Impact and Value of Improving TB Control in Africa
Principal Investigator:
- Kenneth A. Freedberg, M.D., M.Sc., Massachusetts General Hospital
Co-Investigators:
- Robin Wood, B.M., B.Ch., M.Med., University of Cape Town, South Africa
- Linda-Gail Bekker, M.B.Ch.B., F.C.P., University of Cape Town, South Africa
- Melissa Bender, M.D., Massachusetts General Hospital
Abstract
HIV and tuberculosis (TB) coinfection in Africa represent a public health emergency, requiring urgent decisions by health care providers and policymakers. AIDS is the leading cause of death in sub-Saharan Africa, and TB is the region’s leading cause of HIV-related morbidity and mortality. Despite numerous studies over many years, there is no consensus regarding the best way to diagnose and prevent TB in HIV-infected people. The rising incidence of TB and the recent emergence of a highly lethal strain of extensively drug resistant (XDR) TB, together with concerns about its transmission in the hospital, magnify the urgency of these questions. Early, rapid TB case detection is essential to stem the trajectory of these XDR outbreaks, but current diagnostic methods used in resource-limited settings lack both sensitivity and speed.
This project will examine the value and impact of improving TB case detection and implementing measures to reduce transmission. We will use a state-transition, computer simulation model to project the clinical impact, costs, and cost-effectiveness of improving TB infection control in an area of high HIV prevalence with the following 3 aims:
- To examine the cost-effectiveness of introducing TB screening at HIV voluntary counseling and testing (VCT) sites;
- To evaluate the cost-effectiveness of standard TB case detection compared with routine sputum culture or rapid TB detection techniques in areas of high XDR prevalence; and
- To assess the cost-effectiveness of implementing TB infection control procedures in resource-limited health care settings with high HIV prevalence.
To carry out these aims, we will use data from the South African PEPFAR site in Cape Town to inform the analysis using the “Cost-Effectiveness of Preventing AIDS Complications” (CEPAC) International model, a widely published, detailed state-transition model of HIV infection. This proposal will benefit from the rich collaborative ties established between investigators in Cape Town and in Boston in addressing the value of rapid TB detection and control in the context of the dual epidemics of HIV and TB disease.