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Advise the patient with HIV• Support by encouraging disclosure and referring to counselor/support group. Advise patient’s partner/s and children be tested for HIV.• Encourage patient to have 1 partner at a time. Advise safe sex even if partner has HIV or patient on ART. Demonstrate and give male/female condoms.• Educate patient that treatment for HIV requires lifelong adherence.• Ensure the patient about to start ART attends drug-readiness training.• Give increased adherence support to the patient with < 80% adherence, poor attendance or viral load > 400:--Educate on the importance of adherence and dangers of resistance.--Refer for support: adherence counselor, support group, treatment buddy, CCW.--Plan with patient how to take treatment. Consider adherence aids (pillboxes, diaries).--See the patient more frequently (weekly instead of monthly).Treat the patient with HIV• Give co-trimoxazole 960mg daily (2 single strength tablets) if stage 2, 3 or 4 or CD4 ≤ 200. Adjust dose if eGFR 10–50: 480mg daily; if eGFR < 10: 480mg 3 times a week.• Give IPT: isoniazid 5mg/kg (up to 300mg) daily. Do not give if TB symptoms, on TB treatment, previous IPT, liver disease or alcohol abuse. If needing ART, start ART before IPT. Decide when to stop IPT 64.• Give pyridoxine 25mg daily while on TB treatment or IPT.• If on ART, continue ART lifelong unless on maternal ART prophylaxis – decide when to stop maternal ART prophylaxis using step 6 64.• If not on ART, start ART if CD4 ≤ 350 or stage 3 or 4 or if pregnant or breastfeeding (regardless of CD4 or stage) using steps 1–4:1. Decide which ART regimen the patient needsHas patient had 2 or 3 ARVs for longer than 1 month in the past?NoYesDoctor review: Patient previously adherent on standard regimen 1 ART, did not have ART side effects and currently well?YesNoViral load previously < 400 or unavailableViral load previously > 1000 on 2 occasionsChoose regimen 1 ARTTDF and 3TC and EFV or fixed dose combination (FDC) TDF/FTC/EFV if available unless:• Depression or psychosis: use NVP instead of EFV. If CD4 > 250 (woman) or > 400 (man), refer/discuss.• If pregnant with depression, psychosis, known kidney disease, diabetes, hypertension or≥ 2+ proteinuria, start AZT 300mg 12 hourly instead of regimen 1 ART and refer to doctor.Choose regimen 2 ARTLPV/r and 3TC and:• AZT if currently using TDF or• TDF if currently using AZT or d4TDo not stop TDF if hepBsAg positive.Discuss with an experiencedART clinican if unwell, notadherent, had an ART sideeffect or previous ART was notFTC/3TC, TDF/d4T, EFV/NVP2. Check baseline bloods according to regimen 62:• If patient not pregnant, review patient with results within 2 weeks.• If patient pregnant, start ART same day and review baseline blood results within 1 week.3. Decide when to start ART:• If patient pregnant, start ART same day. If pregnant and starting TB treatment, give AZT 300mg 12 hourly and switch to ART after 2 weeks.• If patient has TB and CD4 ≤ 50, start ART within 7 days. If CD4 50–350 start ART within 2–8 weeks of starting TB treatment once tolerating TB treatment. If CD4 > 350 start ART at 8 weeksof TB treatment• If TB meningitis or cryptococcal meningitis, start ART after 4–6 weeks of treatment.• If patient does not have TB, start ART within 7 days if CD4 < 200 or stage 4, otherwise within 2 weeks.63