Untitled

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