To determine the effectiveness and cost-effectiveness of a program to provide screening for tuberculosis infection and directly observed preventive therapy (DOPT) in methadone maintenance clinics, we determined completion rates of screening for tuberculosis infection, medical evaluation, and preventive therapy, as well as the number of active tuberculosis cases and tuberculosis-related deaths prevented, in five clinics in San Francisco, California.
Between 1990 and 1995, a total of 2,689 clients (of whom 18% were HIV-seropositive) were screened at least once.
Of eligible clients, 99% received tuberculin skin tests, 96% received a medical examination, 91% began isoniazid preventive therapy, and 82% completed preventive therapy.
Program effectiveness was enhanced by close collaboration between public health and methadone maintenance programs and the use of incentives and enablers.
Over a 3-yr follow-up period, only one verified case of tuberculosis was reported among clients with a positive tuberculin skin test, thereby preventing as much as 95% of expected tuberculosis cases.
Over 10 yr, we estimate the program would prevent 30.0 (52%) of 57.7 expected cases of tuberculosis, and 7.6 (57%) of 13.4 expected tuberculosis-related deaths.
The program cost $771,569, but averted an estimated $876,229, for a net savings of $104,660 (average of $3,724 per case prevented). (...)
Mots-clés Pascal : Mycobacterium tuberculosis, Mycobacteriaceae, Mycobacteriales, Actinomycetes, Bactérie, Tuberculose, Mycobactériose, Bactériose, Infection, Prévention, Dépistage, Programme sanitaire, Méthadone, Analgésique narcotique, Traitement, Analyse coût efficacité, Chimiothérapie, Toxicomanie, Homme, Opiacés
Mots-clés Pascal anglais : Mycobacterium tuberculosis, Mycobacteriaceae, Mycobacteriales, Actinomycetes, Bacteria, Tuberculosis, Mycobacterial infection, Bacteriosis, Infection, Prevention, Medical screening, Sanitary program, Methadone, Narcotic analgesic, Treatment, Cost efficiency analysis, Chemotherapy, Drug addiction, Human, Opiates
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0413902
Code Inist : 002B05B02O. Création : 22/03/2000.