Table 3.

Evolving criteria for ART initiation and ART monitoring in South Africa from 2004 to 2016

Year	Guidelines	ART initiation criteria/CD4 and VL monitoring
2004	National ARV Treatment Guidelines (2004)36	Criteria for ART initiation  CD4 <200 cells/mm3 irrespective of stage or WHO stage IV AIDS-defining illness, irrespective of CD4 count, and patient expresses willingness and readiness to take ART adherently ART monitoring  CD4: staging and every 6 months  VL: staging and every 6 months
2010	The South African Antiretroviral Treatment Guidelines 201037	Criteria for ART initiation  CD4 count <200 cells/mm3 irrespective of clinical stage or CD4 count <350 cells/mm3 in patients with TB/HIV or pregnant women or WHO stage IV irrespective of CD4 count or MDR/XDR irrespective of CD4 Require fast track (ie, ART initiation within 2 weeks of being eligible)  Pregnant women eligible for lifelong ART, patients with very low CD4 (<100)  Stage 4, CD4 count not yet available  MDR/XDR TB ART monitoring  CD4: staging, 6 and 12 months and annually thereafter  VL: 6 and 12 months and annually thereafter
2011	Circular on New Criteria for Initiation of Adults on ART at CD4 Count of 350 cells/mm3 and below, 26 August 2011	Baseline CD4 for initiation at CD4 <350 cells/mm3
2012	Accelerating Access to ART Services and Uptake (circular), 17 April 2012	Criteria for ART initiation  CD4 count <350 cells/mm3 irrespective of clinical stage or patients with TB/HIV irrespective of CD4 count or pregnant women or WHO stage IV irrespective of CD4 count or MDR/XDR irrespective of CD4 Require fast track (ie, same day ART initiation)  Pregnant women eligible for lifelong ART, patients with low CD4 (<200)  Stage 4, CD4 count not yet available  MDR/XDR TB  Screening and treatment of patients with very low CD4 counts (<100) for cryptococcal infection ART monitoring  CD4: staging, 12 months and annually thereafter  VL: 6 and 12 months and annually thereafter
2013	The South African Antiretroviral Treatment Guidelines 201338	Criteria for ART initiation  CD4 count <350 cells/mm3 irrespective of WHO clinical stage or irrespective of CD4 count and all types of TB (In patients with TB drug resistance or sensitivity, including extrapulmonary TB) and WHO stage 3 or 4 irrespective of CD4 count Require fast track (ie, ART initiation within 7 days of being eligible)  HIV-positive women who are pregnant or breast feeding or patients with low CD4 <200 or patients with stage 4, irrespective of CD4 count or patients with TB/HIV comorbidity with CD4 count <50 (patients with Cryptococcus meningitis or TB meningitis (defer ART for 4–6 weeks) ART monitoring  CD4: staging and 1 year  VL: 6 and 12 months and annually thereafter
2015	National Consolidated Guidelines for the Prevention of Mother-to-Child Transmission of HIV and the Management of HIV in Children, Adolescents and Adults 201539	Criteria for ART initiation  CD4 count<500 cells/mm3 irrespective of WHO clinical stage or all types of TB or WHO stage 3 or 4 or HBV coinfection irrespective of CD4 count Immediate initiation  All HIV-positive pregnant or breastfeeding women, as long as no active TB Require fast track (ie, ART initiation within 7 days of being eligible)  Patients with low CD4 <200 or patients with stage 4, irrespective of CD4 count ART monitoring  CD4: staging and 1 year  VL: 6 and 12 months and annually thereafter
2016	Circular on Implementation of the Universal Test and Treat Strategy for HIV Positive Patients and Differentiated Care for Stable Patients, 22 August 201640	Criteria for ART initiation  All HIV-positive adolescents and adults regardless of CD4 count ART monitoring  CD4 staging and 1 year  VL monitoring at 6 and 12 months and annually thereafter

ART, antiretroviral therapy; TB, tuberculosis; VL, viral load.