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BMC Public Health

, 5:130

First Online: 12 December 2005Received: 07 April 2005Accepted: 12 December 2005DOI: 10.1186-1471-2458-5-130

Cite this article as: Currie, C.S., Floyd, K., Williams, B.G. et al. BMC Public Health 2005 5: 130. doi:10.1186-1471-2458-5-130

Abstract

BackgroundThe 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.

MethodsOur 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.

ResultsThe 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.

ConclusionTo 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.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-5-130 contains supplementary material, which is available to authorized users.

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Author: Christine SM Currie - Katherine Floyd - Brian G Williams - Christopher Dye

Source: https://link.springer.com/







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