ArticleThe Lancet. Global health2022
Re-evaluating the health impact and cost-effectiveness of tuberculosis preventive treatment for modern HIV cohorts on antiretroviral therapy: a modelling analysis using data from Tanzania.
Article in The Lancet. Global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses.PharmacoEconomics · 2024Pooled it
- Mid-level managers' perspectives on implementing isoniazid preventive therapy for people living with HIV in Ugandan health districts: a qualitative study.BMC health services research · 2024Trial
- Review
- The implementation of tuberculosis preventive therapy in HIV care clinics in Africa, Asia and Latin America: a multiregional site survey.BMJ global health · 2026Article
- Implications of progressive lung damage and post-tuberculosis sequelae for the health benefits of prompt tuberculosis treatment in high HIV prevalence settings: a mathematical modelling analysis.The Lancet. Global health · 2025Article
- Tuberculosis Preventive Treatment in High TB-Burden Settings: A State-of-the-Art Review.Drugs · 2025Review
- Anemia and Iron Supplementation in Relation to Viral Load and Mortality among 70,442 People Living with Human Immunodeficiency Virus in Tanzania.The Journal of nutrition · 2024Article
- Preventing tuberculosis with community-based care in an HIV-endemic setting: a modeling analysis.medRxiv : the preprint server for health sciences · 2023Article
- Impact and cost-effectiveness of short-course tuberculosis preventive treatment for household contacts and people with HIV in 29 high-incidence countries: a modelling analysis.The Lancet. Global health · 2023Article
- Isoniazid prophylaxis: highly effective but underutilised to prevent tuberculosis in people living with HIV.The Lancet. Global health · 2022Article
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundIsoniazid preventive therapy (IPT) can prevent tuberculosis among people receiving antiretroviral therapy (ART). HIV programmes are now initiating patients on ART with higher average CD4 cell counts and lower tuberculosis risks under test-and-treat guidelines. We aimed to investigate how this change has affected the health impact and cost-effectiveness of IPT.
methodsWe constructed a tuberculosis-HIV microsimulation model parameterised using data from a large HIV treatment programme in Dar es Salaam, Tanzania. We simulated long-term health and cost outcomes for the 211 748 individuals initiating ART between Jan 1, 2014, and Dec 31, 2020, under three scenarios: no IPT access; observed levels of IPT access (75%) and completion (71%); and full (100%) IPT access and completion. We stratified results by ART initiation year and starting CD4 cell count.
findingsObserved levels of IPT access were estimated to have averted 12 800 (95% uncertainty interval 7300 to 21 600) disability-adjusted life-years (DALYs) and saved US$23 000 (-2 268 000 to 1 388 000). Full IPT access would have averted 24 500 (15 100 to 38 300) DALYs and cost $825 000 (-1 594 000 to 4 751 000), equivalent to $23·4 per DALY averted. Lifetime health benefits of IPT were estimated to be greater for more recent ART cohorts, while lifetime costs were stable. In subgroup analyses, a higher CD4 cell count at ART initiation was associated with greater health gains from IPT (15 900 [10 300 to 22 500] DALYs averted by full IPT per 100 000 patients for CD4 count >500 cells per μL at ART initiation, versus 7400 [4500 to 11 600] for CD4 count <100 cells per μL) and lower incremental lifetime costs.
interpretationIPT remains highly cost-effective or cost-saving for recent ART cohorts. The health impact and cost-effectiveness of IPT are estimated to improve as patients initiate ART earlier in the course of infection.
fundingUS National Institutes of Health.
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