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Baggaley RF, Vegvari C, Dimala CA, Lipman M, Miller RF, Brown J, Degtyareva S, White HA, Hollingsworth TD, Pareek M. Health economic analyses of latent tuberculosis infection screening and preventive treatment among people living with HIV in lower tuberculosis incidence settings: a systematic review. Wellcome Open Res 2023; 6:51. [PMID: 37025515 PMCID: PMC10071141.2 DOI: 10.12688/wellcomeopenres.16604.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction: In lower tuberculosis (TB) incidence countries (<100 cases/100,000/year), screening and preventive treatment (PT) for latent TB infection (LTBI) among people living with HIV (PLWH) is often recommended, yet guidelines advising which groups to prioritise for screening can be contradictory and implementation patchy. Evidence of LTBI screening cost-effectiveness may improve uptake and health outcomes at reasonable cost. Methods: Our systematic review assessed cost-effectiveness estimates of LTBI screening/PT strategies among PLWH in lower TB incidence countries to identify model-driving inputs and methodological differences. Databases were searched 1980-2020. Studies including health economic evaluation of LTBI screening of PLWH in lower TB incidence countries (<100 cases/100,000/year) were included. Results: Of 2,644 articles screened, nine studies were included. Cost-effectiveness estimates of LTBI screening/PT for PLWH varied widely, with universal screening/PT found highly cost-effective by some studies, while only targeting to high-risk groups (such as those from mid/high TB incidence countries) deemed cost-effective by others. Cost-effectiveness of strategies screening all PLWH from studies published in the past five years varied from US$2828 to US$144,929/quality-adjusted life-year gained (2018 prices). Study quality varied, with inconsistent reporting of methods and results limiting comparability of studies. Cost-effectiveness varied markedly by screening guideline, with British HIV Association guidelines more cost-effective than NICE guidelines in the UK. Discussion: Cost-effectiveness studies of LTBI screening/PT for PLWH in lower TB incidence settings are scarce, with large variations in methods and assumptions used, target populations and screening/PT strategies evaluated. The limited evidence suggests LTBI screening/PT may be cost-effective for some PLWH groups but further research is required, particularly on strategies targeting screening/PT to PLWH at higher risk. Standardisation of model descriptions and results reporting could facilitate reliable comparisons between studies, particularly to identify those factors driving the wide disparity between cost-effectiveness estimates. Registration: PROSPERO CRD42020166338 (18/03/2020).
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Affiliation(s)
- Rebecca F. Baggaley
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Carolin Vegvari
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- UCL Respiratory, University College London, London, UK
| | - Christian A. Dimala
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Marc Lipman
- Royal Free London National Health Service Foundation Trust, London, UK
- RUDN University, Moscow, Russian Federation
| | | | | | - Svetlana Degtyareva
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Manish Pareek
- Big Data Institute, University of Oxford, Oxford, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, LE1 7RH, UK
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Care cascade of tuberculosis infection treatment for people living with HIV in the era of antiretroviral therapy scale-up. Sci Rep 2022; 12:16136. [PMID: 36167744 PMCID: PMC9515204 DOI: 10.1038/s41598-022-20394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
Testing and treatment of tuberculosis infection (TBI) are recommended for people living with HIV (PLWH). We aimed to evaluate the care cascade of TBI treatment among PLWH in the era of antiretroviral therapy (ART) scale-up. This retrospective study included adult PLWH undergoing interferon-gamma release assay (IGRA)-based TBI screening during 2019–2021. PLWH testing IGRA-positive were advised to receive directly-observed therapy for TBI after active TB disease was excluded. The care cascade was evaluated to identify barriers to TBI management. Among 7951 PLWH with a median age of 38 years and CD4 count of 616 cells/mm3, 420 (5.3%) tested positive and 38 (0.5%) indeterminate for IGRA. The TBI treatment initiation rate was 73.6% (309/420) and the completion rate was 91.9% (284/309). More than 80% of PLWH concurrently received short-course rifapentine-based regimens and integrase strand transfer inhibitor (InSTI)-containing ART. The main barrier to treatment initiation was physicians’ concerns and patients’ refusal (85.6%). The factors associated with treatment non-completion were older age, female, anti-HCV positivity, and higher plasma HIV RNA. Our observation of a high TBI completion rate among PLWH is mainly related to the introduction of short-course rifapentine-based regimens in the InSTI era, which can be the strategy to improve TBI treatment uptake.
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Auguste PE, Mistry H, McCarthy ND, Sutcliffe PA, Clarke AE. Cost-effectiveness of testing for latent tuberculosis infection in people with HIV. AIDS 2022; 36:1-9. [PMID: 34873091 DOI: 10.1097/qad.0000000000003060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the cost-effectiveness of screening strategies for predicting LTBI that progresses to active tuberculosis (TB) in people with HIV. DESIGN We developed a decision-analytical model that constituted a decision tree covering diagnosis of LTBI and a Markov model covering progression to active TB. The model represents the lifetime experience following testing for LTBI, and discounting costs, and benefits at 3.5% per annum in line with UK standards. We undertook probabilistic and one-way sensitivity analyses. SETTING UK National Health Service and Personal Social Service perspective in a primary care setting. PARTICIPANTS Hypothetical cohort of adults recently diagnosed with HIV. INTERVENTIONS Interferon-gamma release assays and tuberculin skin test. MAIN OUTCOME MEASURE Cost per quality-adjusted life year (QALY). RESULTS All strategies except T-SPOT.TB were cost-effective at identifying LTBI, with the QFT-GIT-negative followed by TST5mm strategy being the most costly and effective. Results indicated that there was little preference between strategies at a willingness-to-pay threshold of £20 000. At thresholds above £40 000 per QALY, there was a clear preference for the QFT-GIT-negative followed by TST5mm, with a probability of 0.41 of being cost-effective. Results showed that specificity for QFT-GIT and TST5mm were the main drivers of the economic model. CONCLUSION Screening for LTBI has important public health and clinical benefits. Most of the strategies are cost-effective. These results should be interpreted with caution because of the paucity of studies included in the meta-analysis of test accuracy studies. Additional high-quality primary studies are needed to have a definitive answer about, which strategy is the most effective.
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Affiliation(s)
| | | | - Noel D McCarthy
- Evidence in Communicable Disease Epidemiology and Control, Warwick Medical School, University of Warwick, Coventry, UK
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Lee SS. The challenge of minimizing tuberculosis burden in people living with HIV in the Asia Pacific. Respirology 2021; 27:12-13. [PMID: 34843631 DOI: 10.1111/resp.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.,School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Baggaley RF, Vegvari C, Dimala CA, Lipman M, Miller RF, Brown J, Degtyareva S, White HA, Hollingsworth TD, Pareek M. Health economic analyses of latent tuberculosis infection screening and preventive treatment among people living with HIV in lower tuberculosis incidence settings: a systematic review. Wellcome Open Res 2021; 6:51. [PMID: 37025515 PMCID: PMC10071141 DOI: 10.12688/wellcomeopenres.16604.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: In lower tuberculosis (TB) incidence countries (<100 cases/100,000/year), screening and preventive treatment (PT) for latent TB infection (LTBI) among people living with HIV (PLWH) is often recommended, yet guidelines advising which groups to prioritise for screening can be contradictory and implementation patchy. Evidence of LTBI screening cost-effectiveness may improve uptake and health outcomes at reasonable cost. Methods: Our systematic review assessed cost-effectiveness estimates of LTBI screening/PT strategies among PLWH in lower TB incidence countries to identify model-driving inputs and methodological differences. Databases were searched 1980-2020. Studies including health economic evaluation of LTBI screening of PLWH in lower TB incidence countries (<100 cases/100,000/year) were included. Study quality was assessed using the CHEERS checklist. Results: Of 2,644 articles screened, nine studies were included. Cost-effectiveness estimates of LTBI screening/PT for PLWH varied widely, with universal screening/PT found highly cost-effective by some studies, while only targeting to high-risk groups (such as those from mid/high TB incidence countries) deemed cost-effective by others. Cost-effectiveness of strategies screening all PLWH from studies published in the past five years varied from US$2828 to US$144,929/quality-adjusted life-year gained (2018 prices). Study quality varied, with inconsistent reporting of methods and results limiting comparability of studies. Cost-effectiveness varied markedly by screening guideline, with British HIV Association guidelines more cost-effective than NICE guidelines in the UK. Discussion: Cost-effectiveness studies of LTBI screening/PT for PLWH in lower TB incidence settings are scarce, with large variations in methods and assumptions used, target populations and screening/PT strategies evaluated. The limited evidence suggests LTBI screening/PT may be cost-effective for some PLWH groups but further research is required, particularly on strategies targeting screening/PT to PLWH at higher risk. Standardisation of model descriptions and results reporting could facilitate reliable comparisons between studies, particularly to identify those factors driving the wide disparity between cost-effectiveness estimates. Registration: PROSPERO CRD42020166338 (18/03/2020).
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Affiliation(s)
- Rebecca F. Baggaley
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Carolin Vegvari
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- UCL Respiratory, University College London, London, UK
| | - Christian A. Dimala
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Marc Lipman
- Royal Free London National Health Service Foundation Trust, London, UK
- RUDN University, Moscow, Russian Federation
| | | | | | - Svetlana Degtyareva
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Manish Pareek
- Big Data Institute, University of Oxford, Oxford, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, LE1 7RH, UK
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Zhang YQ, Li XX, Li WB, Jiang JG, Zhang GL, Zhuang Y, Xu JY, Shi J, Sun DY. Analysis and predication of tuberculosis registration rates in Henan Province, China: an exponential smoothing model study. Infect Dis Poverty 2020; 9:123. [PMID: 32867846 PMCID: PMC7457775 DOI: 10.1186/s40249-020-00742-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization End TB Strategy meant that compared with 2015 baseline, the reduction in pulmonary tuberculosis (PTB) incidence should be 20 and 50% in 2020 and 2025, respectively. The case number of PTB in China accounted for 9% of the global total in 2018, which ranked the second high in the world. From 2007 to 2019, 854 672 active PTB cases were registered and treated in Henan Province, China. This study was to assess whether the WHO milestones could be achieved in Henan Province. Methods The active PTB numbers in Henan Province from 2007 to 2019, registered in Chinese Tuberculosis Information Management System were analyzed to predict the active PTB registration rates in 2020 and 2025, which is conductive to early response measures to ensure the achievement of the WHO milestones. The time series model was created by monthly active PTB registration rates from 2007 to 2016, and the optimal model was verified by data from 2017 to 2019. The Ljung-Box Q statistic was used to evaluate the model. The statistically significant level is α = 0.05. Monthly active PTB registration rates and 95% confidence interval (CI) from 2020 to 2025 were predicted. Results High active PTB registration rates in March, April, May and June showed the seasonal variations. The exponential smoothing winter’s multiplication model was selected as the best-fitting model. The predicted values were approximately consistent with the observed ones from 2017 to 2019. The annual active PTB registration rates were predicted as 49.1 (95% CI: 36.2–62.0) per 100 000 population and 34.4 (95% CI: 18.6–50.2) per 100 000 population in 2020 and 2025, respectively. Compared with the active PTB registration rate in 2015, the reduction will reach 23.7% (95% CI, 3.2–44.1%) and 46.8% (95% CI, 21.4–72.1%) in 2020 and 2025, respectively. Conclusions The high active PTB registration rates in spring and early summer indicate that high risk of tuberculosis infection in late autumn and winter in Henan Province. Without regard to the CI, the first milestone of WHO End TB Strategy in 2020 will be achieved. However, the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province, China.
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Affiliation(s)
- Yan-Qiu Zhang
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China.
| | - Xin-Xu Li
- Center for Drug Evaluation, National Medical Products Administration, Beijing, 100022, P. R. China
| | - Wei-Bin Li
- Kaifeng Municipal Health Commission, Kaifeng, 475000, P. R. China
| | - Jian-Guo Jiang
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China
| | - Guo-Long Zhang
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China
| | - Yan Zhuang
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China
| | - Ji-Ying Xu
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China
| | - Jie Shi
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China
| | - Ding-Yong Sun
- Henan Center for Disease Control and Prevention, Zhengzhou, 450016, P. R. China
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