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graph LR subgraph "Suspected TB Case" A[Presumptive TB case identified (symptoms, X-ray, etc.)] --> B{HIV testing offered and provided?}; end B -- Yes --> C[HIV positive] B -- No --> D[HIV testing declined/not available] subgraph "HIV Positive" C --> E{Active TB screening (CXR, GeneXpert, etc.)}; E -- Positive --> F[Diagnosed with TB]; E -- Negative --> G[TB Preventive Therapy (TPT) offered]; G --> H[Initiate TPT]; F --> I[Initiate Anti-TB treatment (ATT)]; I --> J[Assess eligibility for ART]; J -- Eligible --> K[Initiate ART]; J -- Not Eligible --> L[Clinical management as per national guidelines]; K --> M[Co-trimoxazole Preventive Therapy (CPT) offered]; M --> N[Initiate CPT]; subgraph "During TB Treatment" I --> O[Regular monitoring for drug interactions & adverse events]; K --> O; O --> P[Adherence counseling for both ATT and ART]; P --> Q[Regular follow-up and monitoring of treatment response]; end end subgraph "HIV Negative/Declined Testing" D --> R[Proceed with standard TB diagnostic and treatment pathway]; end subgraph "Key Coordination Points" F --> S[Notification of TB case to public health authorities]; C --> S; I --> T[Collaboration between National TB Elimination Program (NTEP) and National AIDS Control Program (NACP)]; K --> T; H --> T; N --> T; Q --> T; S --> T; T --> U[Joint monitoring and evaluation of HIV-TB collaborative activities]; end style T fill:#ccf,stroke:#888,stroke-width:2px style B fill:#ccf,stroke:#888,stroke-width:2px style E fill:#ccf,stroke:#888,stroke-width:2px style J fill:#ccf,stroke:#888,stroke-width:2px
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