Document Detail

Tuberculosis prevention in methadone maintenance clinics. Effectiveness and cost-effectiveness.
MedLine Citation:
PMID:  10390397     Owner:  NLM     Status:  MEDLINE    
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). Our study demonstrates that when effectively implemented, screening for tuberculosis infection and DOPT in methadone maintenance clinics is a highly cost-effective approach to prevent tuberculosis.
D C Snyder; E A Paz; J C Mohle-Boetani; R Fallstad; R L Black; D P Chin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  160     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-08-11     Completed Date:  1999-08-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  178-85     Citation Subset:  AIM; IM; X    
California Department of Health Services, Tuberculosis Control Branch, Francis J. Curray National Tuberculois Center, San Francisco, CA, USA.
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MeSH Terms
AIDS-Related Opportunistic Infections / economics,  mortality,  prevention & control*
Antitubercular Agents / administration & dosage
Cost-Benefit Analysis
Drug Therapy, Combination
Follow-Up Studies
HIV Seropositivity / diagnosis*,  economics,  mortality
Isoniazid / administration & dosage
Mass Screening / economics*
Methadone / economics,  therapeutic use*
Middle Aged
Pyridoxine / administration & dosage
San Francisco
Substance Abuse, Intravenous / economics,  mortality,  rehabilitation*
Survival Rate
Treatment Outcome
Tuberculin Test / economics
Tuberculosis, Pulmonary / economics,  mortality,  prevention & control*
Urban Population* / statistics & numerical data
Reg. No./Substance:
0/Antitubercular Agents; 54-85-3/Isoniazid; 65-23-6/Pyridoxine; 76-99-3/Methadone

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