Adults Providing a package of essential interventions focuses attention on preventing, diagnosing and treating the most common causes of morbidity and mortality among people with advanced HIV disease. Identifying people with advanced HIV disease who are eligible for elements of a package of care requires CD4 testing. In addition, determining the immune status of people whose treatment is failing according to virological criteria can help in guiding clinical management decisions. Attention should also be paid to other important causes of severe illness not covered by the package, especially in regions in which specific comorbidities and coinfections are prevalent. Of note, increased pill burden and side-effects may affect treatment adherence, and intensified adherence support interventions are an important component of the advanced HIV disease package. To support treatment adherence, shorter regimens for TB preventive treatment are recommended (56). Identifying suitable screening tools for use is also an important research gap. Table 2 summarizes the specific components of the package of interventions that should be offered to people presenting with advanced HIV disease. Further information on current WHO recommendations is in the chapter on management of opportunistic infections. Additional detailed guidance on using systematic TB screening for people, including screening tools recommended for people living with HIV and diagnostic tools such as lateral flow urine lipoarabinomannan assay (LFLAM), WHO-approved molecular rapid diagnostics and TB preventive treatment, are available in the consolidated guidelines and operational handbooks for TB modules 1, 2 and 3 (56–58). Key considerations for managing TB disease are highlighted in the subsection on TB in this publication. Children All children younger than five years (who are not already receiving ART and clinically stable) are considered to have advanced HIV disease. Those who are established on ART and older than two years should not be considered to have advanced disease and should be eligible for multimonth dispensing (8). The main differences in the package of care for children compared with adolescents and adults is that routine cryptococcal antigen screening and pre-emptive therapy are not recommended for children younger than 10 years because of the low prevalence of cryptococcal meningitis in this age group. However, if a child younger than 10 years presents with signs and symptoms of meningitis, cryptococcal meningitis should still be considered and the appropriate investigations and treatment for this should be implemented (Tables 2, 3). The burden of TB is high among children living with HIV. Table 3 highlights the main recommendations for TB screening. WHO now suggests using integrated treatment decision algorithms for children younger than 10 years and concurrent testing of (1) respiratory samples and (2) stool with molecular WHO-recommended rapid diagnostics along with (3) urine testing using point-of-care LF-LAM testing for children living with HIV (59, 60). Concurrent use of the multiple sample types and tests should be given priority to maximize opportunities for confirming TB. Treatment for drug-sensitive TB among children comprises a four-drug regimen that includes rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) to be provided with available child-friendly, fixed-dose combinations in dispersible formulations to decrease the pill burden and facilitate administration for young children (61). Drug–drug interactions between rifampicin and lopinavir + ritonavir or dolutegravir need to be considered and ART dosing adjusted accordingly. Additional details are provided in the section on TB. Although rapid ART initiation within seven days of diagnosis is a priority, especially for children older than five years, children with severe acute malnutrition, TB meningitis or other severe illnesses need urgent clinical stabilization. However, initiating ART is encouraged as part of the child’s hospitalization, since referral after discharge may lead to loss to follow-up and failure to initiate ART. Among children with signs of or confirmed TB meningitis, ART initiation should be delayed in accordance with existing guidelines. Similarly, ensuring linkage to the facility in which the child will receive ongoing HIV care on discharge is critical. Preventing opportunistic infections in advanced HIV disease among children comprises rapid ART initiation, preventing TB disease with bacille Calmette-Guérin (BCG) vaccination and TB preventive treatment, preventing Pneumocystis jirovecii pneumonia with co-trimoxazole prophylaxis and administering age-appropriate vaccinations and catch-up vaccine administration when indicated (Table 3). Guidelines for managing HIV, TB, routine child health and development interventions (vitamin A, nutritional support, deworming and the Expanded Programme on Immunization) should align as much as possible to prevent multiple visits to health-care services. At the facility level, centres introducing the advanced HIV disease package for children should provide a child-friendly environment and ensure access to child-specific resources such as drug formulations for children, a mid-upper arm circumference tape, stadiometer, appropriate scales and expertise in phlebotomy for children. Health-care providers should be sensitized on child-specific issues such as growth monitoring and other routine child health interventions. Efforts should additionally be put in place to support and equip parents and caregivers to recognize warning signs and be able to reliably administer the prescribed medications. Clinical considerations The role of presumptive treatment is important in settings in which access to diagnostic tests is limited, especially if the person presenting to care is seriously ill.3 Other clinical conditions, such as elevated body temperature of ≥39°C, can also be considered based on local epidemiology and clinical judgement. People with advanced HIV disease may start both ART and prophylaxis at the same time (53). However, ART initiation should be deferred when clinical symptoms suggest TB meningitis or cryptococcal meningitis to avoid paradoxical worsening of the existing infection, which can be life-threatening