TB Screening Improves Preventive Therapy Uptake

HIV Clinical Trial

— TB SCRIPT  

Official title:

TB Screening Improves Preventive Therapy Uptake Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04557176
• Other study ID #: 18-25623
• Secondary ID: 1R61HL146365-01A
• Status: Active, not recruiting
• Phase: N/A
• Start date: November 16, 2020
• Est. completion date: March 15, 2025

Study information

• Verified date: November 2023
• Source: University of California, San Francisco
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

HIV-infected people have an increased risk of developing active tuberculosis (TB). To reduce the burden of TB among people living with HIV (PLHIV), the World Health Organization (WHO) recommends systematic TB screening followed by 1) confirmatory TB testing for all those who screen positive and 2) TB preventive therapy (TPT) for all TPT-eligible PLHIV who screen negative.

The objective of the TB Screening Improves Preventive Therapy Uptake (TB SCRIPT) trial is to determine whether TB screening based on C-reactive protein (CRP) levels, measured using a rapid and low-cost point-of-care (POC) assay, improves TPT uptake and clinical outcomes of PLHIV, relative to symptom-based TB screening.

Description:

The overall objective of the TB SCRIPT trial is to evaluate the effectiveness and cost-effectiveness of POC CRP-based TB screening, which is the next step required for successful scale-up of both systematic TB screening and TPT. The study's central hypothesis is that compared to symptom-based TB screening, a TB screening strategy based on CRP levels measured at the point-of-care will improve TPT uptake, thereby reducing TB incidence and its associated mortality among PLHIV.

To test this hypothesis, the investigators will conduct an individual randomized control trial enrolling PLHIV presenting to clinics in Uganda for routine antiretroviral therapy (ART) initiation. Eligible participants will be randomized to either POC CRP-based TB screening (intervention arm) or symptom-based TB screening (control arm). In both arms, screen-positive participants will undergo confirmatory TB testing; participants found to have prevalent TB will be initiated on standard TB treatment. In both arms, screen-negative participants will be assessed for TPT eligibility; TPT-eligible participants will be initiated on standard TPT. All participants will be followed for 2 years.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 1719
• Est. completion date: March 15, 2025
• Est. primary completion date: March 15, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age = 18 years

• Confirmed HIV+ test result

• CD4 T lymphocyte count of = 350 cells/µL

• Capacity to provide written (or witnessed verbal, if illiterate) informed consent

Exclusion Criteria:

• Completed treatment for active pulmonary or extra-pulmonary TB within the past 2 years

• Completed a full course of TPT within the past year

• Actively taking any internationally-approved medication for TB treatment for any reason, within 2 weeks of study entry

• Prior history of combined ART for HIV treatment for any duration (does not include single-dose ART for prevention of vertical transmission of HIV)

• Currently resides 25 km outside their enrollment site, plans to move 25 km outside their enrollment site in the next 2 years, or plans to transfer their HIV care from their current enrollment site

Related Conditions & MeSH terms

• HIV
• Latent Tuberculosis
• Tuberculosis
• Tuberculosis Prevention

Intervention

Device:
• CRP, point-of-care assay
CRP is a non-specific marker of inflammation whose levels rise in the setting of interleukin 6 (IL-6)-mediated inflammation, such as active TB. In clinical settings, CRP is used to identify patients with systemic inflammation from infection or non-infectious cases. In settings with high TB prevalence, the investigators hypothesize that CRP can be used to accurately screen individuals for active TB (i.e., distinguish individuals with high likelihood of having active TB from those individuals unlikely to have active TB).

Locations

Country	Name	City	State
Uganda	Kampala Capital City Authority Clinic	Kampala

Sponsors (5)

Lead Sponsor	Collaborator
University of California, San Francisco	Infectious Diseases Research Collaboration, Uganda, Johns Hopkins University, Makerere University, National Heart, Lung, and Blood Institute (NHLBI)

Country where clinical trial is conducted

Uganda, 

References & Publications (52)

Breen RA, Leonard O, Perrin FM, Smith CJ, Bhagani S, Cropley I, Lipman MC. How good are systemic symptoms and blood inflammatory markers at detecting individuals with tuberculosis? Int J Tuberc Lung Dis. 2008 Jan;12(1):44-9. — View Citation

Chaisson LH, Semitala FC, Asege L, Mwebe S, Katende J, Nakaye M, Andama AO, Marquez C, Atuhumuza E, Kamya M, Cattamanchi A, Yoon C. Point-of-care C-reactive protein and risk of early mortality among adults initiating antiretroviral therapy. AIDS. 2019 Apr 1;33(5):895-902. doi: 10.1097/QAD.0000000000002130. — View Citation

Choi CM, Kang CI, Jeung WK, Kim DH, Lee CH, Yim JJ. Role of the C-reactive protein for the diagnosis of TB among military personnel in South Korea. Int J Tuberc Lung Dis. 2007 Feb;11(2):233-6. — View Citation

Churchyard GJ, Fielding KL, Lewis JJ, Coetzee L, Corbett EL, Godfrey-Faussett P, Hayes RJ, Chaisson RE, Grant AD; Thibela TB Study Team. A trial of mass isoniazid preventive therapy for tuberculosis control. N Engl J Med. 2014 Jan 23;370(4):301-10. doi: 10.1056/NEJMoa1214289. — View Citation

Claus DR, Osmand AP, Gewurz H. Radioimmunoassay of human C-reactive protein and levels in normal sera. J Lab Clin Med. 1976 Jan;87(1):120-8. — View Citation

DERBES VJ, JACOBS S, LINN RH, TURNER M, WALSH JJ. C-reactive protein in pulmonary tuberculosis. Am Rev Tuberc. 1956 Sep;74(3):464-7. doi: 10.1164/artpd.1956.74.3.464. No abstract available. — View Citation

Drain PK, Kupka R, Msamanga GI, Urassa W, Mugusi F, Fawzi WW. C-reactive protein independently predicts HIV-related outcomes among women and children in a resource-poor setting. AIDS. 2007 Oct 1;21(15):2067-75. doi: 10.1097/QAD.0b013e32826fb6c7. — View Citation

Durovni B, Saraceni V, Moulton LH, Pacheco AG, Cavalcante SC, King BS, Cohn S, Efron A, Chaisson RE, Golub JE. Effect of improved tuberculosis screening and isoniazid preventive therapy on incidence of tuberculosis and death in patients with HIV in clinics in Rio de Janeiro, Brazil: a stepped wedge, cluster-randomised trial. Lancet Infect Dis. 2013 Oct;13(10):852-8. doi: 10.1016/S1473-3099(13)70187-7. Epub 2013 Aug 16. — View Citation

Flesch IE, Kaufmann SH. Role of cytokines in tuberculosis. Immunobiology. 1993 Nov;189(3-4):316-39. doi: 10.1016/S0171-2985(11)80364-5. — View Citation

Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999 Feb 11;340(6):448-54. doi: 10.1056/NEJM199902113400607. No abstract available. Erratum In: N Engl J Med 1999 Apr 29;340(17):1376. — View Citation

Ganter U, Arcone R, Toniatti C, Morrone G, Ciliberto G. Dual control of C-reactive protein gene expression by interleukin-1 and interleukin-6. EMBO J. 1989 Dec 1;8(12):3773-9. doi: 10.1002/j.1460-2075.1989.tb08554.x. — View Citation

Getahun H, Kittikraisak W, Heilig CM, Corbett EL, Ayles H, Cain KP, Grant AD, Churchyard GJ, Kimerling M, Shah S, Lawn SD, Wood R, Maartens G, Granich R, Date AA, Varma JK. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011 Jan 18;8(1):e1000391. doi: 10.1371/journal.pmed.1000391. — View Citation

Grant AD, Charalambous S, Fielding KL, Day JH, Corbett EL, Chaisson RE, De Cock KM, Hayes RJ, Churchyard GJ. Effect of routine isoniazid preventive therapy on tuberculosis incidence among HIV-infected men in South Africa: a novel randomized incremental recruitment study. JAMA. 2005 Jun 8;293(22):2719-25. doi: 10.1001/jama.293.22.2719. — View Citation

Gupta A, Montepiedra G, Aaron L, Theron G, McCarthy K, Bradford S, Chipato T, Vhembo T, Stranix-Chibanda L, Onyango-Makumbi C, Masheto GR, Violari A, Mmbaga BT, Aurpibul L, Bhosale R, Mave V, Rouzier V, Hesseling A, Shin K, Zimmer B, Costello D, Sterling TR, Chakhtoura N, Jean-Philippe P, Weinberg A; IMPAACT P1078 TB APPRISE Study Team. Isoniazid Preventive Therapy in HIV-Infected Pregnant and Postpartum Women. N Engl J Med. 2019 Oct 3;381(14):1333-1346. doi: 10.1056/NEJMoa1813060. — View Citation

Henostroza G, Harris JB, Chitambi R, Siyambango M, Turnbull ER, Maggard KR, Kruuner A, Kapata N, Reid SE. High prevalence of tuberculosis in newly enrolled HIV patients in Zambia: need for enhanced screening approach. Int J Tuberc Lung Dis. 2016 Aug;20(8):1033-9. doi: 10.5588/ijtld.15.0651. — View Citation

Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med. 2009 Dec;24(4):337-42. doi: 10.3904/kjim.2009.24.4.337. Epub 2009 Nov 27. — View Citation

Kihara M, Kamakura M, Feldman MD. Introduction: HIV/AIDS surveillance in a new era. J Acquir Immune Defic Syndr. 2003 Feb;32 Suppl 1:S1-2. doi: 10.1097/00126334-200302011-00001. No abstract available. — View Citation

Kufa T, Mngomezulu V, Charalambous S, Hanifa Y, Fielding K, Grant AD, Wada N, Chaisson RE, Churchyard GJ, Gounder CR. Undiagnosed tuberculosis among HIV clinic attendees: association with antiretroviral therapy and implications for intensified case finding, isoniazid preventive therapy, and infection control. J Acquir Immune Defic Syndr. 2012 Jun 1;60(2):e22-8. doi: 10.1097/QAI.0b013e318251ae0b. — View Citation

Kuller LH, Tracy R, Belloso W, De Wit S, Drummond F, Lane HC, Ledergerber B, Lundgren J, Neuhaus J, Nixon D, Paton NI, Neaton JD; INSIGHT SMART Study Group. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. 2008 Oct 21;5(10):e203. doi: 10.1371/journal.pmed.0050203. — View Citation

Latent tuberculosis infection: updated and consolidated guidelines for programmatic management [Internet]. Geneva: World Health Organization; 2018. Available from http://www.ncbi.nlm.nih.gov/books/NBK531235/ — View Citation

Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, Vogt M, Bekker LG, Wood R. Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study. PLoS Med. 2011 Jul;8(7):e1001067. doi: 10.1371/journal.pmed.1001067. Epub 2011 Jul 26. — View Citation

Lawn SD, Kerkhoff AD, Vogt M, Wood R. Diagnostic and prognostic value of serum C-reactive protein for screening for HIV-associated tuberculosis. Int J Tuberc Lung Dis. 2013 May;17(5):636-43. doi: 10.5588/ijtld.12.0811. — View Citation

Lawn SD, Obeng J, Acheampong JW, Griffin GE. Resolution of the acute-phase response in West African patients receiving treatment for pulmonary tuberculosis. Int J Tuberc Lung Dis. 2000 Apr;4(4):340-4. — View Citation

Lawn SD, Wiktor S, Coulibaly D, Ackah AN, Lal RB. Serum C-reactive protein and detection of tuberculosis in persons co-infected with the human immunodeficiency virus. Trans R Soc Trop Med Hyg. 2001 Jan-Feb;95(1):41-2. doi: 10.1016/s0035-9203(01)90328-1. No abstract available. — View Citation

Neuhaus J, Jacobs DR Jr, Baker JV, Calmy A, Duprez D, La Rosa A, Kuller LH, Pett SL, Ristola M, Ross MJ, Shlipak MG, Tracy R, Neaton JD. Markers of inflammation, coagulation, and renal function are elevated in adults with HIV infection. J Infect Dis. 2010 Jun 15;201(12):1788-95. doi: 10.1086/652749. — View Citation

Ogawa T, Uchida H, Kusumoto Y, Mori Y, Yamamura Y, Hamada S. Increase in tumor necrosis factor alpha- and interleukin-6-secreting cells in peripheral blood mononuclear cells from subjects infected with Mycobacterium tuberculosis. Infect Immun. 1991 Sep;59(9):3021-5. doi: 10.1128/iai.59.9.3021-3025.1991. — View Citation

PEPFAR Uganda Program data. (https://www.pepfar.gov/documents/organization/285851.)

Pfafflin A, Schleicher E. Inflammation markers in point-of-care testing (POCT). Anal Bioanal Chem. 2009 Mar;393(5):1473-80. doi: 10.1007/s00216-008-2561-3. Epub 2008 Dec 23. — View Citation

Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, Arndt G, Lode H. Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J. 2003 Jun;21(6):939-43. doi: 10.1183/09031936.03.00055103. — View Citation

Rajan JV, Semitala FC, Mehta T, Seielstad M, Montalvo L, Andama A, Asege L, Nakaye M, Katende J, Mwebe S, Kamya MR, Yoon C, Cattamanchi A. A Novel, 5-Transcript, Whole-blood Gene-expression Signature for Tuberculosis Screening Among People Living With Human Immunodeficiency Virus. Clin Infect Dis. 2019 Jun 18;69(1):77-83. doi: 10.1093/cid/ciy835. — View Citation

Rangaka MX, Wilkinson RJ, Boulle A, Glynn JR, Fielding K, van Cutsem G, Wilkinson KA, Goliath R, Mathee S, Goemaere E, Maartens G. Isoniazid plus antiretroviral therapy to prevent tuberculosis: a randomised double-blind, placebo-controlled trial. Lancet. 2014 Aug 23;384(9944):682-90. doi: 10.1016/S0140-6736(14)60162-8. Epub 2014 May 13. — View Citation

Sage EK, Noursadeghi M, Evans HE, Parker SJ, Copas AJ, Edwards SG, Miller RF. Prognostic value of C-reactive protein in HIV-infected patients with Pneumocystis jirovecii pneumonia. Int J STD AIDS. 2010 Apr;21(4):288-92. doi: 10.1258/ijsa.2010.009551. — View Citation

Saunders R, Robson S, Soule S, Kirsch RE. Secretion of interleukin-6 by peripheral blood mononuclear cells from patients with pulmonary tuberculosis and their contacts. J Clin Lab Immunol. 1993;40(1):19-28. — View Citation

Schleicher GK, Herbert V, Brink A, Martin S, Maraj R, Galpin JS, Feldman C. Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia. Eur Respir J. 2005 Apr;25(4):688-92. doi: 10.1183/09031936.05.00067604. — View Citation

Semitala FC, Cattamanchi A, Andama A, Atuhumuza E, Katende J, Mwebe S, Asege L, Nakaye M, Kamya MR, Yoon C. Brief Report: Yield and Efficiency of Intensified Tuberculosis Case-Finding Algorithms in 2 High-Risk HIV Subgroups in Uganda. J Acquir Immune Defic Syndr. 2019 Dec 1;82(4):416-420. doi: 10.1097/QAI.0000000000002162. — View Citation

Shapiro AE, Hong T, Govere S, Thulare H, Moosa MY, Dorasamy A, Wallis CL, Celum CL, Grosset J, Drain PK. C-reactive protein as a screening test for HIV-associated pulmonary tuberculosis prior to antiretroviral therapy in South Africa. AIDS. 2018 Aug 24;32(13):1811-1820. doi: 10.1097/QAD.0000000000001902. — View Citation

Shikuma CM, Ribaudo HJ, Zheng Y, Gulick RM, Meyer WA, Tashima KT, Bastow B, Kuritzkes DR, Glesby MJ; AIDS Clinical Trials Group A5095 Study Team. Change in high-sensitivity c-reactive protein levels following initiation of efavirenz-based antiretroviral regimens in HIV-infected individuals. AIDS Res Hum Retroviruses. 2011 May;27(5):461-8. doi: 10.1089/aid.2010.0154. Epub 2010 Nov 23. — View Citation

Swindells S, Komarow L, Tripathy S, Cain KP, MacGregor RR, Achkar JM, Gupta A, Veloso VG, Asmelash A, Omoz-Oarhe AE, Gengiah S, Lalloo U, Allen R, Shiboski C, Andersen J, Qasba SS, Katzenstein DK; AIDS Clinical Trials Group 5253 Study Team. Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253. Int J Tuberc Lung Dis. 2013 Apr;17(4):532-9. doi: 10.5588/ijtld.12.0737. — View Citation

TEMPRANO ANRS 12136 Study Group; Danel C, Moh R, Gabillard D, Badje A, Le Carrou J, Ouassa T, Ouattara E, Anzian A, Ntakpe JB, Minga A, Kouame GM, Bouhoussou F, Emieme A, Kouame A, Inwoley A, Toni TD, Ahiboh H, Kabran M, Rabe C, Sidibe B, Nzunetu G, Konan R, Gnokoro J, Gouesse P, Messou E, Dohoun L, Kamagate S, Yao A, Amon S, Kouame AB, Koua A, Kouame E, Ndri Y, Ba-Gomis O, Daligou M, Ackoundze S, Hawerlander D, Ani A, Dembele F, Kone F, Guehi C, Kanga C, Koule S, Seri J, Oyebi M, Mbakop N, Makaila O, Babatunde C, Babatounde N, Bleoue G, Tchoutedjem M, Kouadio AC, Sena G, Yededji SY, Assi R, Bakayoko A, Mahassadi A, Attia A, Oussou A, Mobio M, Bamba D, Koman M, Horo A, Deschamps N, Chenal H, Sassan-Morokro M, Konate S, Aka K, Aoussi E, Journot V, Nchot C, Karcher S, Chaix ML, Rouzioux C, Sow PS, Perronne C, Girard PM, Menan H, Bissagnene E, Kadio A, Ettiegne-Traore V, Moh-Semde C, Kouame A, Massumbuko JM, Chene G, Dosso M, Domoua SK, N'Dri-Yoman T, Salamon R, Eholie SP, Anglaret X. A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. N Engl J Med. 2015 Aug 27;373(9):808-22. doi: 10.1056/NEJMoa1507198. Epub 2015 Jul 20. — View Citation

Tien PC, Schneider MF, Cox C, Cohen M, Karim R, Lazar J, Young M, Glesby MJ. HIV, HAART, and lipoprotein particle concentrations in the Women's Interagency HIV Study. AIDS. 2010 Nov 27;24(18):2809-17. doi: 10.1097/QAD.0b013e32833fcb3b. — View Citation

Uganda Ministry of Health. Isoniazid preventive therapy in Uganda: a health worker's guide. Kampala: MOH, 2014.

Uganda Ministry of Health. Report on the Population-based survey of prevalence of tuberculosis disease in Uganda 2014-2015. Kampala: MOH, 2017.

Weinhold B, Ruther U. Interleukin-6-dependent and -independent regulation of the human C-reactive protein gene. Biochem J. 1997 Oct 15;327 ( Pt 2)(Pt 2):425-9. doi: 10.1042/bj3270425. — View Citation

WHO. Global Tuberculosis Report 2017. Geneva, Switzerland. World Health Organization 2017.

WHO. Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings. Geneva, Switzerland. World Health Organization 2011.

WHO. High-priority target product profiles for new tuberculosis diagnostics: report of a consensus meeting. Geneva, Switzerland. World Health Organization 2014.

Wilson D, Badri M, Maartens G. Performance of serum C-reactive protein as a screening test for smear-negative tuberculosis in an ambulatory high HIV prevalence population. PLoS One. 2011 Jan 10;6(1):e15248. doi: 10.1371/journal.pone.0015248. — View Citation

Yoon C, Chaisson LH, Patel SM, Allen IE, Drain PK, Wilson D, Cattamanchi A. Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis. Int J Tuberc Lung Dis. 2017 Sep 1;21(9):1013-1019. doi: 10.5588/ijtld.17.0078. — View Citation

Yoon C, Davis JL, Huang L, Muzoora C, Byakwaga H, Scibetta C, Bangsberg DR, Nahid P, Semitala FC, Hunt PW, Martin JN, Cattamanchi A. Point-of-care C-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV. J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):551-6. doi: 10.1097/QAI.0000000000000085. — View Citation

Yoon C, Semitala FC, Asege L, Katende J, Mwebe S, Andama AO, Atuhumuza E, Nakaye M, Armstrong DT, Dowdy DW, McCulloch CE, Kamya M, Cattamanchi A. Yield and Efficiency of Novel Intensified Tuberculosis Case-Finding Algorithms for People Living with HIV. Am J Respir Crit Care Med. 2019 Mar 1;199(5):643-650. doi: 10.1164/rccm.201803-0490OC. — View Citation

Yoon C, Semitala FC, Atuhumuza E, Katende J, Mwebe S, Asege L, Armstrong DT, Andama AO, Dowdy DW, Davis JL, Huang L, Kamya M, Cattamanchi A. Point-of-care C-reactive protein-based tuberculosis screening for people living with HIV: a diagnostic accuracy study. Lancet Infect Dis. 2017 Dec;17(12):1285-1292. doi: 10.1016/S1473-3099(17)30488-7. Epub 2017 Aug 25. — View Citation

Yung-Pin C. Biased coin design with imbalance tolerance. Stochastic Models. 1999 Jan 1;15(5):953-75. doi: 10.1080/15326349908807570

* Note: There are 52 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Microbiologically-confirmed incident TB and all-cause mortality	Time to first diagnosis of microbiologically-confirmed incident TB or death from any cause	two years
Secondary	TB incidence: number diagnosed	Number diagnosed with microbiologically-confirmed incident TB	two years
Secondary	TB incidence: incidence	Incidence of microbiologically-confirmed TB (excluding prevalent TB cases)	two years
Secondary	TB incidence: Time to microbiologically-confirmed incident TB diagnosis	Days from three months post-enrollment to incident TB diagnosis (or censoring)	two years
Secondary	TB incidence: incidence rate	Incident rate of microbiologically-confirmed TB	two years
Secondary	TB incidence: drug resistant TB	Number diagnosed with drug-resistant incident TB	two years
Secondary	TB incidence: drug resistant TB among people receiving TPT	Proportion of participants receiving TPT diagnosed with incident drug resistant TB	two years
Secondary	Mortality: number of deaths from any cause	Number who died from any cause	two years
Secondary	Mortality: time to death from any cause	Number of days from enrollment to death from any cause	two years
Secondary	Mortality: all-cause death rate	Rate of deaths from any cause	two years
Secondary	Mortality: number who died from TB	Number who died from confirmed or probable TB	two years
Secondary	TPT uptake: number screen-negatives prescribed TPT	Number of screen-negatives prescribed TPT	two years
Secondary	TPT uptake: number screen-positives prescribed TPT	Number screen-positives prescribed TPT	two years
Secondary	TPT uptake: number initiated on TPT	Number screen-negatives prescribed TPT + number screen-positives prescribed TPT	two years
Secondary	TPT uptake: time to TPT initiation	Days from baseline TB screening to initiation of TPT	two years
Secondary	TPT uptake: number completing TPT	Number initiated on TPT who completed =90% of treatment over prescribed TPT period	two years
Secondary	Prevalent TB diagnosis: number microbiologically-confirmed prevalent TB cases detected by screening test	Number screen-positives diagnosed with prevalent TB	two years
Secondary	Prevalent TB diagnosis: number microbiologically-confirmed prevalent TB cases missed by screening test	Number screen-negatives diagnosed with prevalent TB	two years
Secondary	Prevalent TB diagnosis: number diagnosed with microbiologically-confirmed prevalent TB	Number screen-positives diagnosed with prevalent TB + number screen-negatives diagnosed with prevalent TB	two years
Secondary	Prevalent TB treatment: Number treated for prevalent TB	Number initiated on TB treatment 3 months or less after study entry	two years
Secondary	Prevalent TB treatment: number with microbiologically-confirmed prevalent TB completing treatment	Number diagnosed and treated who completed treatment	two years
Secondary	Prevalent TB treatment: time to treatment of microbiologically-confirmed prevalent TB	Days from prevalent TB diagnosis to initiation of TB treatment	two years