Cost-effectiveness of the Three I’s for HIV/TB and ART to prevent TB among people living with HIV
Published Date:Oct 2014
Source:Int J Tuberc Lung Dis. 18(10):1159-1165.
CD4 Lymphocyte Count
Drug Resistance, Bacterial
Intensified TB Case Finding
Sensitivity And Specificity
Pubmed Central ID:PMC4886505
Funding:CC999999/Intramural CDC HHS/United States
To evaluate the cost-effectiveness of the Three I’s for HW/TB (human immunodeficiency virus/tuberculosis): antiretroviral therapy (ART), intensified TB case finding (ICF), isoniazid preventive treatment (IPT), and TB infection control (IC).
Using a 3-year decision-analytic model, we estimated the cost-effectiveness of a base scenario (55% ART coverage at CD4 count ≤350 cells/mm3) and 19 strategies that included one or more of the following: 1) 90% ART coverage, 2) IC and 3) ICF using four-symptom screening and 6- or 36-month IPT. The TB diagnostic algorithm included 1) sputum smear microscopy with chest X-ray, and 2) Xpert® MTB/RIF.
In resource-constrained settings with a high burden of HIV and TB, the most cost-effective strategies under both diagnostic algorithms included 1) 55% ART coverage and IC, 2) 55% ART coverage, IC and 36-month IPT, and 3) expanded ART at 90% coverage with IC and 36-month IPT. The latter averted more TB cases than other scenarios with increased ART coverage, IC, 6-month IPT and/or IPT for tuberculin skin test positive individuals. The cost-effectiveness results did not change significantly under the sensitivity analyses.
Expanded ART to 90% coverage, IC and a 36-month IPT strategy averted most TB cases and is among the cost-effective strategies.
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