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

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Smith, Tyler ; Samandari, Taraz ; Abimbola, Taiwo ; Marston, Barbara ; Sangrujee, Nalinee
• 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.
  
  
• Subjects:
  Anti-HIV Agents Antiretroviral Therapy Antituberculosis Therapy Article Botswana Cost Cost-Benefit Analysis Cost-effectiveness HIV Infection HIV Infections Humans Isoniazid Tuberculosis

  More +
• 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
• Volume:
  70
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ef340e0a47e8a3e24ea1c1482f2e1878ed6ac2a5ee2a01837126b8616cbc9e96
• Download URL:
  https://stacks.cdc.gov/view/cdc/43113/cdc_43113_DS1.pdf
• File Type:
  [PDF - 780.97 KB ]