One year funding - Community-wide TB case-finding linked to a nested cluster-randomised trial of promotion of HIV-testing and prevention of HIV-rel ated TB (360G-Wellcome-091769_Z_10_C)

The key goal is to identify a high impact strategy that could be used to achieve rapid reductions in TB incidence within a few years in high HIV prevalence urban setting. Two strategies will be investigated, first whether community-based case-finding alone can achieve this goal. An alternative possibility will be investigated through a parallel nested cluster-randomised trial: the additional impact of intensive prevention of HIV-related TB (promotion of HIV testing in the community linked t o isoniazid preventive therapy and referral for routine antiretroviral therapy). The same periodic outreach TB case-finding strategy that successfully reduced the prevalence of undiagnosed TB in Harare will be used, this time applied over a longer period (4 years) to a confluent population of 108,000 adults in order to capture the impact on TB transmission rates and new incident disease. Our community-based HIV/TB intervention will be delivered to 16,800 individual in the intervention arm of cluster randomised trial using local counsellors, including the option of supervised self-testing for HIV, and linked to community-distribution of isoniazid preventive therapy and referral for facility-based antiretroviral therapy. The key goals will be the effect on TB incidence, and acceptability and uptake of the HIV testing strategy.