Indications for CD4 testing in HIV programmes. CD4 testing to identify advanced HIV disease among people living with HIV who are: a. initiating or reinitiating ART b. re-engaging in care following disengagement c. have treatment failure or clinically identified treatment failure d. hospitalized or seriously ill or are considered clinically unstable. CD4 testing to support the identification of treatment failure when viral load testing is unavailable CD4 testing to assess eligibility to stop co-trimoxazole prophylaxis CD4 testing to assess eligibility for fluconazole prophylaxis. Key considerations for pointof-care and lab-based tests Programmes should give priority to developing job aids or tools to support the reading of point-of-care test results for health-care workers. Current evidence on point-of-care testing Point-of-care CD4 testing can provide more rapid test results, during a single health-care visit, to enable rapid clinical decision-making (47). This is likely to be critical for people living with advanced HIV disease. Two assays remain on the market and are available for procurement (48). Training and task sharing Health cadres (community health workers, nurses, and laboratory personnel) should undergo training on point-of-care CD4 tests and on conventional CD4 testing. Task-sharing approaches could help to lower implementation costs and improve CD4 coverage within HIV programmes (49–52). Monitoring and quality assurance Implementation of robust monitoring and quality assurance systems to maintain testing standards for CD4 testing is an important component of implementing and scaling up CD4 testing. Integration and referral pathways The Guideline Development Group considered CD4 testing suitable for integrated care initiatives between HIV and other disease programmes or primary health care depending on the specific context. The Guideline Development Group noted the importance of having clear referral pathways for individuals who are identified to be seriously unwell with advanced HIV disease. Diagnostic networks Box 1. Who needs a CD4 test (adults, adolescents and children)? Indications for CD4 testing in HIV programmes CD4 testing to identify advanced HIV disease among people living with HIV who are: a. initiating or reinitiating ART b. re-engaging in care following disengagement c. have treatment failure or clinically identified treatment failure d. hospitalized or seriously ill or are considered clinically unstable CD4 testing to support the identification of treatment failure when viral load testing is unavailable CD4 testing to assess eligibility to stop co-trimoxazole prophylaxis CD4 testing to assess eligibility for fluconazole prophylaxis 10 would need to be optimized in programmes in which more than one type of CD4 test (conventional and point-of-care tests) are being used and ensuring that the type of test is matched to the facility (conventional CD4 tests for higher-volume sites).