Cost-effectiveness of including tuberculin skin testing in an IPT program for HIV-infected persons in Uganda.

Abstract

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.

• Authors: R K Shrestha, B Mugisha, R Bunnell, J Mermin, C Hitimana-Lukanika, R Odeke, P Madra, F Adatu, J M Blandford
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 10 Issue 6 Pg. 656-62 (Jun 2006) ISSN: 1027-3719 [Print] France
• PMID: 16776453 (Publication Type: Journal Article)

Chemical References

• Antitubercular Agents
• Isoniazid

Topics

• Antitubercular Agents (economics, therapeutic use)
• Cost-Benefit Analysis
• HIV Infections (complications)
• Humans
• Isoniazid (economics, therapeutic use)
• Program Evaluation
• Sensitivity and Specificity
• Tuberculin Test (economics)
• Tuberculosis, Pulmonary (diagnosis, economics, etiology, prevention & control)
• Uganda