Chemotherapeutic treatment for HIV-associated Kaposi’s sarcoma is only for those with Kaposi’s sarcoma diagnosis confirmed by histopathology. Clinical diagnosis of Kaposi’s sarcoma, which is based on the macroscopic appearance of the Kaposi’s sarcoma lesions, has suboptimal positive predictive value – about 23–42% of diagnoses based on clinical suspicion alone are not Kaposi’s sarcoma (195–197). The Guideline Development Group noted that in special situations in which access to the preferred treatment options is lacking, other available treatments can be considered, noting their limitations and side-effects, such as the combination of bleomycin + vincristine, gemcitabine or etoposide. No specific recommendation was made for these treatment options.

• Importance of diagnosis and screening for Kaposi’s sarcoma: correctly identifying Kaposi’s sarcoma is a challenge in many low- and middle-income settings and is often misdiagnosed as other diseases. Training health-care workers is critical for ensuring accurate clinical diagnosis. Linking to histopathological infrastructure is also important.
• Timely ART initiation: ART remains central to the treatment approach for Kaposi’s sarcoma.
• Importance of access to cancer treatment: countries should take steps to promote and provide access to cancer treatment (Table 10).
• Integrated care models may be considered to distribute limited resources in the most effective manner.
• Capacity building and training: important to support and train health-care workers for identifying and managing Kaposi’s sarcoma, identifying and managing toxicity from treatment and approaches to counselling individuals with Kaposi’s sarcoma.
• Monitoring and follow-up: since Kaposi’s sarcoma is known to recur among people previously treated for Kaposi’s sarcoma, regular follow-up and identifying potential adherence challenges in individuals who present to care with Kaposi’s sarcoma recurrence and retreatment are important.
• Stigma and psychosocial support: HIV programmes must take steps to support individuals with Kaposi’s sarcoma who report stigmatization through counselling and psychosocial support to ensure that these individuals access and complete treatment for Kaposi’s sarcoma.