Informing People-Centered Target Product Profiles for TB Diagnostics: A Multi-Country Qualitative Study.

Background: Timely and accurate tuberculosis (TB) diagnosis remains a key challenge in high-burden settings. The World Health Organization (WHO) has developed Target Product Profiles (TPPs) to guide diagnostic development, which have largely reflected the perspectives of experts, with limited input from people affected by TB. This qualitative study explored preferences and experiences to inform people-centered TB diagnostic strategies.

Prioritizing countries for TB vaccine readiness research using a global stakeholder-centric approach.

The promise of new tuberculosis (TB) vaccine candidates prompts the need for research on vaccine demand and health system readiness to help ensure effective and equitable vaccine deployment. We developed an approach to prioritizing countries for TB vaccine readiness research by combining stakeholder preferences, elicited through best-worst scaling (BWS) with an analytical hierarchy process (AHP) framework. We conducted a self-administered electronic survey targeting TB vaccine stakeholders involved in vaccine development, advocacy, and implementation across 23 of the 24 USAID TB priority countries, and key stakeholders working globally.

Preferences for Tongue Swab versus Sputum Collection for Tuberculosis Testing: A Multi-Country Survey.

Background: Sputum collection for tuberculosis (TB) diagnosis poses challenges for children, people living with HIV, and those who struggle with sputum production. Tongue swab-based molecular testing offers a promising non-invasive alternative, but person-centered research on acceptability is limited.

Methods: We conducted a pragmatic survey across eight countries (Vietnam, Philippines, South Africa, Nigeria, Zambia, India, Uganda, Peru) among people with presumptive TB attending primary care facilities.

CROI 2025: tuberculosis, Mpox, and other infectious complications in people with HIV.

Updated strategies and new insights into tuberculosis and mpox treatment were a major focus at the 2025 Conference on Retroviruses and Opportunistic Infections, headlined by findings that high-dose rifampicin plus levofloxacin increased early mortality in hospitalized people with HIV with disseminated tuberculosis, whereas tecovirimat demonstrated no efficacy for clade II mpox. Herein, we summarize clinically relevant updates related to tuberculosis, mpox, Kaposi sarcoma, human papillomavirus, and other HIV-associated infectious complications presented at the conference.

Predicted choice and acceptability of regimens for tuberculosis preventive treatment among people living with HIV in Uganda - a discrete choice experiment.

Introduction: Little is known about how people living with HIV would choose if offered different tuberculosis preventive treatment (TPT) regimens, and under which conditions they would accept treatment. Actionable evidence regarding preference for TPT is needed to inform policy and the development of novel TPT regimens.

Methods: Adults engaged in care at an HIV clinic in Kampala, Uganda, completed a discrete choice experiment survey with nine random choice tasks.

Identifying preferred program delivery attributes for long-acting injectable cabotegravir-rilpvirine in three U.S. HIV clinics: A discrete choice experiment.

Background: Long-acting injectable cabotegravir and rilpivirine (CAB/RPV-LA) may overcome adherence barriers and provide treatment choice among people with HIV (PWH). However, little is known about the factors most likely to facilitate CAB/RPV-LA use.

Methods: We conducted a discrete choice experiment (DCE) at three urban U.

Intention to receive new vaccines post-COVID-19 pandemic among adults and health workers in Lusaka, Zambia.

Objectives: To estimate intention to receive newly introduced adult vaccines among community members and healthcare workers (HCWs) in Lusaka, Zambia in the context of previous COVID-19 vaccine uptake and perceived disease threat and, identify trusted sources of vaccine information.

Methods: We conducted a cross-sectional survey among a random sample of community members and a convenience sample of HCWs from 13 November to 15 December 2023. We evaluated future vaccination intentions by self-reported COVID-19 vaccine uptake, community role, vaccine type (COVID-19 booster, HIV, tuberculosis, malaria, pneumonia, diarrheal disease) and source of information using adjusted, mixed effects Poisson regression and adjusted probability models.

Designing community-based strategies to reach non-household contacts of people with tuberculosis in Lusaka, Zambia: a rapid qualitative study among key stakeholders.

Background: In high-burden settings, most tuberculosis (TB) transmission likely occurs outside the home. Our qualitative study in Zambia explored the acceptability and preferences for designing TB active case finding (ACF) strategies to reach non-household contacts of people with TB.

Methods: We conducted 56 in-depth interviews with persons with TB ( = 12), TB healthcare workers (HCWs) ( = 10), TB lay HCWs ( = 10), and leaders/owners ( = 12) and attendees ( = 12) of community venue types identified as potential TB transmission locations.

Preferences of people living with HIV for features of tuberculosis preventive treatment regimens in Uganda: a discrete choice experiment.

Introduction: Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens.

Urine-Xpert Ultra for the diagnosis of tuberculosis in people living with HIV: a prospective, multicentre, diagnostic accuracy study.

Background: Diagnostic delays for tuberculosis are common, with high resultant mortality. Urine-Xpert Ultra (Cepheid) could improve time to diagnosis of tuberculosis disease and rifampicin resistance. We previously reported on lot-to-lot variation of the Fujifilm SILVAMP TB LAM.

The accuracy of point-of-care C-Reactive Protein as a screening test for tuberculosis in children.

Systematic screening for TB in children, especially among those at high risk of TB, can promote early diagnosis and treatment of TB. The World Health Organization (WHO) recently recommended C-Reactive Protein as a TB screening tool in adults and adolescents living with HIV (PLHIV). Thus, we aimed to assess the performance of point-of-care (POC) CRP as a screening tool for TB in children.

Mapping the existing body of knowledge on new and repurposed TB vaccine implementation: A scoping review.

There is global consensus on the urgent need for a safe and effective TB vaccine for adults and adolescents to improve global TB control, and encouragingly, several promising candidates have advanced to late-stage trials. Significant gaps remain in understanding the critical factors that will facilitate the successful implementation of new and repurposed TB vaccines in low- and middle-income countries (LMICs), once available. By synthesizing the existing body of knowledge, this review offers comprehensive insights into the current state of research on implementation of these adult and adolescent vaccines.

CROI 2024: Tuberculosis, Mpox, and Other Infectious Complications in People With HIV.

Several novel antituberculosis agents, including long-acting injectable agents in mouse models, have shown promise in preclinical and early clinical studies. This encouraging news is offset by the failures of a tuberculosis (TB) vaccine to prevent disease recurrence and a 3-month clofazimine-based treatment regimen for drug-susceptible TB. Clinically focused insights regarding TB, mpox, and other HIV-associated infectious complications that were presented at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) are summarized in this review.

A Prospective Evaluation of the Diagnostic Accuracy of the Point-of-Care VISITECT CD4 Advanced Disease Test in 7 Countries.

Background: CD4 measurement is pivotal in the management of advanced human immunodeficiency virus (HIV) disease. VISITECT CD4 Advanced Disease (VISITECT; AccuBio, Ltd) is an instrument-free, point-of-care, semiquantitative test allowing visual identification of CD4 ≤ 200 cells/µL or >200 cells/ µL from finger-prick or venous blood.

Methods: As part of a diagnostic accuracy study of FUJIFILM SILVAMP TB LAM, people with HIV ≥18 years old were prospectively recruited in 7 countries from outpatient departments if a tuberculosis symptom was present, and from inpatient departments.

Lessons from a decade of adult vaccine rollout in low- and middle-income countries: a scoping review.

Introduction: The historical focus of vaccines on child health coupled with the advent of novel vaccines targeting adult populations necessitates exploring strategies for adult vaccine implementation.

Areas Covered: This scoping review extracts insights from the past decade's experiences introducing adult vaccines in low- and middle-income countries. Among 25 papers reviewed, 19 focused on oral cholera vaccine, 2 on Meningococcal A vaccines, 2 on tetanus toxoid vaccine, 1 on typhoid vaccine, and 1 on Ebola vaccine.

Prospective multicentre accuracy evaluation of the FUJIFILM SILVAMP TB LAM test for the diagnosis of tuberculosis in people living with HIV demonstrates lot-to-lot variability.

There is an urgent need for rapid, non-sputum point-of-care diagnostics to detect tuberculosis. This prospective trial in seven high tuberculosis burden countries evaluated the diagnostic accuracy of the point-of-care urine-based lipoarabinomannan assay FUJIFILM SILVAMP TB LAM (FujiLAM) among inpatients and outpatients living with HIV. Diagnostic performance of FujiLAM was assessed against a mycobacterial reference standard (sputum culture, blood culture, and Xpert Ultra from urine and sputum at enrollment, and additional sputum culture ≤7 days from enrollment), an extended mycobacterial reference standard (eMRS), and a composite reference standard including clinical evaluation.

Preferences of people living with HIV for features of tuberculosis preventive treatment regimens - a discrete choice experiment.

Background: Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens.

CROI 2023: Tuberculosis and Infectious Complications in Persons With HIV.

Novel implementation strategies to increase uptake and adherence to tuberculosis (TB) preventive therapy hold promise for reducing TB incidence in persons with HIV in high-burden settings. In persons who develop drug-susceptible TB, progress to shorten TB treatment continues to be made with the introduction of new drugs and novel treatment strategies that could allow for treatment shortening to 2 months for most people. A global case series provided powerful evidence that mpox should be considered an HIV-related opportunistic infection given its severe manifestations and poor outcomes.

Improving measurement of tuberculosis care cascades to enhance people-centred care.

Care cascades represent the proportion of people reaching milestones in care for a disease and are widely used to track progress towards global targets for HIV and other diseases. Despite recent progress in estimating care cascades for tuberculosis (TB) disease, they have not been routinely applied at national and subnational levels, representing a lost opportunity for public health impact. As researchers who have estimated TB care cascades in high-incidence countries (India, Madagascar, Nigeria, Peru, South Africa, and Zambia), we describe the utility of care cascades and identify measurement challenges, including the lack of population-based disease burden data and electronic data capture, the under-reporting of people with TB navigating fragmented and privatised health systems, the heterogeneity of TB tests, and the lack of post-treatment follow-up.

Strategies to increase childhood tuberculosis case detection at the primary health care level: Lessons from an active case finding study in Zambia.

Introduction: In high TB burden settings, it is estimated that 10-20% of total notifications should be children, however, currently only 6-8% of the total TB notifications in Zambia are children. We assessed whether the implementation of a multicomponent strategy, at primary healthcare facilities, that systematically targets barriers at each step of the childhood TB diagnostic cascade can increase childhood TB case detection.

Methods: We conducted a controlled, interrupted time series analysis to compare childhood TB case notifications before (January 2018-December 2019), and during implementation (January 2020-September 2021) in two intervention and two control Level 1 hospitals in Lusaka, Zambia.

A mixed methods study on men's and women's tuberculosis care journeys in Lusaka, Zambia-Implications for gender-tailored tuberculosis health promotion and case finding strategies.

Men and women with undiagnosed tuberculosis (TB) in high burden countries may have differential factors influencing their healthcare seeking behaviors and access to TB services, which can result in delayed diagnoses and increase TB-related morbidity and mortality. A convergent, parallel, mixed-methods study design was used to explore and evaluate TB care engagement among adults (≥18 years) with newly diagnosed, microbiologically-confirmed TB attending three public health facilities in Lusaka, Zambia. Quantitative structured surveys characterized the TB care pathway (time to initial care-seeking, diagnosis, and treatment initiation) and collected information on factors influencing care engagement.

Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis.

Background: The World Health Organization (WHO) recommends that outpatient people living with HIV (PLHIV) undergo tuberculosis screening with the WHO four-symptom screen (W4SS) or C-reactive protein (CRP) (5 mg·L cut-off) followed by confirmatory testing if screen positive. We conducted an individual participant data meta-analysis to determine the performance of WHO-recommended screening tools and two newly developed clinical prediction models (CPMs).

Methods: Following a systematic review, we identified studies that recruited adult outpatient PLHIV irrespective of tuberculosis signs and symptoms or with a positive W4SS, evaluated CRP and collected sputum for culture.

Correction: Evaluation of kidney function among people living with HIV initiating antiretroviral therapy in Zambia.

[This corrects the article DOI: 10.1371/journal.pgph.