No abstract

No abstract

The cost-effectiveness of chemotherapy for pulmonary sputum smear-positive tuberculosis was examined in the national tuberculosis control programmes of Malawi, Mozambique and Tanzania. In these three programmes, routine cure rates have exceeded 80 per cent. Average, average incremental and marginal unit costs for standard, short-course and retreatment regimens with and without hospitalization have been measured. The average incremental cost per year of life saved through chemotherapy ranged from US $0.90-3.10. In all conditions, short-course chemotherapy is preferable to standard 12-month chemotherapy. When hospitalization during the intensive phase of chemotherapy increases the cure rate by 10-15 percentage points, it can be relatively cost-effective. Analysing the cost-effectiveness of short-course and standard chemotherapy, where the depth of the margin of benefit is different, illustrates some of the dangers of simplistic use of cost-effectiveness ratios.

A population-based case-control study was carried out in Mwanza Region, Tanzania, to determine the relative and population attributable risk of human immunodeficiency virus type 1 (HIV-1) infection for developing active tuberculosis. Cases were 441 consecutively diagnosed patients with tuberculosis (all types), aged 15-54 years. Controls were a representative population sample of 4161 people, drawn in a stratified cluster sample from urban areas, roadside settlements, and rural villages. HIV-1 infection was determined by ELISA and if the ELISA result was indeterminate by Western Blot. The HIV-1 prevalence in cases was 23.0% in rural, 32.1% in roadside, and 54.1% in urban areas, while in controls these prevalences were 3.4%, 7.2% and 12.1% respectively. The relative risk (RR) of HIV-1 infection for the development of active tuberculosis was estimated to be 8.3 (95% confidence interval [CI] 6.4-11.0). This risk varied little by sex or residence, but appeared to be more pronounced in the age group 25-34 years. The case detection rate of tuberculosis in those aged 15-54 years was 125/100,000 people per year. The population attributable risk was 36/100,000 people per year, implying that 29% of tuberculosis cases at present may be attributable to HIV-1 infection. It is concluded that HIV-1 infection is a major contributing factor to the increased case detection rate of tuberculosis observed over the past 10 years in Mwanza Region. If the prevalence of HIV-1 continues to increase, the incidence of tuberculosis will continue to rise as well.(ABSTRACT TRUNCATED AT 250 WORDS)