Tuberculosis preventive therapy for HIV-infected people in sub-Saharan Africa is cost-effective

Abstract:

Objective: Since antiretroviral therapy is largely unavailable to HIV-infected patients in developing countries and recent clinical trials have shown that tuberculosis (TB) preventive therapy can reduce TB and HIV-associated morbidity and mortality, we studied the effectiveness and cost-effectiveness of TB preventive therapy for HIV-infected persons in sub-Saharan Africa.

Methods: : A Markov model that used results of clinical trials of TB preventive therapy in sub-Saharan Africa and literature-derived medical care costs was used to evaluate three preventive therapy regimens in HIV-infected, tuberculin-positive patients in Uganda: (1) daily isoniazid (INH) for 6months, (2) daily INH and rifampin (RIF) for 3months, and (3) twice-weekly RIF and pyrazinamide (PZA) for 2months.
Results: All three regimens extend life expectancy and reduce the number of TB cases. When only medical care costs are considered, all three preventive therapy regimens cost more than not providing preventive therapy to extend life and prevent active tuberculosis. When medical care and social costs are considered together, 6-months of daily INH treatment will save money relative to no preventive therapy and when the costs associated with treating secondary infections are included, all three preventive therapy regimens are less expensive than no preventive therapy. With the inclusion of secondary infection costs, 6months of daily INH results in savings of $24.16 per person.

Conclusions: : TB preventive therapy taken by HIV-infected tuberculin reactors in sub-Saharan Africa results in extended life-expectancy, reduction of the incidence of TB and monetary savings in medical care and social costs. TB control policy in sub-Saharan Africa should include preventive therapy.

Source: www.aidsonline.com, AIDS, August 20, 1999.

HIV fuels soaring TB death rate

IOL, Di Caelers, June 22 2006

A deadly combination of HIV and tuberculosis is cutting a swathe through South Africa, sending death rates skyrocketing - with 93 percent more women dying in 2003 than six years previously.

The shocking figures have huge significance for the Western Cape, which has the highest TB rate in Africa. They also reveal that TB is the biggest cause of mortality in South Africa, with nearly 70 000 deaths recorded in 2003.

The statistics are the most recent available and were released by Statistics SA at the end of last month, prompting HIV and Aids activists to sound an urgent warning to President Thabo Mbeki.
top.

"We have a crisis of death in South Africa, and this crisis is caused by the HIV epidemic, which has resulted in deaths due to TB and other opportunistic infections spiralling," activists from 22 African countries said in a statement after a Treatment Action Campaign TB and HIV workshop in Cape Town this week.

'We have a crisis of death'"We call on President Mbeki to lead us through this crisis by recognising that the HIV epidemic is an emergency."

Criticising the apparently stealthy release of the statistics by Stats SA at the end of last month, the TAC's Zackie Achmat said it was time for everyone to wake up to "the emergency".

In 1997, Stats SA recorded 22 000 deaths as a result of TB. By 2003, that figure had trebled to 67 000, making the disease "by far" the biggest cause of death.

"Given the substantial increase in TB deaths since 1997, it is almost certain that the vast majority of these are HIV-related," Achmat said.Overall, deaths in South Africa 2003 were 74 percent up on the figure for 1997, the statistics show.

With the decline in that period of non-natural deaths, like car accidents and murder, "the vast majority of the increase can only be explained by the HIV epidemic", Achmat told the workshop.

The close link between HIV and TB is well established. Last year, the Cape Argus reported that a staggering two-thirds of TB patients in Cape Town were HIV-positive.

City health chief Dr Ivan Toms warned at the time that HIV was the "wild card" in seeking to bring the TB epidemic under control.In the Western Cape, the average TB infection rate is about 900 per 100 000 people, compared with a national rate of 684 per 100 000.

But a local study found that in one city township, HIV pushed that figure up to 1 900 per 100 000.People whose immune systems are compromised, such as those with HIV and Aids, are more likely to contract TB than others.

Statistics from Stats SA also show substantial increases in deaths among infants and economically active people aged 30 to 34, especially women.

Death certificates, according to the report, show that 20 000 more children under four died in 2004 than in 1997. In a normal population, most adults would die a lot later.

But in South Africa in 2003, deaths in the 30 to 34 age group (55 148) were higher than in any other group.There were just over half that number in the 60-to-64 group and the 70-to-74 age group.

Achmat said this trend, where the largest group dying consisted of young adults, could only be explained by a huge HIV epidemic. According to the Stats SA report, a change in gender patterns in deaths is also evident - in 2003 recorded male deaths were 60 percent up on the figure for 1997, and female deaths up by 93 percent.

The TAC called for the first meeting of the SA National Aids Council to "set everything aside and look only at these death statistics".

Source: IOL