One size does not fit all: reaching agricultural workers in South Africa with TB services.

BACKGROUND: Despite decreasing incidence of TB in South Africa, people with TB continue to be missed by facility-based case-finding interventions, and agricultural workers suffer disproportionately from limited access to services. We implemented two community-based active case-finding strategies to engage agricultural workers and assessed the cost of these interventions.METHODS: We summarized costs for two interventions - one led by enrolled nurses and one by non-governmental organizations (NGOs) - from April 2017 to December 2019, and calculated cost per person reached by services, screened for TB, identified as having TB and started on TB treatment. We performed Mann-Kendall tests of monotonic trend and conducted a sensitivity analysis of intervention costs.RESULTS: The enrolled nurses-led implementation started 442 people on TB treatment at a cost of US$118 per person, with decreasing trend in costs over the implementation period (P = 0.005). The NGO-led intervention started 160 people on treatment at a cost of US$554 per person, with decreasing trend in costs over the implementation period (P = 0.004).CONCLUSION: Community-based case-finding strategies find TB patients who would be missed by the health system. These strategies should be scaled up to close the missing cases gap in South Africa and to meet UN targets for ending TB.

Examining the cost of community-based tuberculosis treatment in South Africa.

SETTING: While South Africa has improved access to tuberculosis (TB) treatment and care, the 2015 treatment success rate for multidrug-resistant TB (MDR-TB) remains low, at 55%. Community-based TB treatment and care improves patient retention compared to the standard of care alone.OBJECTIVE: To assess the cost of a USAID-funded community-based TB model in Nelson Mandela Bay Health District (NMBHD), Eastern Cape Province, South Africa compared to the national standard of care alone.DESIGN: We estimated the cost of community-based DR-TB treatment and adherence support compared to the standard of care alone.RESULTS: Average overall costs were US$2827 lower per patient on the community-based model than the standard of care alone.CONCLUSION: The per-patient cost of the community-based model is lower than the standard of care alone. Assuming the costs and effects of a community-based model implemented in NMBHD were observed at a larger scale, implementing the model could reduce overall health system costs.