Effectiveness of active case-finding strategies in tuberculosis control in Kampala, Uganda.

BACKGROUND: Passive case finding (PCF) is the strategy implemented by most developing countries to detect new cases of tuberculosis (TB), but detection rates remain low. Active case finding (ACF) is an alternative strategy, although cost is a barrier to implementation. We estimated the cost-effectiveness of a city-wide ACF programme in Kampala, Uganda, compared to the PCF strategy. METHODS: We developed a decision tree and Markov model to compare ACF vs. PCF across several outcome measures. Parameter estimates for costs, probabilities and utility scores were obtained from published reports and peer-reviewed journal articles. The main outcome measures were TB cases detected, deaths averted, life years saved (LYS) and quality-adjusted life years (QALYs). RESULTS: Our model found that ACF implemented city-wide would result in an additional 1594 TB cases detected in 1 year, 675 deaths averted over a 5-year period, 21,928 LYS, and would cost an additional US$109 per additional QALY. The 25-34 year age group received most health benefits (556 cases detected, 229 deaths averted, 8058 LYS), and the programme was most cost-effective in the 45-54 year age group (US$51/QALY). CONCLUSIONS: ACF is an effective strategy for TB control and improving quality of life and is also cost-effective.

Factors associated with human immunodeficiency virus testing among tuberculosis patients receiving treatment at health facilities in Uganda.

SETTING: One peri-urban and four rural districts in Uganda. OBJECTIVES: To determine the level of and factors associated with human immunodeficiency virus (HIV) testing among tuberculosis (TB) patients. DESIGN: A cross-sectional study was conducted in five selected districts from August to November 2007. Patients aged > or = 18 years returning for TB treatment refills at facilities offering TB and HIV services were included. Patients were excluded if they were very sick or unable to speak English or any of the local study languages. The outcome was self-reported HIV testing after TB diagnosis, validated using clinic registers. RESULTS: Of 261 patients analysed, 169 (65%) had been tested for HIV following TB diagnosis. In a multivariate analysis, age >45 years (OR 0.27, 95%CI 0.08-0.87), not receiving information about the TB-HIV association (OR 0.35, 95%CI 0.15-0.77), not being offered HIV testing by health provider (OR 0.02, 95%CI 0.006-0.042), dissatisfaction with privacy (OR 2.49, 95%CI 1.11-5.55) and spending 30-60 min at the clinic (OR 4.48, 95%CI 1.66-12.10) significantly influenced level of HIV testing. CONCLUSION: The level of HIV testing among TB patients was suboptimal, as per policy all patients should be tested. The Uganda Ministry of Health should continue to scale-up HIV testing and other collaborative TB-HIV services at health facilities.