1. Can ProTEST Strengthen DOTS?
Political commitment
strategic expansion plan, needed at all levels
Diagnosis by smear microscopy
catalyst function, problem of large proportion of smear negative patients
Standardized treatment and treatment outcome
Indirectly
Reporting and recording
Not parallel, confidentiality, work through established TB program, can improve by liaison with community

2. Minimum requirements for ProTEST acivities
Situation analysis
Needs
Opportunities
Performance of TB program (“reasonable treatment outcome”)
? Use HIV/TB activities to improve DOTS

3. TB screening Reflect the prevailing conditions of the district
Symptomatic screening (3 weeks of cough) is sufficient

4. Screen all VCT clients or HIC positives?
Minimum all HIV positives
All clients for nosocomial infection control?

5. Referral system Refer persons or samples? Only if stand-alone VCT
should we promote/discourage stand-alone VCT because of referral problems
Pro : demedicalization, high volume, focus on prevention, ..

6. Increased case finding
ProTEST is one component of intensified case-finding
ProTEST : symptomatic TB screening and TB education for all HIV infected persons
Broader view: operations research needed for creative ways to improve existing passive symptomatic case finding, especially among high risk populations

7. Effect of Intensive case finding
Proportion of cases found through ProTEST is small (catchement area ?)
Increased awareness of TB/HIV
Increased capacity for diagnosis (and case management)
ARV introduction might have larger effect compared to current ProTEST activities

8. Recommended activities
Screen HIV infected individuals for active TB
Promote joint TB/HIV activities, capacity, commitment