PAHO | Bigg Rec

Bibliographic information

GuidelineConsolidated HIV guidelines: service delivery

Year of Publication2026

Issuing InstitutionWorld Health Organization

Maintained

Antiretroviral therapy (ART) initiation should be offered on the same day to people who are ready to start

Recommended in favor

Strong

Certainty of evidence

High

Treatment literacy and psychosocial readiness for initiation should be assessed. However, initiation should not be delayed to complete counselling content. Counselling should be scheduled over the initial weeks of treatment. Consider options to provide this initial counselling and assessment of treatment literacy remotely or in the community.
Confirmatory HIV testing should be carried out. CD4 cell count testing and clinical assessment should be performed to determine whether the client has advanced HIV disease and to prevent opportunistic infections.
Among people with TB symptoms, evidence supports starting ART while investigating for TB (10). ART initiation should be delayed among people with meningitis and cryptococcal meningitis because of the increased risk of severe adverse events and immune reconstitution inflammatory syndrome. Cryptococcal meningitis is diagnosed with serum cryptococcal antigen screening and confirmed by cerebrospinal fluid analysis.
People should not be coerced to start immediately and should be supported in making an informed choice regarding when to initiate ART.