| Title: |
Novel health system strategies for tuberculin skin test-guided Isoniazid preventive therapy |
| Authors: |
Van Ginderdeuren, E; Bassett, J; Hanrahan, C F; Mutunga, L; Van Rie, A |
| Source: |
European Journal of Public Health ; volume 30, issue Supplement_5 ; ISSN 1101-1262 1464-360X |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2020 |
| Description: |
Background Global TB elimination demands a scale-up of Isoniazid preventive therapy (IPT) but tuberculin skin test (TST)-guided IPT poses great logistical and human resource challenges. Objectives Performance of TST self-reading by patients and fast-track TST reading by trained low cadre health care workers (task-shifting) was compared to formal TST reading by high cadre staff in a cohort of 278 South African adults living with HIV. Health economic impact of these novel strategies was assessed from a provider and societal perspective and simulations were performed for 5 other countries (USA, Germany, Brazil, India, Russia) to evaluate generalizability. In addition, accuracy of TST at antiretroviral treatment (ART) initiation was assessed by a repeat TST 6 and 12 month later. Results TST self-reading was highly accurate, with 89% sensitivity (95% CI 80, 95) and 100% specificity (95% CI 97,100) for detecting presence/absence of any induration. Agreement in TST reading between low and high cadre health care workers was very high (kappa 0.97). Compared to standard of care, a combined fast-track, task-shifting and self-reading strategy reduced TST reading costs in South Africa from a patient perspective by 81% and from a provider perspective by 92%. In all 5 countries simulated, TST reading cost was reduced by ≥ 78 % from a provider perspective. Repeat testing at 6 and 12 months showed high (31%, 95% CI 23, 40) TST conversion during the first 12 months of ART. Conclusions Empiric IPT for all people living with HIV followed by TST assessment after 6 or 12 months to identify those in need for lifelong IPT could increase the effectiveness of IPT programs. TST self-reading to reduce the number of patients that need to return for TST reading (to only those patients with self-determined presence of any induration) together with fast-tracking and task-shifting of TST reading could increase cost-effectiveness and reduce patient costs associated with IPT programs. Key messages Novel strategies are essential to ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/eurpub/ckaa166.557 |
| Availability: |
https://doi.org/10.1093/eurpub/ckaa166.557; http://academic.oup.com/eurpub/article-pdf/30/Supplement_5/ckaa166.557/33819025/ckaa166.557.pdf |
| Rights: |
https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model |
| Accession Number: |
edsbas.7D2242C6 |
| Database: |
BASE |