As HIV services integrate, how do we protect advanced HIV disease care?
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Across many high-burden countries, HIV programs are entering a period of significant transition. As donor funding shifts and health systems face growing pressure to deliver more with fewer resources, countries are increasingly integrating HIV services into broader health care systems. This shift offers important opportunities to improve efficiency, strengthen sustainability, and ensure that HIV services remain accessible in the long term.
At the same time, integration is occurring against a backdrop of unprecedented financing uncertainty. Changes to major global funding streams, workforce reductions, and evolving implementation models are forcing programs to rethink how HIV services are organized and delivered. While these transitions may support more resilient health systems over time, they also raise important questions about how differentiated services will be maintained—particularly among the most vulnerable recipients of care.
Few populations illustrate this challenge more clearly than people living with advanced HIV disease (AHD).
Despite substantial progress in HIV treatment and prevention, AHD remains a major contributor to AIDS-related morbidity and mortality. Individuals with AHD often require services that extend beyond routine HIV care, including CD4 testing, screening and treatment for opportunistic infections such as tuberculosis and cryptococcal disease, rapid treatment initiation and optimization, prophylaxis, and intensive follow-up. These interventions, collectively captured within the WHO AHD package of care for adults and the STOP-AIDS package of care for children, have been shown to reduce mortality and improve outcomes when implemented effectively.
As HIV services become more integrated, there is an opportunity to expand access to AHD care by embedding these interventions within broader health systems and primary care platforms. Integration can strengthen referral networks, improve continuity of care, and help ensure that AHD services are not confined to a small number of specialized facilities.
However, integration also carries risks. Specialized expertise may become diluted. Critical diagnostic and treatment commodities may become harder to prioritize within broader procurement systems. Monitoring frameworks may lose visibility of AHD-specific indicators. Without deliberate planning, the patients with the most complex needs risk being left behind.
These challenges are particularly important for children and adolescents, who continue to experience substantial inequities in HIV outcomes and often face additional barriers to accessing timely diagnosis and comprehensive AHD services.
As countries navigate this evolving landscape, several questions emerge:
How do programs maintain access to the diagnostic and treatment commodities needed to identify and manage AHD?
How do programs ensure AHD remains prioritized within integrated systems?
What role can communities play in identifying, linking, and supporting people with AHD—and how can these approaches be sustained?
These questions will be explored during the AIDS 2026 satellite session, Sustaining Advanced HIV Disease Care: Lessons from Program Integration and Country Experiences, co-hosted by Unitaid and CHAI. Bringing together representatives from ministries of health, community organizations, global agencies, and implementation partners, the session will examine how countries are adapting AHD services in the face of changing funding realities and evolving health system structures.
 Through the generous support of Unitaid, the Clinton Health Access Initiative (CHAI)-led THRIVE Project is enabling access to critical prevention, screening, and treatment commodities for advanced HIV disease to dramatically reduce mortality among adults and children living with HIV. The THRIVE project is conducted in partnership with AFROCAB and Penta. Â
 Disclaimer: The views expressed are those of CHAI and do not necessarily reflect those of Unitaid or other partners.