A pragmatic randomised study to optimise screening, prevention and care for tuberculosis in Malawi (PROSPeCT Study)

Tuberculosis (TB) is the leading cause of death from infection worldwide. In Africa, HIV has led to very high TB rates, and progress towards reducing deaths from TB has been too slow. People attending clinics often do not get the tests they need and they have a high risk of dying before they begin their treatment.

This research will investigate a new strategy to find out how people with TB symptoms can be most effectively diagnosed and given TB and HIV treatment if needed. We will take chest X-rays from adults with TB symptoms in Malawi and use a new computer tool to identify X-rays that show any abnormality. We will then confirm TB disease in the clinic using a new rapid sputum test. We will test how good this strategy is at improving the timeliness of TB and HIV diagnosis and uptake of treatment by comparing it with the current method used to diagnose TB and HIV in the clinic.

This pragmatic trial will provide urgently needed information for patients and policy makers about how TB can be best diagnosed in areas where poverty and HIV are common.