Tuberculosis prevention in methadone maintenance clinics - Effectiveness and cost-effectiveness

To determine the effectiveness and cost-effectiveness of a program to provi de screening for tuberculosis infection and directly observed preventive th erapy (DOPT) in methadone maintenance clinics, we determined completion rat es of screening for tuberculosis infection, medical evaluation, and prevent ive therapy, as well as the number of active tuberculosis cases and tubercu losis-related deaths prevented, in five clinics in San Francisco, Californi a. Between 1990 and 1995, a total of 2,689 clients (of whom 18% were HIV-se ropositive) were screened at least once. Of eligible clients, 99% received tuberculin skin tests, 96% received a medical examination, 91% began isonia zid preventive therapy, and 82% completed preventive therapy. Program effec tiveness was enhanced by close collaboration between public health and meth adone maintenance programs and the use of incentives and enablers. Over a 3 -yr follow-up period, only one verified case of tuberculosis was reported a mong clients with a positive tuberculin skin test, thereby preventing as mu ch as 95% of expected tuberculosis cases. Over 10 yr, we estimate the progr am 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 (aver age of $3,724 per case prevented). Our study demonstrates that when effecti vely implemented, screening for tuberculosis infection and DOPT in methadon e maintenance clinics is a highly cost-effective approach to prevent tuberc ulosis.