Impact and Economics of Tuberculosis Prevention and Treatment in South Africa

Project Description

South Africa bears a disproportionately large burden of HIV/tuberculosis (TB) co-infection and of multi-drug resistant tuberculosis (MDR-TB). Although the successful scaleup of antiretroviral therapy for HIV/AIDS has reduced HIV-related mortality, TB continues to be the largest single cause of adult death in the country, and MDR-TB accounts for a very large share of the national TB control budget. To help the Government of South Africa, PEPFAR, the WHO, and other organizations improve TB prevention, case-finding, diagnosis, and treatment, CGHD assists its South African partner, the Health Economics and Epidemiology Research Office (HE2RO), conduct research on the impact and economics of tuberculosis service delivery.

Research addresses three main areas:

• Site-level Costs and Outcomes of TB and MDR-TB Treatment. At a number of clinics that deliver TB and/or MDR-TB treatment, CGHD and HE2RO are studying the cascade of TB and drug-resistant TB diagnosis and treatment, outcomes of patients diagnosed with TB, and the costs of providing TB treatment. Research is also underway to map the MDR-TB referral system within the City of Johannesburg, to help improve  the linkage of patients to care and treatment completion.

• RECON: Rewards for TB Contact Screening. Because of the high risk of both TB and HIV among the household contacts of TB patients and the importance of early case detection for both diseases and especially for drug-resistant TB, improving TB case finding is a priority. Having healthcare workers make multiple visits to the homes of TB patients in order to screen household contacts is a logistically challenging and resource-intensive strategy. One alternative to home visits that could prove effective and affordable is to offer small economic rewards to the household contacts of TB patients who voluntarily present at a healthcare facility for TB symptom screening and optional HIV testing. RECON is an evaluation of the feasibility, acceptability, and cost of offering an economic reward, in the form of a $5-$10 shopping voucher, to the household contacts of index patients (outpatient drug-susceptible and drug-resistant TB patients) who present at the study clinic for TB screening and optional HIV testing. If successful, this pilot project will create a demand for screening among high risk patients, who will be rewarded for identifying themselves to the healthcare system, and could prove to be an affordable alternative to resource-intensive home visits. It will also shift responsibility for contact tracing from overburdened clinic staff to those who have the most to gain from early case detection- the patients and their families.

•Modeling the National Costs of TB Diagnosis and Treatment. In 2011, the National Health Laboratory Service asked the CGHD/HE2RO team to help estimate the costs of introducing GeneXpert MTB/RIF (Cepheid) technology into public sector laboratories across the country, a policy announced by the Minister of Health earlier in the year. Cost models were developed for this purpose and are now being used to guide decisions about the pace of scaleup of Xpert capacity, the numbers and sizes of machines required, and the algorithms to be used to diagnose TB.

Project Details

Principal Investigator Sydney Rosen
Boston University Co-Investigators
Country(ies) South Africa
Dates of Research 2010 – 2017
  • USAID logo United States Agency for International Development (USAID)
  • National Institutes of Health (NIH)