The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
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Int. J. Tuberc. Lung Dis. · Apr 2013
Multicenter StudyCost utility of lateral-flow urine lipoarabinomannan for tuberculosis diagnosis in HIV-infected African adults.
In-patient hospitals in South Africa and Uganda. ⋯ For every 1000 patients tested, adding lateral-flow urine LAM generated 80 incremental appropriate anti-tuberculosis treatments and averted 224 DALYs. Estimated cost utility was US$353 per DALY averted (95% uncertainty range $192$1161) in South Africa and $86 per DALY averted (95% uncertainty range $49$239) in Uganda, reflecting the lower treatment costs in Uganda. Cost utility was most sensitive to assay specificity, cost of anti-tuberculosis treatment, life expectancy after TB cure and cohort TB prevalence, but did not rise above $1500 per DALY averted in South Africa under any one-way sensitivity analysis. The probability of acceptability was >99.8% at a per-DALY willingness-to-pay threshold equal to the per capita gross domestic product in South Africa ($7275) and Uganda ($509).
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Int. J. Tuberc. Lung Dis. · Apr 2013
Integrating patients' perspectives into integrated tuberculosis-human immunodeficiency virus health care.
Escalating rates of tuberculosis-human immunodeficiency virus (TB-HIV) co-infection call for improved coordination of TB and HIV health care services in high-burden countries such as South Africa. Patient perspectives, however, are poorly understood in the context of current integration efforts. ⋯ Our study highlights the imperative to address service fragmentation, HIV medical confidentiality and provider mistrust within the health care system, and the cultural differences associated with TB and HIV disease control.
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Int. J. Tuberc. Lung Dis. · Apr 2013
Multidrug resistance in new tuberculosis patients: burden and implications.
In 2010, 30 countries with anti-tuberculosis drug resistance surveillance data were each estimated to have more than 700 multidrug-resistant tuberculosis (MDR-TB) cases among their notified TB cases. New TB patients comprised a median of 54% (interquartile range 45-67) of the MDR-TB cases. ⋯ While MDR-TB case-finding efforts should first prioritize previously treated patients, reaching universal access requires rapidly adding other risk groups, and then all new TB patients. Epidemiological data as presented in this paper can help inform country scale-up plans.