# New pathways to prevention from community TB screening in South Africa

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2024 · $168,574

## Abstract

ABSTRACT
International and South African guidelines recommend TB preventive therapy (TPT) for people with HIV (PWH)
and other people at high risk for TB, including close contacts of people with TB. Despite the evidence for reduced
morbidity and mortality for people with HIV (PWH) who receive TPT, and guidelines recommending use, there
remains a substantial gap between people recommended to receive and people who actually receive and
complete a course of TPT. The 2022 WHO Global TB Report highlighted the growing gap in access and provision
of TPT, which has been aggravated by the COVID-19 pandemic. Bridging this gap is a South African and global
priority. With the recent availability and evidence for newer, shorter regimens of TPT, a transformation of HIV
care delivery models (in part forced by the COVID-19 pandemic) and evolving national guidelines for TPT, it is
increasingly urgent to explore new patient-friendly models of TPT delivery in order to inform programmatic
guidance that results in greater uptake, adherence, and completion of TPT. HIV care has benefited from the
expansion of “differentiated care delivery” models, which encourage community-delivered care, infrequent
clinic/facility visits, limited laboratory monitoring, and task-shifted treatment models to deliver comprehensive
HIV care to stable adults in community settings. Emerging demonstration projects have found that HIV preventive
medication, or PrEP, can be safely and effectively delivered by pharmacists rather than clinicians. These
successful models for differentiated HIV treatment and prevention delivery may be able to be translated to include
TB preventive therapy. The availability of safe, effective, short-course TB preventive therapy with limited
monitoring requirements suggests that similar community-based models may be adapted to provide this similarly
essential preventive treatment.
We will explore two approaches of adapting HIV differentiated services to TB prevention. We hypothesize that
people who receive community-delivered TPT have higher rates of completion of a course of TPT than people
who receive standard-of-care clinic-based TPT. We will conduct a randomized controlled trial of community vs.
clinic-based TPT delivery among people participating in a community-based TB screening program in South
Africa, and explore participant reasons for completion and noncompletion with qualitative research. We will also
conduct preliminary research on the feasibility and acceptability of task-shifted TPT delivery, engaging clinic-
based pharmacy assistants to provide TPT to low-risk clients. Through formative research, qualitative interviews
with nurses, clinic operational managers, and workflow mapping exercises, we will identify barriers and
facilitators for pharmacy assistant task-shifted TPT delivery. Together, this research will establish the foundation
for subsequent larger trials of patient-centered, differentiated TPT delivery approaches to increase TPT uptake
and com...

## Key facts

- **NIH application ID:** 10928785
- **Project number:** 5R21AI179276-02
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** ADRIENNE E SHAPIRO
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $168,574
- **Award type:** 5
- **Project period:** 2023-09-13 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10928785

## Citation

> US National Institutes of Health, RePORTER application 10928785, New pathways to prevention from community TB screening in South Africa (5R21AI179276-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10928785. Licensed CC0.

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