Cost-effectiveness of the Three I's for HIV/TB and ART to prevent TB among people living with HIV

摘要

Objective: To evaluate the cost-effectiveness of the Three I's for HIV/TB (human immunodeficiency virus/ tuberculosis): antiretroviral therapy (ART), intensified TB case finding (ICF), isoniazid preventive treatment (IPT), and TB infection control (IC).Methods: Using a 3-year decision-analytic model, we estimated the cost-effectiveness of a base scenario (55% ART coverage at CD4 count 6350 cells/mm3) and 19 strategies that included one or more of the following: 1) 90% ART coverage, 2) IC and 3) ICF using foursymptom screening and 6- or 36-month IPT. The TB diagnostic algorithm included 1) sputum smear microscopy with chest X-ray, and 2) Xpertw 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 ARTat 90% coverage with IC and 36-month IPT. The latter averted more TB cases than other scenarios with increased ARTcoverage, 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.