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Free Content Cost-effectiveness of including tuberculin skin testing in an IPT program for HIV-infected persons in Uganda

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SETTING: 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.

DESIGN: 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 $211 per patient; the incremental cost using a non-TST strategy was $768 per patient.

CONCLUSION: 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.
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Keywords: HIV-1; Uganda; cost-effectiveness; isoniazid prophylaxis; latent tuberculosis

Document Type: Regular Paper

Affiliations: 1: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: AIDS Information Centre, Kampala, Uganda 3: Global AIDS Program, Centers for Disease Control and Prevention, Entebbe, Uganda 4: National TB and Leprosy Programme, Ministry of Health, Kampala, Uganda

Publication date: 2006-06-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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