Table 1.
Collaborative TB/HIV Activities | Research question | Expected programmatic impact |
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A. Establish the mechanisms for collaboration
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A.1. Coordinating bodies for TB/HIV activities A.2. Surveillance of HIV prevalence in TB patients A.3. Joint TB/HIV planning A.4. Monitoring and evaluation |
1. What are the best models of delivery of integrated HIV and TB services which may also include maternal and child health and chronic non-communicable diseases like diabetes? | 1. Increased uptake of HIV testing and care for TB patients, and better TB case finding in pre-ART and ART clinics |
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B. Decrease the burden of TB in PLHIV
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B.1. Establish intensified TB case-finding (ICF) B.2. Introduce isoniazid preventive therapy (IPT) B.3. Ensure TB infection control (IC) B.4. Better coverage and earlier use of ART |
1. Does a strategy of empirical TB treatment reduce early mortality in PLWH with low CD4+ counts who are about to start ART compared with a strategy of ICF using established or new TB diagnostic tests? | 1. Reduced early mortality in PLWH starting ART |
2. Does universal HIV testing and early initiation of ART reduce individual and community risk of TB? | 2. Reduced TB incidence in PLWH and high HIV-prevalence communities | |
3. What is the optimum frequency of repeat ICF after baseline screening in pre-ART and ART clinics? | 3. Evidence to guide baseline and serial ICF leading to increased TB diagnosis | |
4. What is the most cost-effective TB diagnostic screening algorithm for ICF in pre-ART and ART clinics using smear microscopy, Xpert MTB/RIF and urine LAM? | 4. Evidence to guide the strategic use of current TB diagnostic tests leading to increased TB diagnosis | |
5. In health facility and congregate settings, how should TB infection control be routinely monitored, recorded and reported? | 5. Better implementation of TB infection control practices | |
6. Is long-term IPT in PLWH before or after the start of ART acceptable to patients and effective in reducing risk of TB without generating drug resistance? | 6. Increased use of IPT which is effective and safe in reducing the risk of TB | |
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C. Decrease the burden of HIV in TB patients | ||
C.1. Provide HIV testing and counselling C.2. Introduce HIV prevention methods C.3. Introduce CPT C.4. Ensure HIV/AIDS care and support C.5. Introduce ART |
1. Does HIV testing of TB suspects and referral of HIV-positive patients to structured HIV care lead to a better prognosis in this group? | 1. Reduced mortality in TB suspects and improved likelihood of TB being diagnosed within structured HIV care |
2. What is the most effective and safest dose of rifabutin to use with protease inhibitors in second-line ART? | 2. Improved treatment of TB in PLWH who have failed first-line ART | |
3. Can mobile phone technology improve adherence to care and treatment for HIV-infected TB patients? | 3. Improved TB treatment success and better retention in HIV care and ART for co-infected patients |
TB = tuberculosis; CPT = cotrimoxazole preventive therapy; ART = antiretroviral therapy; PLWH = people living with HIV/AIDS; ICF = intensified TB case finding; IPT = isoniazid preventive therapy; IC = infection control; LAM = lipoarabinomannan