Cost-effectiveness of the Three I's for HIV/TB and ART to prevent TB among people living with HIV
METHODS: 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.
RESULTS: 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.
CONCLUSION: Expanded ART to 90% coverage, IC and a 36-month IPT strategy averted most TB cases and is among the cost-effective strategies.
Keywords: RIF; Xpert® MTB; economic analysis; intensified TB case finding; isoniazid
Document Type: Original Article
Affiliations: 1: Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland 2: US Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Cape Town, South Africa 4: Independent Consultant, Huntingdon, UK
Publication date: 01 October 2014
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