Tuberculosis — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mr Alemu is a 34-year-old recent migrant with smear-positive, Xpert-confirmed pulmonary tuberculosis without molecular evidence of rifampicin resistance, complicated by a new diagnosis of HIV with a CD4 count of 120. His problems are: infectious pulmonary TB requiring urgent treatment and isolation; advanced HIV requiring antiretroviral therapy on a defined clock; the interaction and IRIS risks of treating both together; a household and workplace exposure that obliges contact tracing; and the social complexity of delivering six months of therapy to a night-shift worker in shared housing. My plan is to start standard four-drug therapy today with public-health notification, integrate ART within two weeks, build an adherence architecture around his life, and trace his contacts through the TB service." ^{[1] [2]}