Tuberculosis prevention in methadone maintenance clinics. Effectiveness and cost-effectiveness

Area of Science:

• Public Health
• Infectious Disease Control
• Health Services Research

Background:

• Methadone maintenance clinics serve vulnerable populations at increased risk for tuberculosis (TB).
• Effective TB screening and treatment programs are crucial for this demographic.

Purpose of the Study:

• To evaluate the effectiveness and cost-effectiveness of a TB screening and directly observed preventive therapy (DOPT) program in methadone clinics.
• To assess TB case and death prevention rates and program costs.

Main Methods:

• A prospective study was conducted in five San Francisco methadone clinics from 1990-1995.
• Screening included tuberculin skin tests, medical evaluations, and isoniazid preventive therapy.
• Completion rates, TB cases, TB deaths, and program costs were analyzed.

Main Results:

• High completion rates were achieved: 99% for skin tests, 96% for medical exams, 91% started therapy, and 82% completed therapy.
• The program prevented up to 95% of expected TB cases in the 3-year follow-up.
• Over 10 years, an estimated 52% of TB cases and 57% of TB deaths were prevented.

Conclusions:

• TB screening and DOPT in methadone clinics are highly effective in preventing TB.
• The program demonstrated significant cost-effectiveness, with net savings and a positive return on investment.
• Collaboration and targeted interventions like incentives enhance program success.