What is it about?
People with advanced HIV disease (AHD), defined as a CD4 count below 200 cells/mm³ or WHO clinical stage 3 or 4, should receive the WHO package of care to meet their specific healthcare needs. Implementation of the WHO-recommended package of care for advanced HIV remains suboptimal across many sub-Saharan African countries. We examined the challenges contributing to persistent implementation gaps in resource-constrained settings. Key findings • Adherence support is routinely provided, but other critical components are inconsistently implemented. • Limited access to diagnostics (e.g., CD4, TB, Cryptococcal screening), ineffective referral and linkage, underutilization of available services by spoke facilities undermines timely and effective care. • Supply chain disruptions and shortages of essential medicines remain major barriers. • Lack of differentiated and specialized AHD services affects quality of care for high-risk patients. • Patient-level challenges (clinical severity, psychological unreadiness, financial constraints) further impede AHD care continuum.
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Why is it important?
Advanced HIV remains a significant yet underexplored challenge in HIV care. Over the past decade, it has been neglected, with inadequate resources and limited research dedicated to its prevention, screening, diagnosis, diagnosis, and treatment. Understanding the challenges in implementing WHO-recommended package of care for AHD patients in resource-constrained settings can inform policy and programmatic changes to improve care for patients with AHD.
Perspectives
These challenges show a major gap in the continuum of care for people with AHD and emphasize the urgent need for targeted interventions, including health system strengthening, reliable supply systems, and tailored service delivery models are urgently needed to achieve the global goals on HIV. Suboptimal implementation of established recommendations, compounded by recent funding cuts, could reverse global efforts to end the AIDS epidemic as a public health threat by 2030.
Temesgen Leka Lerango
Dilla University
Read the Original
This page is a summary of: Challenges in implementing the WHO-recommended package of care for advanced HIV disease in resource-constrained settings: A mixed-methods study, PLOS One, January 2026, PLOS,
DOI: 10.1371/journal.pone.0341162.
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