Training Adequate training needs to be provided to healthcare workers on conducting WHO clinical staging and giving priority to medical personnel for conducting clinical staging of clients. Clinical protocols Symptom-based diagnosis protocols should be developed along with support for additional diagnostics for opportunistic infections for completeness of clinical staging. Referral pathways Clear referral pathways need to be developed following clinical staging owing to limitations to correctly identify advanced HIV disease but also since sites offering clinical staging may not have access to other diagnostics necessary to complete clinical staging. Monitoring, training and quality assurance Programmes should adequately monitor the implementation of clinical staging and develop quality assurance systems, owing to the evidence around a lack of consistency and information on how clinical staging was conducted and who conducted it. Resource priority-setting Improving access to CD4 testing is critical rather than primarily investing resources in training health-care workers on clinical staging owing to the limited improvements in accuracy expected with its use and highly variable costs. Training healthcare workers on performing a physical examination may contribute to improved clinical care overall but CD4 testing would have to be scaled up since many individuals with advanced HIV disease may not have any clinically identifiable signs or symptoms of disease but continue to have an elevated risk of developing opportunistic infections. Use of CD4 testing additionally would support the rapid roll-out of testing for advanced HIV disease and improve coverage of screening for advanced HIV disease compared with clinical staging.