Table 1 SLATE II algorithm screens and differences between SLATE I and SLATE II
Screen | Overall purpose of screen | Reasons for screening out (SLATE II) | Justification | If screen out, anticipated next step | Differences from SLATE I |
|---|---|---|---|---|---|
Symptom report and TB module | Identify self-reported conditions that require additional investigation | Severe TB symptoms regardless of LAM or positive LAM test result | See text for explanation; clinician’s judgment as to seriousness | Referral for TB test | In SLATE I, any TB symptom (cough, fever, night sweats, weight loss) of any duration or seriousness was a criterion for screening out. No LAM test was used. Clinicians in SLATE I were trained to regard any other symptom as a criterion for screening out, rather than only relevant, serious symptoms |
Persistent headache for > 2 days | Referral for CrAg screening | ||||
Other serious self-reported symptoms | Other symptoms could indicate the need for further clinical investigation; clinician’s judgment as to seriousness | Referral for additional clinical consultation | |||
Medical history | Through self-report, identify individuals on concurrent medications or who may struggle with adherence | Started TB treatment within the past 2 weeks and not yet tolerated, based on clinical judgment | Guidelines recommend up to 2 weeks’ delay in ART initiation for patients starting TB treatment to allow them to tolerate the TB medications before starting ART. | ART initiation by the clinic as soon as TB treatment is tolerated | In SLATE I, all TB treatment initiated within 14 days, any prior default from ART, and any report of substance abuse were always criteria for screening out. These were removed and replaced in SLATE II |
Previous ART default due to rash, hepatitis, or a psychiatric or neurologic condition or default from second line regimen | Prescription of a different regimen may be required. Default from first-line ART for other reasons is no longer a criterion for screening out | Referral for additional clinical consultation | |||
Concurrent medications or conditions that may create problems for patients | Some medications, ongoing intravenous recreational drug use, or mental illness may interact with ARVs or hamper adherence | Referral for additional clinical or pharmacy consultation | |||
Physical examination | Record weight, height, temperature and blood pressure and identify any observable serious conditions that require additional investigation | Any conditions that call for further investigation prior to ART initiation | Patient may identify previously unreported symptoms or clinician may observe conditions that indicate a need for further clinical investigation before starting ART; clinician’s judgment as to seriousness | Referral for additional clinical consultation | No major differences. Clinicians in SLATE II are encouraged to use clinical judgment of seriousness of any conditions identified |
Readiness assessment | Confirm that the patient feels ready to start ART today | Responses that indicate reluctance, hesitation, or serious concerns in starting and adhering to treatment | Creates a structured opportunity for clinician and patient to discuss any concerns that the patient has not yet raised | Referral for additional counseling and follow-up support as indicated | Logistical reasons for not being ready, such as concern about future transportation to the clinic, are no longer criteria for screening out in SLATE II |