Cost-effectiveness of including tuberculin skin testing in an IPT program for HIV-infected persons in Uganda.
METHODS
Tuberculosis (TB) is the most common opportunistic infection among persons with human immunodeficiency virus or the acquired immune-deficiency syndrome (HIV/AIDS). Isoniazid preventive therapy (IPT) effectively treats latent TB infection (LTBI) and prevents progression to active TB.


OBJECTIVE
To analyse the costs and cost-effectiveness of tuberculin skin testing (TST) prior to offering IPT.


METHODS
We implemented a program for LTBI screening and IPT using TST for persons with HIV at a voluntary counseling and testing (VCT) center in Kampala, Uganda. Cost-effectiveness analyses using Markov methods were adopted to compare strategies of using and not using TST before offering IPT.


RESULTS
The program enrolled 7073 persons with HIV. Based on the prevalence of LTBI in the population, 34/100 HIV-infected patients would benefit from IPT. The results showed that 28% of LTBI patients would be treated using the TST strategy, and 40% would be treated with a non-TST strategy. Compared to no intervention, the estimated incremental cost of identifying and providing IPT using TST was dollars 211 per patient; the incremental cost using a non-TST strategy was dollars 768 per patient.


CONCLUSIONS
At a large VCT center in Uganda, the inclusion of TST to identify the HIV-infected persons who will most benefit from IPT is cost-effective.
Shrestha
R K
RK
Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. rshrestha@cdc.gov
Mugisha
B
B
Bunnell
R
R
Mermin
J
J
Hitimana-Lukanika
C
C
Odeke
R
R
Madra
P
P
Adatu
F
F
Blandford
J M
JM
D000995:Antitubercular Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007538:Isoniazid / Q000191:economics* / Q000627:therapeutic use*; D015397:Program Evaluation; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000191:economics*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D014454:Uganda
D000995:Antitubercular Agents; D007538:Isoniazid