3.3.4. Testing for TB infection

TST or IGRA can be used to test for TB infection. People living with HIV who are on ART (including adolescents and children) benefit from TPT regardless of whether they test positive or negative for TB infection. People living with HIV who are not on ART and who test positive for TB infection are shown to benefit more from TPT than those who test negative (49). WHO recommends that testing for TB infection should not be a requirement for initiating TPT among people living with HIV and child contacts aged under 5 years, particularly in countries with a high TB incidence, given that the benefits of TPT (even without testing) clearly outweigh the risks (15). For older contacts, TB infection testing may be used to determine eligibility for TPT if it is available. Non-availability of TB infection testing and CXR should not pose a barrier to TPT. The algorithm in Figure 3.4 caters for situations where these investigations are unavailable

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