These recommendations would apply equally to people who present to care again after a period of disengagement from care with advanced HIV disease. Cryptococcal antigen screening followed by pre-emptive therapy would be preferrable over providing fluconazole primary prophylaxis when considering cost, the potential for developing antifungal resistance and concerns about fetal safety among women of childbearing age without access to adequate contraception. Fluconazole primary prophylaxis should be made available in settings in which cryptococcal antigen screening is not available or there may be prolonged delays in receiving the result since cryptococcal disease and mortality peak in the first four weeks among people presenting with a CD4 cell count <100 cells/mm3 (55). National guidelines should determine the optimal duration of prophylaxis based on available resources. The duration of fluconazole primary prophylaxis differed in the randomized trials that support the clinical benefit of this intervention. In the REALITY trial conducted in Kenya, Malawi, Uganda and Zimbabwe, fluconazole (100 mg once daily) was discontinued after 12 weeks (55). In another trial conducted in Uganda in the era of ART, fluconazole (200 mg three times per week) was discontinued when participants’ CD4 cell counts reached 200 cells/mm3 (126). These recommendations apply to adults and adolescents with advanced HIV disease. The decision to not extend these recommendations to children was based on the recognition that cryptococcal disease in this age group is rare, even in countries with high incidence