Academic journal article Bulletin of the World Health Organization

Costs of Measures to Control tuberculosis/HIV in Public Primary Care Facilities in Cape Town, South Africa/Couts Des Mesures De Lutte Contre la Tuberculose et le VIH Dans Les Etablissements De Soins De Sante Primaires De la Ville Du Cap, En Afrique Du Sud/Costo De Las Medidas De Control De la tuberculosis/VIH En Centros De Atencion Primaria De Ciudad del Cabo, Sudafrica

Academic journal article Bulletin of the World Health Organization

Costs of Measures to Control tuberculosis/HIV in Public Primary Care Facilities in Cape Town, South Africa/Couts Des Mesures De Lutte Contre la Tuberculose et le VIH Dans Les Etablissements De Soins De Sante Primaires De la Ville Du Cap, En Afrique Du Sud/Costo De Las Medidas De Control De la tuberculosis/VIH En Centros De Atencion Primaria De Ciudad del Cabo, Sudafrica

Article excerpt

Introduction

With an antenatal human immunodeficiency virus (HIV) prevalence of 29.5% and an estimated 6.29 million people infected, (1) South Africa has the largest number of people living with HIV/ acquired immunodeficiency syndrome (AIDS) in the world. (2) HIV increases tuberculosis (TB) incidence by reactivation of latent infection (3) and rapid progression of recent infection. (4) With increasing HIV prevalence, TB incidence has risen throughout sub-Saharan Africa. (5,6) In South Africa, the incidence of TB increased from 187/100 000 in 1989 (7) to 599/100 000 in 2004. (8)

Following the recommendations by national reviews for improved collaboration between the TB and HIV/AIDS programmes in South Africa, (9,10) four TB/HIV Pilot Districts were initiated in 1999. These districts participated in ProTEST, (11) a WHO supported package of TB/HIV interventions by providing voluntary counselling and testing (VCT) with rapid HIV testing, screening for TB through intensified case-finding (ICF), isoniazid preventive therapy (IPT), cotrimoxazole preventive therapy (CPT), and improved management of opportunistic infections. ProTEST aimed to decrease the transmission of HIV through VCT, decrease the transmission of TB through ICF and prevent the reactivation of TB through IPT. (12)

Cost and cost-effectiveness data for ProTEST interventions are important for programme managers to decide what is affordable for expanded implementation. The data are relevant in the era of antiretroviral treatment (ART) programmes because VCT is necessary to identify HIV-infected persons and ICE IPT and CPT remain part of the comprehensive package of HIV care. There are few studies in developing countries on the cost-effectiveness of VCT, (13) rapid HIV testing, (14) IPT (15-19) and CPT. (20)

We measured the costs and estimated the cost-effectiveness of the ProTEST package of TB/HIV interventions in Cape Town, South Africa.

Methods

setting

The Central District of Cape Town, with a population of 296 000, consists of urban/peri-urban areas with vast socioeconomic disparities. The antenatal HIV prevalence was 17% in 2001 and the TB incidence was 488/100 000 in 2002. (21)

Using purposive sampling, we chose three public primary health care facilities--a community health centre (CHC), a primary health care (PHC) clinic and a sexually transmitted infections (STI) clinic--from the 12 facilities that participated in ProTEST (Table 1, web version only, available from: http://www. who.int/bulletin). All facilities promoted VCT to self-presenting and antenatal clients as well as TB and STI patients, and provided improved management of HIV-related infections. The CHC and PHC clinic also offered ICF (TB symptom screening for HIV-positive patients, and sputum smear investigations as well as chest X-ray for TB symptomatics), IPT (isoniazid 300 mg daily for six months for HIV-positive patients with no TB symptoms, a normal chest X-ray, and a positive tuberculin skin test) and CPT (life-long cotrimoxazole 480 mg daily for patients with HIV/AIDS, WHO clinical stage III or IV) (Fig. 1). We evaluated only VCT in the STI clinic and the complete ProTEST package in the CHC and PHC clinics.

[FIGURE 1 OMITTED]

Cost analysis

Following the Costing guidelines for HIV/ AIDS prevention strategies developed by UNAIDS, (22) we collected the costs incurred by public and nongovernmental organization (NGO) health-care providers retrospectively, using ingredients-based costing, i.e. costing each component of an activity, including capital and recurrent costs for one financial year. Financial costs represented actual expenditure, while economic costs were financial costs plus the estimated value of goods or services with no financial transactions and some adjusted financial costs when the price paid did not reflect the cost of using it elsewhere.

We did not include the costs of research. …

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