350
  • Patients in the Pre-ART and Wellness Programme shall be considered for UTT
  • Willingness and readiness to start ART shall be assessed and patients who are not ready after assessment shall be kept in the Wellness Programme. Continuous counselling on the importance of early treatment and scheduled CD4 monitoring as per SA clinical guidelines shall continue at every visit
  • Baseline monitoring of CD4 count will still be done, as it is the key factor in determining the need to initiate opportunistic infection prophylaxis at CD4 ≤200, identify eligibility for CrAg at CD4 ≤100, prioritization at CD4 ≤350 and fast tracking at CD4 ≤200

            Timing of ART initiation

ART should be started as soon as the patient is ready and within 2 weeks of CD4 count being done.

Immediate priority:

All HIV-positive pregnant or breastfeeding women, with no active TB or contraindication to FDC (TDF/FTC/EFV)

Fast track initiation:

HIV stage 4 patients with CD4 ≤200 cells

In case of TB:

  • If diagnosed with TB, start TB treatment first, followed by ART as soon as possible and within 8 weeks:
    • If CD4 < 50 cells, initiate ART within 2 weeks after starting TB treatment, when the patient’s symptoms are improving and TB treatment is tolerated
    • If CD4 > 50 cells, initiate ART within 2-8 weeks after starting TB treatment
    • In cases with Cryptococcal or TB meningitis, defer ART initiation for 4-6 weeks