# Advanced HIV Diseases (AHD)

# Overview

Overview of the AHD module

# Introduction

## What is Advanced HIV Disease (AHD)?

Advanced HIV Disease (AHD) refers to a stage of HIV infection where the immune system is severely weakened, typically defined by:

- CD4 count < 200 cells/mm³, or
- WHO clinical stage 3 or 4 conditions.

It often includes opportunistic infections such as TB, cryptococcal meningitis (CM), or other severe clinical manifestations.

## Why AHD Screening is Important

- Early identification of patients at high risk of opportunistic infections.
- Integration with ART workflows to streamline management.
- Compliance with WHO AHD guidelines.

## Integration into EMR

The AHD module is designed to work within the Point of Care (POC) [ART module](https://bookstack.hismalawi.org/books/egpaf-his/page/art-module "ART Module") of the national EMR, facilitating early detection and prompt treatment.

## Goals

- Improve patient outcomes through earlier detection.
- Standardize AHD data collection.
- Enable real-time decision-making at the facility level.

# Functional Requirements

The following are the functional capabilities required for the AHD module within the ART POC system.

## 1. User Management
- Create and manage user accounts.
- Assign roles and permissions (e.g. ART Provider, Clerk, Administrator).

## 2. Client Registration
- Capture patient demographics:
  - Name, birth date, gender, region, village, phone number, etc.
- Generate unique patient identifier and barcode.

## 3. AHD Screening Workflow
- Trigger AHD screening based on:
  - Vitals (e.g., fever ≥39°C, HR ≥120 BPM)
  - CD4 count < 200
  - WHO stage 3/4
  - Reported symptoms
- Prompt for TB/CrAg screening, KS symptoms, and drug prescriptions.

## 4. OI Screening & Lab Orders
- Enter and order tests:
  - CD4
  - TB (LAM, microscopy, culture)
  - CrAg (Serum and CSF)
- Capture results and link to patient record.

## 5. Summary & Follow-up
- Provide AHD summary with test results.
- Support next appointment booking based on assessment outcome.

# CD4 Testing and Staging Workflow

## Purpose
This page outlines the clinical workflow for CD4 testing and AHD staging within the ART POC module.

## Step-by-Step

1. **CD4 Test Entry**
   - Enter CD4 result or place lab order.
   - Capture test location and date.

2. **Auto-Staging**
   - System computes WHO staging based on symptoms and test results.
   - CD4 < 200 triggers AHD warning.

3. **Trigger Criteria for AHD Screening**
   - CD4 < 200
   - WHO stage 3 or 4
   - Critical illness flags from vitals

4. **System Prompt**
   - System presents a pop-up:
     > "Client meets AHD screening criteria. Proceed to OI screening?"

## Data Elements
| Field | Type | Required | Notes |
|-------|------|----------|-------|
| cd4_result | Integer | Yes | Required for AHD trigger |
| test_date | Date | Yes | |
| test_location | Text | Yes | Lab name |

# Workflows



# AHD Summary Page

## Purpose
Summarizes all AHD-related screenings, test results, and clinical decisions made during the encounter.

## Displayed Fields
- CD4 count result and date
- TB Screening: Ordered, completed, result
- Serum CrAg: Ordered, completed, result
- CSF CrAg: if applicable
- KS symptoms and Biopsy (if available)
- Final staging and decision made

## Example Output
```plaintext
AHD Status: Positive
- CD4: 137 (23-Apr-2025)
- TB LAM: Negative
- Serum CrAg: Positive
- CSF CrAg: Pending
- KS symptoms: None
Recommended Action: Proceed to CM treatment

# CD4 Testing and Staging Workflow

## Purpose
This page outlines the clinical workflow for CD4 testing and AHD staging within the ART POC module.

## Step-by-Step

1. **CD4 Test Entry**
   - Enter CD4 result or place lab order.
   - Capture test location and date.

2. **Auto-Staging**
   - System computes WHO staging based on symptoms and test results.
   - CD4 < 200 triggers AHD warning.

3. **Trigger Criteria for AHD Screening**
   - CD4 < 200
   - WHO stage 3 or 4
   - Critical illness flags from vitals

4. **System Prompt**
   - System presents a pop-up:
     > "Client meets AHD screening criteria. Proceed to OI screening?"

## Data Elements
| Field | Type | Required | Notes |
|-------|------|----------|-------|
| cd4_result | Integer | Yes | Required for AHD trigger |
| test_date | Date | Yes | |
| test_location | Text | Yes | Lab name |