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

项目总结 结核病(TB)是世界上主要的死亡传染病，占#年死亡人数的1/3。 艾滋病毒携带者(PLHIV)。艾滋病毒携带者儿童和青少年受到的影响不成比例，因为 预防服务不足、大的病例发现差距、遵守挑战和知识差距。我们的 该项目将产生证据，为针对结核病/艾滋病毒级联护理中这些薄弱环节的干预措施提供信息。 结核病的早期发现和治疗可改善PLHIV的治疗结果。检测出血吸虫病的一个关键挑战 已经实施了艾滋病毒相关结核病筛查，以确定要完成的正确人群 诊断性测试。越来越多的证据表明推荐症状筛查的性能很差 和诊断方法。因此，我们的目标是在以下方面定义更准确的结核病筛查和检测策略 PLHIV。 结核病预防治疗(TPT)可避免与艾滋病毒相关的结核病。然而，在PLHIV中，TPT启动 完成率不是最优的，没有定义有效的交付策略。因此，我们的目标是确定 通过利用有效改善艾滋病毒治疗的方法，实现最有效的TPT交付战略 坚持不懈。 尽管有证据表明，异烟肼预防治疗对幼儿是划算的 生活在结核病/艾滋病毒高负担的环境中，较新的短期TPT的成本效益主要是 在结核病低负担、高收入的背景下进行研究。我们的目标是产生证据来填补这一空白 通知政策。 为了确保我们的工作产生可持续的影响，我们将在以下方面提供最佳做法的指导 根据不断发展的国家指导方针，并利用我们土著贝勒已证明的能力 基金会合作伙伴在艾滋病毒相关结核病护理方面提供高质量的指导。作为艾滋病领域的地区领导者 相关的结核病护理，我们将开发一个在线资源，作为结核病差距回声中心，以提供 区域专家咨询、指南更新和为儿童和儿童管理提供者提供的新证据 该区域感染艾滋病毒相关结核病的青少年。 我们的团队在开发、实施和评估循证创新方面具有得天独厚的优势 在五个疾控中心目标优先国家采取预防、发现和治愈艾滋病毒相关结核病的方法。我们的建议 该项目利用了我们良好协调的临床网络，该网络与通用的电子医疗相连接 记录以最大限度地提高项目可交付成果。

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.