Cost-Effectiveness of Antiretroviral Therapy and Isoniazid Prophylaxis to Reduce Tuberculosis and Death in People Living With HIV in Botswana
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Cost-Effectiveness of Antiretroviral Therapy and Isoniazid Prophylaxis to Reduce Tuberculosis and Death in People Living With HIV in Botswana

Filetype[PDF-780.97 KB]


  • English
    • Details Supporting Files You May Also Like

    Details:

    • Alternative Title:
      J Acquir Immune Defic Syndr
    • Personal Author:
    • Description:
      Objective

      In Botswana, a 36-month course of isoniazid treatment of latent tuberculosis (TB) infection [isoniazid preventive therapy (IPT)] was superior to 6-month IPT in reducing TB and death in persons living with HIV (PLHIV), having positive tuberculin skin tests (TSTs) but not in those with negative TST. We examined the cost-effectiveness of IPT in Botswana, where antiretroviral therapy (ART) is widely available.

      Design

      Using a decision-analytic model, we determined the incremental cost-effectiveness of strategies for reducing TB and death in 10,000 PLHIV over 36 months.

      Methods

      IPT for 6 months and provision of ART if CD4+ lymphocyte count <250 cells per microliter (2011 Botswana policy) was compared with 6 alternative strategies that varied the use of IPT, TST, and ART for CD4+ count thresholds, including CD4+ <350 and <500 cells per microliter.

      Results

      Botswana policy, 2011 was dominated by most other strategies. IPT of 36 months for TST-positive PLHIV with ART for CD4+ <250 cells per microliter resulted in 120 fewer TB cases for an additional cost of $1612 per case averted and resulted in 80 fewer deaths for an additional $2418 per death averted compared with provision of 6-month IPT to TST-positive PLHIV who received ART for CD4+ <250 cells per microliter, the next most effective strategy. Alternative strategies offered lower incremental effectiveness at higher cost. These findings remained consistent in sensitivity analyses.

      Conclusions

      A strategy of treating PLHIV who have positive TST with 36-month IPT is more cost effective for reducing both TB and death compared with providing IPT without a TST, providing only 6-month IPT, or expanding ART eligibility without IPT.

    • Subject:
    • Source:
      J Acquir Immune Defic Syndr. 70(3):e84-e93
    • Pubmed ID:
      26258564
    • Pubmed Central ID:
      PMC5131632
    • Document Type:
      Journal Article
    • Funding:
      CC999999/Intramural CDC HHS/United States
    • Collection(s):
      CDC Public Access
    • Main Document Checksum:
    • File Type:

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