Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa

Abstract

South Africa has one of the highest burdens of TB worldwide, driven by the country’s widespread prevalence of HIV, and further complicated by drug resistance. Active case finding within the community, particularly in rural areas where healthcare access is limited, can significantly improve diagnosis and treatment coverage in high-incidence settings. We evaluated the potential health and economic consequences of implementing community-based TB/HIV screening and linkage to care. Using a dynamic model of TB and HIV transmission over a time horizon of 10 years, we compared status quo TB/HIV control to community-based TB/HIV screening at frequencies of once every two years, one year, and six months. We also considered the impact of extending IPT from 36 months for TST positive and 12 months for TST negative or unknown patients (36/12) to lifetime use for all HIV-infected patients. We conducted a probabilistic sensitivity analysis to assess the effect of parameter uncertainty on the cost-effectiveness results. We identified four strategies that saved the most life years for a given outlay: status quo TB/HIV control with 36/12 months of IPT and TB/HIV screening strategies at frequencies of once every two years, one year, and six months with lifetime IPT. All of these strategies were very cost-effective at a threshold of $6,618 per life year saved (the per capita GDP of South Africa). Community-based TB/HIV screening with linkage to care is therefore very cost-effective in rural South Africa.

Cost Effectiveness Analysis Of High-Risk Group Tb Screening In Malaysia

“…This study indicates that TB screening among PL HIV is the most cost-effective strategy. The result consistent with past studies, which revealed TB screening among HIV is cost effective in both community and hospital settings (15,16). HIV is a well-known risk factor for TB infection in low-and middle-income countries (1).…”

Integrated Tuberculosis/Human Immunodeficiency Virus Community-Based Case Finding in Rural South Africa: Implications for Tuberculosis Control Efforts

“…Although modeling has confirmed the impact on reducing incidence and mortality from TB and HIV [ 30 ], these findings require confirmation in other regions. Furthermore, a recent study has demonstrated the cost effectiveness of the integrated TB/HIV CBICF strategy in rural resource-limited regions [ 38 ].…”

Modelling the HIV-Associated TB Epidemic and the Impact of Interventions Aimed at Epidemic Control

“…The intensified case finding was found to be the single most effective intervention for TB incidence, with around a 25% reduction over 10 years and a comparable impact on combined TB and HIV mortality as expanded ART policies. Gilbert et al [125] built on this to evaluate the projected cost-effectiveness of their intensified case finding strategy, finding it cost-effective in rural South Africa.…”