ABSTRACT
SETTING: Treatment of latent tuberculosis (TB) infection using isoniazid preventive therapy (IPT) in a human immunodeficiency virus (HIV) volunteer counseling and testing center in Kampala, Uganda. OBJECTIVE: To analyze the cost-utility of an IPT program for persons newly diagnosed with HIV. DESIGN: The cost-utility analysis of the IPT program was conducted using Markov cohort simulation methods. Newly diagnosed HIV-infected persons were evaluated using tuberculin skin test (TST); those with positive TST were offered IPT for 9 months (targeted testing strategy). An alternative strategy of offering IPT to all HIV-infected clients without TST screening was also evaluated (treat all strategy). The cost-utility of targeted testing was compared to the 'no program' and the 'treat all' strategies. RESULTS: The IPT program with the targeted testing strategy would produce 11 quality-adjusted life-years (QALYs) per 100 HIV-infected clients compared to no program. Offering IPT using the treat all strategy gained an additional 30 QALYs per 100 clients compared to targeted testing. Compared to no program, the incremental cost-utility of the targeted testing program was US$102/QALY gained. The cost-utility of the IPT program under the treat all strategy was US$106/QALY gained compared to the targeted testing strategy. CONCLUSIONS: The provision of IPT for HIV-infected persons was cost-effective. The use of TST screening prior to IPT reduced costs per QALY gained, but saved fewer overall QALYs.
Subject(s)
AIDS-Related Opportunistic Infections/economics , Communicable Disease Control/economics , Health Care Costs , Tuberculosis, Pulmonary/economics , Tuberculosis, Pulmonary/prevention & control , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/therapy , Adult , Cost-Benefit Analysis , Decision Support Techniques , Developing Countries , Female , Humans , Male , Markov Chains , Primary Prevention/economics , Risk Assessment , Severity of Illness Index , Socioeconomic Factors , Tuberculosis, Pulmonary/therapy , Uganda , Young AdultABSTRACT
SETTING: A large, urban human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) center in Kampala, Uganda. OBJECTIVE: Tuberculosis (TB) is a leading cause of morbidity and mortality in persons with HIV infection in sub-Saharan Africa. Intensified TB case finding and use of isoniazid preventive therapy (IPT) for latent infection reduces the burden of TB, but few programs have been implemented due to concerns about feasibility. DESIGN: Retrospective evaluation of a TB case finding and IPT program. RESULTS: Over a 25-month period, 6305 patients newly diagnosed with HIV infection underwent evaluation: 293 (5%) had TB disease; 1955 (37%) patients were not eligible for preventive therapy because they lived > 20 km away, had advanced HIV disease, or had previously had TB. Of 3366 who had a tuberculin skin test (TST) placed, 2548 (76%) had the TST read; 894 (35%) of these were positive. Of 506 persons who started treatment, 335 (66%) completed it. CONCLUSION: This unique program was feasible, detected a high proportion of undiagnosed TB, and successfully treated persons with latent infection. Expanding access to HIV VCT as well as collaboration between HIV/ AIDS and TB programs can increase the proportion of HIV-infected persons who can benefit from these programs.
Subject(s)
Counseling , Tuberculosis/diagnosis , Tuberculosis/prevention & control , Adolescent , Adult , Aged , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Tuberculosis/epidemiology , Uganda/epidemiologyABSTRACT
SETTING: Tuberculosis (TB) is the most common opportunistic infection among persons with human immunodeficiency virus or the acquired immune-deficiency syndrome (HIV/AIDS). Isoniazid preventive therapy (IPT) effectively treats latent TB infection (LTBI) and prevents progression to active TB. OBJECTIVE: To analyse the costs and cost-effectiveness of tuberculin skin testing (TST) prior to offering IPT. DESIGN: We implemented a program for LTBI screening and IPT using TST for persons with HIV at a voluntary counseling and testing (VCT) center in Kampala, Uganda. Cost-effectiveness analyses using Markov methods were adopted to compare strategies of using and not using TST before offering IPT. RESULTS: The program enrolled 7073 persons with HIV. Based on the prevalence of LTBI in the population, 34/100 HIV-infected patients would benefit from IPT. The results showed that 28% of LTBI patients would be treated using the TST strategy, and 40% would be treated with a non-TST strategy. Compared to no intervention, the estimated incremental cost of identifying and providing IPT using TST was dollars 211 per patient; the incremental cost using a non-TST strategy was dollars 768 per patient. CONCLUSION: At a large VCT center in Uganda, the inclusion of TST to identify the HIV-infected persons who will most benefit from IPT is cost-effective.
