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

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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.