Expanding screening offers possible return on investment

Expanding screening and preventive treatment for people at high risk of tuberculosis would deliver a substantial return on investment with a potential benefit of $39 for every $1 spent in SA, according to a World Health Organisation (WHO) study.

The modelling study developed with the governments of SA, Brazil, Georgia and Kenya is expected to help countries push for more resources to meet the commitments agreed to by heads of state at the 2023 UN High Level Meeting on TB.

It shows that investing $1.77bn from 2024 to 2050, or $1.1 per person per year, in screening and preventive treatment for high risk individuals could result in 1.4-million fewer TB cases and save 276 000 lives in SA. The model defined people at high risk of TB infection as individuals living with HIV, household contacts of TB patients and people living in communities with high TB incidence.

“This analysis is making a case for SA’s policy to increase and improve prevention and screening efforts, using (a range of) diagnostic tools and approaches, some of which are not in policy yet,” said study coauthor Mmamapudi Kubjane, an epidemiologist with the Wits Health Economics and Epidemiology Research Office (HE2RO).

For example, the analysis assumes increasing the use of chest X-rays with computeraided detection and using Creactive protein tests to improve the detection of TB in people living with HIV, which are not yet widely used in SA, she said.

SA’s has one of the world’s highest TB burdens, driven by its large HIV epidemic. TB is preventable and treatable yet remains SA’s leading cause of death accounting for an estimated 54 000 deaths in 2022.

The Aurum Institute’s technical director for TB Pria Subrayen, who was not directly involved in the study, said the investment case would also aid countries in their efforts to secure donor funding. Key donors in global efforts to combat TB include the Bill & Melinda Gates Foundation and the Global Fund to fight AIDS, TB and Malaria. SA has already rolled out the preventive treatment regimen modelled in the study, which includes a three month course of rifampicin and isoniazid, but patients in SA do not yet have access to pills that combine the two drugs, said Subrayen. A fixed dose combination pill would make it easier for patients to stick to the treatment.

The WHO said widening access to TB screening plus preventive treatment could substantially reduce TB incidence and mortality. These investments were essential for achieving the targets set out in its End TB Strategy.

“The investment case outlines the health and economic rationale for investing in evidence-based, WHO-recommended interventions on TB screening and prevention that can contribute to advancing universal health coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “Today, we have the knowledge, tools and political commitment that can end this millennia-old disease that remains one of the world’s top infectious killers”.

TB causes 1.3-million deaths yearly, according to the WHO.