6.3 Considerations for implementation

There are no new implementation considerations beyond the current standards of care for PLHIV. NTPs need to work closely with HIV programmes to further expand HIV testing and ART coverage among TB patients. A particular exception highlighted in the recommendation on timing of the ART relates to situations when signs and symptoms of meningitis are present. In general, it is recommended to start ART within 2 weeks of initiating TB treatment; however, caution is needed in PLHIV with tuberculous meningitis, because immediate ART is significantly associated with more serious adverse events. Thus, delaying ART for 4–8 weeks after initiation of TB treatment might be considered in these situations (38). In patients commencing ART with a CD4 count of less than 100 cells/mm³ , giving steroids may reduce TB-related IRIS.

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