Preventing tuberculosis with community-based care in an HIV-endemic setting: a modelling analysis.

Area of Science:

• Epidemiology
• Public Health
• Health Economics

Background:

• Antiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) are crucial for preventing tuberculosis (TB) deaths in people with HIV.
• Differentiated, community-based care models can improve ART and TPT uptake, especially in regions with high HIV-associated TB burdens, including among men.

Purpose of the Study:

• To model the impact of scaling up community-based ART and TPT care on TB incidence, mortality, and cost-effectiveness.
• To assess the potential of community-based models to reduce gender disparities in TB outcomes among people with HIV.

Main Methods:

• A gender-stratified dynamic model simulated TB and HIV transmission in 100,000 adults (15-59) in KwaZulu-Natal, South Africa.
• Parameters were derived from the DO ART trial and scientific literature, simulating 10 years of scaled-up community-based care.
• Projected outcomes included TB cases, deaths, disability-adjusted life years (DALYs) averted, program costs, and incremental cost-effectiveness ratios (ICERs).

Main Results:

• Community-based ART care could decrease TB incidence by 27.0% and mortality by 34.6% over 10 years.
• Integrating TPT into community-based care could further reduce TB incidence by 29.7% and mortality by 36.0%.
• Community-based ART with TPT care reduced gender disparities in TB mortality, with projected annual deaths among men decreasing from 109 to 54 compared to standard care. The mean cost per DALY averted was $846 USD.

Conclusions:

• Scaling up community-based ART and TPT significantly increases coverage for people with HIV.
• This approach is effective in reducing TB incidence and mortality in high HIV-associated TB settings.
• Community-based care models show promise in mitigating gender disparities in TB outcomes.