Studies on the prevention and control of human immune deficiency virus associated tuberculosis

The overall question the thesis intended to answer was how to optimise interventions for the prevention and control of human immune deficiency virus (HIV) -associated tuberculosis (TB) in high TB and HIV burden settings such as South Africa. In these settings the incidence of and mortality from TB has been declining but the decline is not sufficient to meet the global targets for TB control. Studies included in the thesis demonstrate the high burden of TB among those with HIV and suggest which interventions need to be optimised in order to meet these targets. The main findings were that while TB treatment and antiretroviral therapy (ART) remain the most widely implemented interventions for the prevention and control of HIV -associated TB, additional interventions such as new TB vaccines, TB preventive appropriately targeted to sub-populations at highest risk of developing TB and improving early diagnosis of TB and HIV, early initiation of ART and retention on ART are needed. Recommendations on the interventions which need strengething were - better linkage into HIV care, initiation of ART at higher CD4 count thresholds, targeting individuals on ART for scale up of TB preventive therapy and better retention in both TB and HIV care. The identified the following research gaps: how to best design cost efficient vaccine trials, better identify HIV-infected individuals likely to benefit from TB preventive therapy, better screen and identify those with TB, better link newly diagnosed HIV patients into care and retain them in care.