Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence

Currie, Christine S. M.; Floyd, Katherine; Williams, Brian G.; Dye, Christopher
January 2005
BMC Public Health;2005, Vol. 5 Issue 1, p130
Academic Journal
Background: The HIV epidemic has caused a dramatic increase in tuberculosis (TB) in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited. Methods: Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices) and effects (TB cases averted, deaths averted, DALYs gained) of these strategies in Kenya during the period 2004-2023. Results: The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure); the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART) had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI) for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels. Conclusion: To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably in combination. Realising the full potential of ART will require substantial new funding and strengthening of health system capacity so that increased funding can be used effectively.


Related Articles

  • Public Health Care Practitioner's Reflections on Tuberculosis Patient's Perspectives on Factors Influencing their Adherence to the Directly Observed Treatment Short-Course. Naidoo, Pamela // Open Public Health Journal;Jan2009, Vol. 2, p33 

    The high prevalence of tuberculosis (TB) in South Africa is well established. TB, Human Immunodeficiency Virus (HIV), and Auto Immune Deficiency Syndrome (AIDS) co-exist, which contributes to the high incidence, prevalence, and recurrent infection rate of TB. Despite the implementation of the...

  • Antiretroviral Therapy in Prevention of HIV and TB: Update on Current Research Efforts. Granich, Reuben; Gupta, Somya; Suthar, Amitabh B.; Smyth, Caoimhe; Hoos, David; Vitoria, Marco; Simao, Mariangela; Hankins, Catherine; Schwartlander, Bernard; Ridzon, Renee; Bazin, Brigitte; Williams, Brian; Lo, Ying-Ru; McClure, Craig; Montaner, Julio; Hirnschall, Gottfried // Current HIV Research;Sep2011, Vol. 9 Issue 6, p446 

    There is considerable scientific evidence supporting the use of antiretroviral therapy (ART) in prevention of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. The complex nature of the HIV and TB prevention responses, resource constraints, remaining questions about cost and...

  • ART for Life's Sake: The Profound affect of Antiretroviral Therapy on H IV in Africa. Winslow, Dean L. // Infectious Disease Alert;Feb2014, Vol. 33 Issue 5, p49 

    Survival benefits in adults attributable to antiretroviral therapy (ART) initiated in South Africa since 2004 were quantified using the Cost-Effectiveness of Preventing AIDS Complications-International model (CEPAC) simulating 8 cohorts of HIV-infected patients initiating therapy each year...

  • HIV and TB co-infection among patients on directly observed treatment of short course in Abeokuta, Ogun State, Nigeria. Okonko, I. O.; Soleye, F. A.; Adeniji, F. O.; Okerentugba, P. O. // Nature & Science;Jun2012, Vol. 10 Issue 6, p10 

    This study aimed to determine the prevalence of HIV and TB among patients on directly observed treatment of short-course (DOTS) in Abeokuta, Nigeria. Two hundred DOTS attendees (124 males and 76 females, age range: 16 to 75 years of age) at the Department of Health Services, UNAAB were randomly...

  • High rates of HIV in surgical patients in Soweto, South Africa: impact on resource utilisation and recommendations for HIV testing. Martinson, Neil A.; Omar, Tanvier; Gray, Glenda E.; Vermaak, Jacobus S.; Badicel, Maria; Degiannis, Elias; Steyn, Jan; McIntyre, James A.; Smith, Martin // Transactions of the Royal Society of Tropical Medicine & Hygiene;Feb2007, Vol. 101 Issue 2, p176 

    Summary: Interactions between HIV and surgical diseases are relatively poorly described in high HIV prevalence settings. We report HIV prevalence and its associations in a prospective study of adults admitted to surgical units in Soweto, South Africa. Voluntary counselling and testing (VCT) for...

  • HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study. Pefura Yone, Eric Walter; Kuaban, Christopher; Pascal Kengne, Andr� // BMC Infectious Diseases;2012, Vol. 12 Issue 1, p190 

    Background: Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occuring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in...

  • From the Executive. Conradie, Francesca // Southern African Journal of HIV Medicine;Jun2013, Vol. 14 Issue 2, p47 

    The article presents the message of Southern Africa HIV Clinician Society president Francesca Conradie on the efforts of the organization to help prevent HIV infection and tuberculosis in South Africa.

  • Isoniazid prophylaxis increases survival in patients infected with HIV and TB. Safrin, Sharon // Modern Medicine;Feb98, Vol. 66 Issue 2, p59 

    Discusses the abstract `Isoniazid Preventive Therapy in Human Immunodeficiency Virus-Infected Persons: Long-term Effect on Development of Tuberculosis and Survival,' by S. Moreno, P. Miralles, M.D. Diaz et al., which appeared in the August 11, 1997 issue of `Archives of Internal Medicine.'

  • HIV infection and TB. De Cock, Kevin M.; Dworkin, Mark S. // World Health;Nov/Dec98, Vol. 51 Issue 6, p14 

    Identifies the four levels of interaction between HIV infection and tuberculosis and its implications for the epidemiology, clinical manifestations, treatment and prevention of both diseases. Relationship between tuberculosis (TB) and HIV infection; How TB is acquired; Susceptibility of persons...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics