Closing -TB GAPs - for people living with HIV: TB Guidance for Adaptable Patient-Centered Service

项目摘要 结核病（TB）是世界上主要的传染性死亡原因， 艾滋病毒感染者（PLHIV）。感染艾滋病毒的儿童和青少年受到的影响尤其严重， 预防服务不足、病例发现差距大、依从性挑战和知识差距。我们 该项目将提供证据，为针对结核病/艾滋病毒级联护理中这些弱点的干预措施提供信息。 结核病的早期发现和治疗可改善艾滋病毒感染者的预后。在检测的一个关键挑战， 艾滋病毒相关结核病已实施筛查，以确定完成的正确人群 诊断测试越来越多的证据表明，推荐的症状筛查效果不佳 诊断方法。因此，我们的目标是制定一个更准确的结核病筛查和测试策略， 艾滋病毒感染者。 结核病预防性治疗（TPT）可避免艾滋病毒相关结核病。然而，在艾滋病毒感染者中， 完成率不够理想，没有制定有效的交付战略。因此，我们的目标是确定 最有效的TPT提供战略，利用有效改善艾滋病毒治疗的方法 坚持。 虽然有证据表明，异烟肼预防性治疗是符合成本效益的幼儿 生活在结核病/艾滋病高负担环境中，新的短程TPT的成本效益主要是 在结核病低负担、高收入背景下进行研究。我们的目标是提供证据来填补这一空白， 知情政策。 为了确保我们的工作产生可持续的影响，我们将提供有关最佳做法的指导， 根据不断变化的国家指导方针，并利用我们本土贝勒的成熟能力， 基金会合作伙伴就艾滋病毒相关结核病护理提供高质量的指导。作为艾滋病毒领域的区域领导者， 相关的结核病护理，我们将开发一个在线资源，作为结核病GAPS回声中心， 区域专家咨询、指南更新以及为儿童管理提供者提供的新证据， 艾滋病毒相关结核病的青少年。 我们的团队具有独特的优势，能够开发、实施和评估基于证据的创新 在五个CDC目标优先国家预防、发现和治愈艾滋病毒相关结核病的方法。我们提出的 该项目利用了我们协调良好的临床网络，该网络与一个共同的电子医疗 最大限度地提高项目的可交付成果。

PROJECT SUMMARY Tuberculosis (TB) is the world’s leading infectious cause of mortality and responsible for 1/3 of deaths in people living with HIV (PLHIV). Children and adolescents living with HIV are disproportionately affected due to inadequate preventive services, large case detection gaps, adherence challenges, and knowledge gaps. Our project will generate evidence to inform interventions targeting these weaknesses in the TB/HIV cascade of care. Early detection and treatment of TB improves outcomes in PLHIV. A key challenge in the detection of HIV-associated TB has been implementation of screening that identifies the correct population to complete diagnostic testing. Increasing evidence demonstrates the poor performance of recommened symptom screens and diagnostic approaches. Hence, we aim to define a more accurate TB screening and testing strategy among PLHIV. TB preventive treatment (TPT) averts HIV-associated TB. Nevertheless, among PLHIV, TPT initiation and completion rates are sub-optimal and effective delivery strategies are not defined. As such, we aim to identify the most effective TPT delivery strategy by leveraging approaches effective at improving HIV treatment adherence. Although evidence demonstrates that isoniazid preventive therapy is cost-effective in young children living in a TB/HIV high burden setting, the cost-effectiveness of newer short-course TPT has primarily been studied in the context of a TB low-burden, high income setting. We aim to generate evidence to fill this gap and inform policy. To ensure that our work makes a sustainable impact, we will provide mentorship on best practices in accordance with evolving country guidelines and harnessing the proven capacity of our indigenous Baylor Foundation partners to provide quality mentorship on HIV associated TB care. As a regional leader in HIV associated TB care, we will develop an online resource that will serve as the TB GAPS Echo Hub to provide regional expert consultation, guideline updates, and emerging evidence for providers managing children and adolescents with HIV associated TB in the region. Our team is uniquely positioned to develop, implement, and evaluate evidence-based, innovative approaches to prevent, find, and cure HIV-associated TB in five CDC target priority countries. Our proposed project capitalizes upon our well-harmonized clinical network that is linked with a common electronic medical record to maximize project deliverables.