FIGURE 3.

TPT delivery for stable PLHIV in DSD: conceptual example of a community-based model. PLHIV stable on ART are enrolled in a DSD model that consists of 6-month clinic visits with TPT dispensed monthly in the community. At the routine 6-month clinic visit, PLHIV are counseled on benefits of TPT and on potential TPT-related AEs using standardized education materials, then given a 1-month supply of TPT. They receive a TPT assessment (screening for presumptive TB, AEs, and adherence) 1 month later at a clinic visit or a community-based group meeting. If no presumptive TB, serious AEs, or adherence concerns are identified, they are given another 1-month supply of TPT along with ART. They continue to receive a TPT assessment at each of their group meetings at Months 2–5. At the next 6-month clinic visit, a TPT assessment and evaluation for completion is conducted by the clinician. The advantage of this model is that stable PLHIV on ART only ‘break’ their regular cycle of 6-month facility visits once if the program decides they must go to a clinic for their 1-month TPT assessment. Of note, this model can be adapted for community ART groups as well, with all eligible PLHIV in the group potentially initiating and completing TPT together, which may reinforce adherence and reporting of possible presumptive TB or TPT-related AEs. ART = antiretroviral therapy; TPT = TB preventive treatment; TB = tuberculosis; AE = adverse event; PLHIV = people living with HIV; DSD = differentiated service delivery.