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Churchyard G, Salazar-Austin N. Overcoming barriers to scaling up tuberculosis preventive treatment for household contacts. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00114-0. [PMID: 38734021 DOI: 10.1016/s2213-2600(24)00114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Gavin Churchyard
- The Aurum Institute, Parktown 2193, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Department of Medicine, Vanderbilt University, Nashville, TN, USA.
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Casenghi M, Furin J, Sekadde MP, Sharma S, Marais BJ. Closing the policy-practice gap for tuberculosis preventive treatment. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:315-317. [PMID: 38522447 DOI: 10.1016/s2352-4642(24)00018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Martina Casenghi
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva 1211, Switzerland.
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Sangeeta Sharma
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Ben J Marais
- The University of Sydney Infectious Diseases Institute and the WHO Collaborating Center for Tuberculosis, University of Sydney, Sydney, NSW, Australia
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Marx FM, de Villiers A. Decentralising screening and preventive treatment among children exposed to tuberculosis in the household. Lancet Glob Health 2023; 11:e1836-e1837. [PMID: 37918418 DOI: 10.1016/s2214-109x(23)00503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Florian M Marx
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Abigail de Villiers
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Mafirakureva N, Tchounga BK, Mukherjee S, Youngui BT, Ssekyanzi B, Simo L, Okello RF, Turyahabwe S, Kuate Kuate A, Cohn J, Vasiliu A, Casenghi M, Atwine D, Bonnet M, Dodd PJ. Cost-effectiveness of community-based household tuberculosis contact management for children in Cameroon and Uganda: a modelling analysis of a cluster-randomised trial. Lancet Glob Health 2023; 11:e1922-e1930. [PMID: 37918416 DOI: 10.1016/s2214-109x(23)00451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND WHO recommends household contact management (HCM) including contact screening and tuberculosis-preventive treatment (TPT) for eligible children. The CONTACT trial found increased TPT initiation and completion rates when community health workers were used for HCM in Cameroon and Uganda. METHODS We did a cost-utility analysis of the CONTACT trial using a health-system perspective to estimate the health impact, health-system costs, and cost-effectiveness of community-based versus facility-based HCM models of care. A decision-analytical modelling approach was used to evaluate the cost-effectiveness of the intervention compared with the standard of care using trial data on cascade of care, intervention effects, and resource use. Health outcomes were based on modelled progression to tuberculosis, mortality, and discounted disability-adjusted life-years (DALYs) averted. Health-care resource use, outcomes, costs (2021 US$), and cost-effectiveness are presented. FINDINGS For every 1000 index patients diagnosed with tuberculosis, the intervention increased the number of TPT courses by 1110 (95% uncertainty interval 894 to 1227) in Cameroon and by 1078 (796 to 1220) in Uganda compared with the control model. The intervention prevented 15 (-3 to 49) tuberculosis deaths in Cameroon and 10 (-20 to 33) in Uganda. The incremental cost-effectiveness ratio was $620 per DALY averted in Cameroon and $970 per DALY averted in Uganda. INTERPRETATION Community-based HCM approaches can substantially reduce child tuberculosis deaths and in our case would be considered cost-effective at willingness-to-pay thresholds of $1000 per DALY averted. Their impact and cost-effectiveness are likely to be greatest where baseline HCM coverage is lowest. FUNDING Unitaid and UK Medical Research Council.
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Affiliation(s)
| | | | | | | | | | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Albert Kuate Kuate
- National Tuberculosis Control Program, Ministry of Health, Yaounde, Cameroon
| | - Jennifer Cohn
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anca Vasiliu
- Baylor College of Medicine, Department of Pediatrics, Global TB Program, Houston, TX, USA; University Montpellier, TransVIHMI, IRD, Inserm, Montpellier, France
| | | | - Daniel Atwine
- Epicentre, Mbarara, Uganda; Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maryline Bonnet
- University Montpellier, TransVIHMI, IRD, Inserm, Montpellier, France
| | - Peter J Dodd
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
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