Intensified case-finding (ICF), TB skin testing (TST) and Isoniazid preventive therapy (IPT)
Screening for TB is relatively quick and easy in people living with HIV (PLHIV), as it simply involves asking about 4 symptoms, which can be done by any level of health care worker. All those with one or more TB symptoms have to then be evaluated for TB, which is much more difficult as it requires an experienced clinician, a setting-specific diagnostic algorithm, and any number of diagnostic tests in people living with HIV.
Those without any TB symptoms can be considered for IPT, with one important exception: those being ‘worked up’ to initiate ART, as they first need to be evaluated for ‘sub-clinical’ TB.
This dossier consists of:
- A publication from Botswana showing that IPT only reduced the risk of active TB in PLHIV having a positive TB skin test (TST) and that only ART could reduce the risk in those with a negative TST.
- Data from Khayelitsha suggesting that IPT be recommended to all those receiving ART in moderate-high incidence settings irrespective of TST status.
- An editorial and publication describing the risk of sub-clinical TB in those being worked-up for ART.
- Guidance on ICF and IPT from WHO.
- Guidance on ICF, TST, and IPT from MSF.