ART in children and adolescents living with HIV aims to improve the length and quality of life, reduce HIV-related morbidity and mortality by reducing the incidence of opportunistic infections (including TB), reduce the viral load, restore and preserve immune function, and restore and preserve normal growth and development. ART improves TB treatment outcomes for children and adolescents living with HIV (6).
WHO recommends that ART should be initiated in all adolescents and children living with HIV, regardless of WHO clinical stage and CD4 cell count. Rapid initiation of ART (within 7 days from the day of HIV diagnosis) should be offered to all people living with HIV following a confirmed HIV diagnosis and clinical assessment. Children and adolescents with advanced HIV disease should be given priority for assessment and initiation. Initiation of ART should be offered on the same day to people living with HIV who are ready to start (78).
Initiation of ART should follow the overarching principles of people-centred care. People-centred care is focused and organized around the health needs, preferences and expectations of people and communities; upholds individual dignity and respect, especially for vulnerable populations; and engages and supports people and families to play an active role in their own care by informed decisionmaking. People living with HIV should be encouraged but not coerced to start ART immediately and should be supported in making an informed choice regarding when to start ART and what regimen to use (78).