A pragmatic randomised study to optimise screening, prevention and care for tuberculosis in Malawi (PROSPeCT Study) (360G-Wellcome-206575_Z_17_Z)

Ambitious global targets have been set to eliminate tuberculosis as a public health problem by 2035. However, in Africa, where HIV has driven extremely high incidence rates, progress in reducing new infections and TB deaths remains too slow. My previous research has shown that adults seeking diagnosis and treatment for TB and HIV face considerable barriers, and have high pre-treatment mortality. Efforts to reduce TB mortality have been hampered by limitations in TB diagnostics, with considerable uncertainty about how available and new tests can be best implemented. The key goals of this Fellowship are: To develop expertise in pragmatic trial design, statistical analysis and policy-translation In a pragmatic randomised trial among adults with TB symptoms in Blantyre, investigate the effects of optimised TB/HIV diagnosis and treatment linkage on case detection and treatment initiation In a nested sub-study, evaluate the accuracy of computer-aided digital chest x-ray triage classification (normal vs. any abnormality) compared to expert radiologist classification and bacteriological diagnosis. This research will provide urgently-needed evidence to inform policy decisions on how best to improve TB/HIV diagnosis and treatment in Africa. The training opportunities will help me develop internationally-recognised expertise in pragmatic randomised trials.