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Economic burden of HIV and TB/HIV coinfection in a middle-income country: a costing analysis alongside a pragmatic clinical trial in Brazil
  1. Noemia Teixeira de Siqueira-Filha1,
  2. Maria de Fatima Militao de Albuquerque2,
  3. Laura Cunha Rodrigues1,
  4. Rosa Legood1,
  5. Andreia Costa Santos1
  1. 1 Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
  2. 2 Centro de Pesquisa Aggeu Magalhaes, Fundação Oswaldo Cruz (FIOCRUZ-PE), Recife, Brazil
  1. Correspondence to Dr Noemia Teixeira de Siqueira-Filha, London School of Hygiene and Tropical Medicine (LSHTM), London WC1H 9SH, UK; noemia.teixeira-filha{at}


Objective The objective of this study was to measure the costs of people living with HIV (PLHIV) as well as active tuberculosis (TB/HIV), latent tuberculosis infection (LTBI/HIV) or without TB (HIV/AIDS).

Methods We analysed the costs through the entire pathway of care during the prediagnosis and treatment periods from the Brazilian public health system perspective. We applied a combination of bottom-up and top-down approaches to capture and estimate direct medical and non-medical costs. We measured the mean cost per patient per type of care (inpatient, outpatient and emergency care) and disease category (HIV/AIDS, HIV/AIDS death, TB/HIV, TB/HIV death and LTBI/HIV).

Results Between March 2014 and March 2016 we recruited 239 PLHIV. During the follow-up 26 patients were diagnosed and treated for TB and 5 received chemoprophylaxis for LTBI. During the prediagnosis and treatment period, the mean total costs for HIV or AIDS and AIDS death categories were US$1558 and US$2828, respectively. The mean total costs for TB/HIV and TB/HIV death categories were US$5289.0 and US$8281, respectively. The mean total cost for the LTBI/HIV category was US$882.

Conclusions Patients with TB/HIV impose a higher economic burden on the health system than HIV/AIDS and LTBI/HIV. Patients with LTBI/HIV were the lowest cost group among all disease categories, indicating that preventive TB treatment can avoid the further costs treating active TB.

Trial registration number RBR-22t943, Results.

  • aids
  • economic analysis
  • tuberculosis

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  • Handling editor Jackie A Cassell

  • Contributors The study was designed by NS-F, MdFM and ACS. NS-F was responsible for data collection, analysis and writing the manuscript. ACS, LCR, RL and MdFM reviewed the manuscript.

  • Funding Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) (470554/2013-4) and Fundação de Amparo à Ciência e Tecnologia do Estado de Pernambuco (APQ-0184-4.06/13). Some of the investigators received partial support from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq): Scholarship PQ-308491/2013-0 to MdFM; Scholarship 220144/2012-5 to NS-F.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Fundacao Oswaldo Cruz (no 279.324) and the London School of Hygiene & Tropical Medicine (ref: 7371) ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.