Université Cheikh Anta Diop de Dakar: Optimising itraconazole-based management for chronic pulmonary aspergillosis in post-tuberculosis patients: a trial development study in Senegal

This Development Award will develop and optimise a pragmatic chronic pulmonary aspergillosis (CPA) intervention pathway for post-tuberculosis (TB) patients in Senegal, integrating early itraconazole-based antifungal management into routine post-TB care. CPA is a major but under-recognised complication of post-TB lung disease in low- and middle-income countries (LMICs), where persistent respiratory symptoms are frequently misclassified as recurrent TB, contributing to delayed antifungal treatment and avoidable morbidity. The project will combine structured clinical assessment, Aspergillus serology, fungal microbiology, and feasible imaging strategies to identify probable CPA and evaluate the feasibility, acceptability, pharmacological practicality, and implementation performance of pathway-guided antifungal management. Particular emphasis will be placed on real-world implementation challenges including itraconazole formulation variability, procurement feasibility, rifampicin and antiretroviral drug interactions, adherence, treatment continuity, and pragmatic monitoring approaches in resource-constrained settings. Approximately 300 post-TB patients with persistent respiratory symptoms will be enrolled through routine TB follow-up pathways in Senegal. The study will generate clinical, pharmacological, operational, and implementation evidence required to optimise the intervention pathway and inform a future African-led pragmatic randomised controlled trial in post-TB fungal disease care.

Programme: Infectious Disease Clinical Trial Development Award

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