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- Title
Public Health Impact and Cost-Effectiveness of Screening for Active Tuberculosis Disease or Infection Among Children in South Africa.
- Authors
Brough, Joseph; Martinez, Leonardo; Hatherill, Mark; Zar, Heather J; Lo, Nathan C; Andrews, Jason R
- Abstract
Background Although tuberculosis disease is a leading cause of global childhood mortality, there remain major gaps in diagnosis, treatment, and prevention in children because tuberculosis control programs rely predominantly on presentation of symptomatic children or contact tracing. We assessed the public health impact and cost-effectiveness of age-based routine screening and contact tracing in children in South Africa. Methods We used a deterministic mathematical model to evaluate age-based routine screening in 1-year increments from ages 0 to 5 years, with and without contact tracing and preventive treatment. Screening incorporated symptom history and tuberculin skin testing, with chest x-ray and GeneXpert Ultra for confirmatory testing. We projected tuberculosis cases, deaths, disability-adjusted life years (DALYs), and costs (in 2021 U.S. dollars) and evaluated the incremental cost-effectiveness ratios comparing each intervention. Results Routine screening at age 2 years with contact tracing and preventive treatment averted 11 900 tuberculosis cases (95% confidence interval [CI]: 6160–15 730), 1360 deaths (95% CI: 260–3800), and 40 000 DALYs (95% CI: 13 000–100 000) in the South Africa pediatric population over 1 year compared with the status quo. This combined strategy was cost-effective (incremental cost-effectiveness ratio $9050 per DALY; 95% CI: 2890–22 920) and remained cost-effective above an annual risk of infection of 1.6%. For annual risk of infection between 0.8% and 1.6%, routine screening at age 2 years was the dominant strategy. Conclusions Routine screening for tuberculosis among young children combined with contact tracing and preventive treatment would have a large public health impact and be cost-effective in preventing pediatric tuberculosis deaths in high-incidence settings such as South Africa.
- Subjects
SOUTH Africa; TUBERCULOSIS diagnosis; TUBERCULOSIS prevention; DISEASE progression; NURSING models; CHEST X rays; CONFIDENCE intervals; LIFE expectancy; MEDICAL screening; PUBLIC health; LATENT tuberculosis; PREVENTIVE health services; COST effectiveness; RESEARCH funding; TUBERCULIN test; DESCRIPTIVE statistics; CONTACT tracing; PEOPLE with disabilities
- Publication
Clinical Infectious Diseases, 2023, Vol 77, Issue 11, p1544
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad449