These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income.

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What is new in the 2020 guidelines update? Key updates ÿ A recommendation for dolutegravir (DTG)-based therapies as the preferred first-line antiretroviral therapy (ART) option (section 11). ÿ Updated guidelines for second-and third-line ART regimens (section 13). ÿ New recommendations on the management of patients on DTG-based therapies who have an elevated viral load (section 12). ÿ A lowering of the threshold for virological failure from 1000 copies/mL to 50 copies/mL (section 8). ÿ A recommendation against routine cluster of differentiation 4 (CD4 + ) monitoring in patients who are clinically well once the CD4 + count is > 200 cells/μL (section 9). ÿ Updated recommendations for isoniazid preventive therapy (IPT) in human immunodeficiency virus (HIV)-positive patients (section 27). ÿ A recommendation for the use of low-dose prednisone as prophylaxis for paradoxical tuberculosis (TB) immune reconstitution inflammatory syndrome (IRIS) in TB/HIV co-infected patients commencing ART within 1 month of TB therapy (section 26).

The majority of Canadian spine surgeons were open to an NPC model of care to assess and triage nonurgent or emergent low back-related complaints. Clinical trials to establish the effectiveness and acceptance of an NPC model of care by all stakeholders are urgently needed.

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