Table 13. Immunologic failure risk assessment and management tool.

Circle any that applies: 1. Baseline CD4 cell count ≥350/mm3? Yes No 2. Baseline WHO Stage III or IV? Yes No
High risk for immunologic treatment failure if answer to either of the questions is Yes. Low risk otherwise.
Date	Month on ART	Adherence*	ART regimen	CD4 count	Immunologic failure** (Y or N)	Decision***	Appointment date
	0
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
	17
	18
	19
	20
	21
	22
	23
	24

*Adherence = G (Good) if missed doses<3 per month; F (Fair) if missed doses 3–5 and 3–9 for 30 and 60 doses regimen per month respectively; P (Poor) if missed doses >5 or >9 for 30 and 60 doses regimen per month respectively.

**Immunological failure criteria: 1.50% below maximum follow-up CD4 cell count; 2. at or below baseline CD4 cell count; 3. persistently below 200. The presence of any one of these criteria in patients who have been taking antiretroviral treatment for at least six months and is still on treatment is used to diagnose it [17, 27].

*** Decision: (Use if there is immunologic failure)

0 = Re-evaluate with CD4 cell count

1 = Re-enforce adherence

2 = Re-evaluate with viral load

3 = Regimen change to second line