The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease.

中文翻译：

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制定晚期艾滋病毒目标：行动呼吁。


世界卫生组织 (WHO) 发布了晚期艾滋病毒 (AHD) 患者的管理指南，以减少与艾滋病毒相关的死亡。该指南由一揽子建议组成，包括预防、诊断和治疗常见机会性感染（包括结核病（TB）、隐球菌病和严重细菌感染）的干预措施，以及快速启动抗逆转录病毒治疗和加强依从性支持。目前这些关键干预措施尚无明确的目标。来自乌干达、坦桑尼亚和尼日利亚的新规划数据表明，估计有 80% 的符合条件的人仍然错过了建议的隐球菌或结核病检测，这突显了在现实世界资源中有效实施世卫组织推荐的 AHD 护理方案仍然面临的挑战。有限的设置。由于缺乏确定死因的机制，缺乏艾滋病毒相关死亡主要原因的死亡率指标，对制定降低死亡率的干预措施产生了负面影响。我们建议，为 CD4 检测、隐球菌抗原和结核病检测以及与世卫组织 AHD 一揽子护理相一致的治疗设定 95-95-95 的目标，将是朝着实现世卫组织终结结核病这一更大目标的正确方向迈出的一步。战略和拟议的结束隐球菌性脑膜炎死亡的新战略。然而，只有对医护人员进行培训，扩大住院患者和符合 AHD 标准的门诊患者获得床边护理点诊断的机会，并加强卫生系统以尽量减少启动治疗的延误，这些目标才能实现。世界卫生组织推荐的结核病和隐球菌病治疗方法。