It is important to acknowledge that there are situations where delays in starting ART can have negative consequences, particularly for people with tuberculosis (TB) or advanced immunosuppression, who are at high risk of death. People starting treatment and carergivers should be informed that the first ART regimen offers the best opportunity for effective viral suppression, immune recovery and consequently clinical benefit and that successful ART requires all medications to be taken as prescribed. Community and peer support can help a person to prepare and make the decision to start therapy. If the person faces mental health or substance use issues or other potential barriers to ART initiation or adherence, appropriate support should be provided and readiness to initiate ART should be reassessed at regular intervals. The choice to accept or decline ART ultimately lies with the person or his or her caregiver, and if they choose to defer initiation, ART can be offered again at subsequent visits. Initiation of ART should always consider nutritional status, any comorbidities and other medications being taken to assess for possible interactions, contraindications and dose adjustment. Retesting all people living with HIV before initiating ART is recommended to ensure a correct diagnosis of HIV infection. In the case of children with HIV, this conversation should directly involve the caregiver and include discussion about disclosing their HIV status. Preparing people living with HIV for ARTīefore people start antiretroviral therapy (ART), health-care providers should initiate a detailed discussion about the willingness and readiness of patients to initiate ART, the antiretroviral (ARV) drug regimen, dosage, scheduling, likely benefits, possible adverse effects and the required follow-up and monitoring visits.
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