# TB PrEP - Integrating HIV prevention with TB household contact evaluation

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2024 · $707,687

## Abstract

ABSTRACT
HIV and TB are leading and linked global epidemics. Household members of people with TB have an elevated
prevalence and incidence of both TB and HIV. HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition by
>90%, and both WHO and the Uganda Ministry of Health recommend PrEP as part of a comprehensive
prevention package for HIV-negative persons with substantial exposure to HIV. New implementation approaches
are needed to ensure that PrEP reaches all people who could benefit. A promising implementation approach to
increase PrEP access is through household-based TB contact investigation, which is a leading strategy to
decrease TB morbidity and mortality, particularly in high-incidence settings like Uganda. Care models that
integrate HIV testing in household TB contact investigation are being evaluated. However, PrEP has not been
integrated into TB household contact investigation in high-prevalence settings.
 Recently, we found that couples identified in households affected by TB in Kampala, Uganda were twice
as likely to be serodifferent for HIV than couples in the general population (16% vs. 8%), suggesting that people
living in TB-affected households may benefit from PrEP. Multiple studies have shown that household-based
linkage to PrEP is feasible and effective in high HIV-burden settings, including among HIV serodifferent couples
and pregnant people. We therefore propose to adapt the proven intervention of PrEP to a new setting of
household TB contact investigation and evaluate its implementation, effectiveness, and costs using the RE-AIM
implementation framework, a widely used framework for evaluating how proven interventions perform in a new
delivery context. We hypothesize that integrating HIV prevention into household TB contact investigation will be
a feasible, acceptable, effective, and cost-effective strategy for expanding access to status-neutral HIV services,
including HIV self-testing and linkage to antiretroviral therapy and PrEP.
 In Aim 1, we assess the implementation and effectiveness of home-based HIV self-testing and PrEP
initiation versus standard clinic referral for PrEP during household TB contact evaluation in Uganda. We use a
household-randomized trial design and test the hypothesis that home-based PrEP initiation will increase PrEP
uptake and retention compared to clinic referral. In Aim 2, we use qualitative methods to examine the processes
of implementing HIV self-testing and PrEP during household TB contact investigation. In Aim 3, we estimate the
cost-effectiveness of the strategy to integrate home-based HIV testing and PrEP with household TB contact
investigation to assess its sustainability. This work is impactful because understanding how to offer HIV self-
testing and PrEP in the setting of household TB contact investigation will facilitate increased use of PrEP, an
underutilized innovation for HIV prevention, by leveraging existing health programs.

## Key facts

- **NIH application ID:** 11008075
- **Project number:** 1R01MH134685-01A1
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Jennifer M Ross
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $707,687
- **Award type:** 1
- **Project period:** 2024-09-09 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11008075

## Citation

> US National Institutes of Health, RePORTER application 11008075, TB PrEP - Integrating HIV prevention with TB household contact evaluation (1R01MH134685-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/11008075. Licensed CC0.

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