The PROSPECT Study: A pragmatic randomised study to optimise screening, prevention and care for tuberculosis in Malawi

Project 3 Mar 2020

Tuberculosis is the leading adult cause of death from an infection worldwide. In Africa, HIV has led to very high TB rates, and progress towards reducing TB deaths has been too slow. People attending clinics often don’t get the tests they need, must make many visits to health facilities at personal expense, and have high risk of dying before they start treatment.

Critical knowledge gaps that need to be answered include: how can people with TB symptoms be most-effectively diagnosed and linked to TB and HIV treatment?

This research will investigate a new strategy to answer this question. 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/HIV diagnosis and treatment uptake by comparing it against what clinicians usually do to diagnose TB and HIV in the clinic.

This sort of study (a “pragmatic trial”) will provide urgently needed information to patients and policymakers about how TB can be best diagnosed in poor-settings where HIV is common. 

The trial protocol can be found here.



International TB Centre

University of Liverpool 
Department of Public Health and Policy

Delft Imaging systems 

MinXray Simprints 

This project is funded by a Wellcome Trust Career Development Clinical Research Fellowship awarded to Dr MacPherson