title: Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa.
abstract: South Africa has one of the highest burdens of TB worldwide, driven by the country's widespread prevalence of HIV, and further complicated by drug resistance. Active case finding within the community, particularly in rural areas where healthcare access is limited, can significantly improve diagnosis and treatment coverage in high-incidence settings. We evaluated the potential health and economic consequences of implementing community-based TB/HIV screening and linkage to care. Using a dynamic model of TB and HIV transmission over a time horizon of 10 years, we compared status quo TB/HIV control to community-based TB/HIV screening at frequencies of once every two years, one year, and six months. We also considered the impact of extending IPT from 36 months for TST positive and 12 months for TST negative or unknown patients (36/12) to lifetime use for all HIV-infected patients. We conducted a probabilistic sensitivity analysis to assess the effect of parameter uncertainty on the cost-effectiveness results. We identified four strategies that saved the most life years for a given outlay: status quo TB/HIV control with 36/12 months of IPT and TB/HIV screening strategies at frequencies of once every two years, one year, and six months with lifetime IPT. All of these strategies were very cost-effective at a threshold of $6,618 per life year saved (the per capita GDP of South Africa). Community-based TB/HIV screening with linkage to care is therefore very cost-effective in rural South Africa.
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.|Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Gilbert
authors.affiliation: Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Sheela V
authors.initials: SV
authors.lastname: Shenoi
authors.affiliation: Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America.|Church of Scotland Hospital, Tugela Ferry, KwaZulu-Natal, South Africa.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Moll
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.|Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.|Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000191:economics / Q000453:epidemiology* / Q000635:transmission