Introduction
TB, HIV infection, viral suppression
HIV INFECTION
Initiating antiretroviral therapy (ART) on the day of HIV diagnosis (same-day ART) or as soon as possible afterwards is now recommended in treatment guidelines worldwide, with the goal of improving ART uptake and linkage to care and decreasing time to viral suppression [The 2017 World Health Organization (WHO) guidelines recommended as a clinical consideration that ART should be briefly delayed while investigating for TB [It is logistically challenging to complete a TB evaluation on the same day of HIV diagnosis, especially in lower-income settings, as the Xpert MTB/RIF assay (Cepheid, Sunnyvale, California, United States of America) has at least a 2-h turnaround time, and tests are often conducted in centralized laboratories, with further delays for specimen transport, testing backlog, and communication of test results. Furthermore, the sensitivity of 1 Xpert MTB/RIF test is about 80% in PLWH, and a single negative test does not rule out active TB [From the health center perspective, a short delay to conduct TB testing is more feasible than same-day TB testing prior to ART initiation in many settings. However, this strategy may result in added visits for patients to return for test results and ART initiation, which may be associated with pretreatment loss to follow-up (LTFU). Data on the consequences of short delays in ART initiation are limited. In the clinical trials of same-day ART versus standard care, the study populations either excluded or included a minority of patients with TB symptoms [We conducted a randomized trial to determine whether same-day TB testing and treatment initiation (TB medication or ART) was associated with superior outcomes, compared with standard care (initiating TB treatment within 7 days and delaying ART to day 7 if TB not diagnosed), in adults with TB symptoms at HIV diagnosis. In a prior study of same-day ART versus standard care, which was conducted by our research team in persons newly diagnosed with early HIV infection in Haiti, we found that same-day ART improved rates of retention in care with viral suppression [