A cost analysis of igra-based community active case finding for tuberculosis among adolescents in urban settings

Abstract

ABSTRACT Background: The increasing prevalence of TB among adolescents and the unique challenges posed by urban environments, there is a critical need to evaluate the economic implications of implementing targeted screening strategies. This study aims at exploring the costs associated with Interferon-Gamma Release Assay (IGRA)-based community active case finding, considering diagnostic tests, personnel, follow-up care, and other relevant factors. The findings of this study have the potential to inform public health policies and interventions aimed at addressing TB in this vulnerable population. By assessing the economic impact of IGRA-based community active case finding, the research contributes to the optimization of resource allocation, development of cost-effective screening programs, and the enhancement of TB control strategies in urban environments. Ultimately, the study seeks to advance our knowledge on the economic dimensions of TB control and promote evidence-based decision-making for public health initiatives targeted at adolescents. Methods and materials: A cross-sectional descriptive study design was employed to determine the cost of actively finding TB cases among adolescents using the IGRA. Cost data was collected from provider perspective (in TZS) covering a period of 6 months. Excel based questionnaire was used to collect cost data related to the implementation of the project. In addition, face to face interviews was conducted to household heads of adolescents who were prevalent of IGRA-positive. The aim was to assess socio-economic and demographic factors that was associated with TB case identification using IGRA. After data cleaning, cost analysis was conducted using Microsoft Excel. All other quantitative data collected from the study participants were analyzed using STATA version 16. Multivariate analysis was used to determine the socio-economic and demographic characteristics associated with IGRA-positive results among adolescents. Results: In this study, a total of 425 study participants were interviewed for socio-economic status when being screened for tuberculosis infections using IGRA, whereby 225 (52.94%) were females, with the mean age of 14 years. Majority of participants belonged to households with low socio-economic status. Majority of participants 143(40.06%) belonged to households with low socio-economic status. In doing cost analysis using 600 adolescents screened for Tuberculosis infections using IGRA, The total capital cost associated with TB vi case detection using IGRA- was 4,953,936 Tshs, with equipment accounting for a large share, 65.7% of the total capital cost. Furthermore, diagnostic services cost more (2,934,388 Tshs) than screening services. The total recurrent cost associated with TB case detection using IGRA was 258,769,757 Tshs, with personnel accounting for a large share of the total recurrent cost. The unit cost of screening a TB case through IGRA-Based community active case finding in urban settings was Tshs. 439,539. Of all the cost inputs, Personnel and contracted services accounted for a large share of the overall cost of detecting a tuberculosis case, that are, 69% and 18%, respectively. In a Univariate analysis, only sex was significantly associated with IGRA-positive results. In a multivariate analysis, sex (aOR=3.69; 95% CI; 1.62 – 8.42; P<0.002) and parent status/father not alive (aOR=5.10; 95% CI; 1.28 – 20.30; P<0.021) were significantly associated with positive results (IGRA positive). Conclusion: The findings of this study revealed that IGRA-based community active case finding is an effective tool for TB case detection, particularly in adolescent populations. Despite high vaccination rates, the prevalence of IGRA-positive cases underscores the need for ongoing TB surveillance and targeted interventions. The cost analysis reveals that while the initial investment in IGRA-based community active case finding is substantial, the comprehensive nature of the approach justifies the costs. Understanding the primary cost drivers and socio-economic factors influencing TB detection can inform more efficient and equitable TB control strategies