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Continue to assess the patient with HIVAssess When to assess NoteIPT screen If no TB symptoms and never had IPT • Do TST 1 : clean arm with alcohol swab, pull skin taut and inject 2 units PPD-RT23 or 5 units PPD-S into skin to see weal develop.• Measure swelling after 48–72 hours. ≥ 5mm is a positive TST. Give IPT according to result and whether on ART or not 63.Pap smear At diagnosis and if normal yearly 27CD4• Pre-ART: at diagnosis, then 6 monthly • If CD4 ≤ 200, give co-trimoxazole 63. Stop after 1 year if CD4 > 200 and patient is well on ART.• On ART: at 12 months on ART• If CD4 ≤ 350 give ART 63.ART bloods At baseline and on ART Check blood according to ART regimen and review result as below.Baseline 1st regimen Baseline 2nd regimen 3 months on ART 6 months on ART 1 year on ART YearlyTDF: eGFR 2Viral loadNVP: ALTAZT: Hb +diffViral load• If starting TDF: eGFR 2• If currently on TDF: HepBsAg• AZT: Hb + diffAZT: Hb+diffTDF: eGFR 2LPV/r: fasting cholesterol & triglyceridesTDF: eGFR 2TDF: eGFR 2 CD4TDF: eGFR 2Viral loadALT• If baseline ALT ≥ 100, refer to doctor: refer if signs of liver failure. If well, doctor to start ART (avoid NVP) and repeat ALT after 1 week.• Check ALT if non-severe rash develops on NVP. (Refer same day the patient with a severe rash 40).--If ALT 50–199 and patient well: continue NVP once a day, repeat ALT in 1 week.--If ≥ 200 or unwell: stop ART and refer same day.--If ALT < 50 and rash resolved increase NVP to 12 hourly.eGFR• Estimated glomerular filtration rate reflects kidney function. Request eGFR on request form and give age, weight and sex.(creatinine clearance)• If baseline eGFR < 60, doctor to review: avoid TDF and adjust doses of ART and co-trimoxazole 64.• On ART, if eGFR < 60 and patient unwell, refer same day. If well and eGFR < 60, doctor to switch TDF to AZT/d4T, stop NSAIDs/streptomycin, check BP and for proteinuria and discuss with specialist.Creatinine if pregnantIf creatinine at baseline or on ART is > 85, discuss/refer.Hb and diff• If baseline Hb < 8, doctor to investigate anaemia and avoid AZT.• Once on ART, if Hb < 8 or neutrophils < 0.75, switch to TDF or d4T.HepBsAgIf hepBsAg positive, do not stop TDF or start regimen 2, and refer to doctor.Fasting cholesterol, triglycerides Refer urgently same day if triglycerides >15 (risk of pancreatitis). If cholesterol > 8 or triglycerides > 8.5, refer to specialist.Viral load• Viral load 400–1000: Give increased adherence support 63 and repeat viral load in 6 months.• Viral load on ART should be • Viral load > 1000 for the 1st time: Give increased adherence support 63 and repeat viral load after 2 months.< 400• Viral load > 1000 for the 2nd time: If getting increased adherence support 63 and adherence > 80%, doctor to switch to regimen 2 ART 63. If failing regimen 2, refer.CD4 Decide when to stop co-trimoxazole and fluconazole prophylaxis 64.Lactate• Check rapid/on-site venousblood lactate (uncuffed).• If lactate < 2.5: if > 1 of weight loss, nausea, vomiting, abdominal pain, shortness of breath and fatigue, refer for laboratory lactate. Look for other cause. Repeat after 1 week.• If lactate ≥ 5: refer same day to hospital.• If lactate 2.5–4.9 and respiratory rate ≥ 20 breaths/minute: refer same day to hospital.• If lactate 2.5–4.9 and respiratory rate < 20 breaths/minute: switch d4T to TDF and recheck lactate after 3 days. If lactate falls and symptoms improve, recheck weekly until normal. Ifsymptoms worse and/or lactate is increasing, stop ART and discuss with specialist.Advise and treat the patient with HIV 63 and 64.1Tuberculin Skin Test (Mantoux ® ) 2 If patient is pregnant, use creatinine instead of eGFR.HIV62