Bess Miller

Towards universal access to HIV prevention, treatment, care, and support: the role of tuberculosis/HIV collaboration

Tuberculosis is the oldest of the worlds current pandemics and causes 8.9 million new cases and 1.7 million deaths annually. The disease is among the most common causes of morbidity and mortality in people living with HIV. However, tuberculosis is more than just part of the global HIV problem; well-resourced tuberculosis programmes are an important part of the solution to scaling-up towards universal access to comprehensive HIV prevention, diagnosis, care, and support. This article reviews the impact of the interactions between tuberculosis and HIV in resource-limited settings; outlines the recommended programmatic and clinical responses to the dual epidemics, highlighting the role of tuberculosis/HIV collaboration in increasing access to prevention, diagnostic, and treatment services; and reviews progress in the global response to the epidemic of HIV-related tuberculosis.

Acquired immunodeficiency syndrome in the United States: an analysis of cases outside high-incidence groups

From 1 June 1981 through 31 January 1984, 201 cases of the acquired immunodeficiency syndrome were reported involving persons who could not be classified into a group identified to be at increased risk for this syndrome. Thirty-five had received transfusions of single-donor blood components in the 5 years preceding diagnosis of the syndrome and 30 were sexual partners of persons belonging to a high-risk group. Information was incomplete for most remaining patients, but because many of these patients were demographically similar to populations recognized to be at increased risk for the syndrome, previously identified risk factors may have been present but not reported for some of them. Additionally, a few persons who met the case definition for the syndrome probably had other reasons for their opportunistic disease and did not have the acquired immunodeficiency syndrome. The slow emergence of the acquired immunodeficiency syndrome in new populations is consistent with transmission mediated through sexual contact or parenteral exposure to blood.

Hospitalization of Homeless Persons With Tuberculosis in the United States

OBJECTIVES This study assessed whether homeless patients are hospitalized for tuberculosis (TB) more frequently and longer than other patients and possible reasons for this. METHODS We prospectively studied hospitalizations of a cohort of TB patients. RESULTS HIV-infected homeless patients were hospitalized more frequently than other patients, while homeless patients who had no insurance or whose insurance status was unknown were hospitalized longer. Hospitalization cost

A model of the cost-effectiveness of directly observed therapy for treatment of tuberculosis.

2000 more per homeless patient than for other patients. The public sector paid nearly all costs. CONCLUSIONS Homeless people may be hospitalized less if given access to medical care that provides early detection and treatment of TB infection and disease and HIV infection. Providing housing and social services may also reduce hospital utilization and increase therapy completion rates.

Tuberculosis Control in a Changing Health Care System: Model Contract Specifications for Managed Care Organizations

A hypothetical cohort of 25,000 TB patients and their contacts were followed for a 10-year period; rates of treatment default, infectiousness following partial treatment, relapse, hospitalization, and development of drug-resistant TB were included. The average cost per case cured was

PEPFAR Support for the Scaling Up of Collaborative TB/HIV Activities

16,846 with 15% of patients starting DOT,

Tuberculosis Prevention Versus Hospitalization: Taxpayers Save with Prevention

17,323 with 100% starting DOT, and

Antiretroviral therapy and tuberculosis: what's the connection and what's the way forward?

20,106 with none starting DOT. The incremental cost per additional case cured was

Health-care expenditures for tuberculosis in the United States

24,064 when all patients, started treatment on DOT, indicating that outpatient DOT provides a cost-effective method of improving health outcomes for TB patients and their contacts while controlling direct costs.

School-based screening for tuberculous infection: A cost-benefit analysis

Increasingly, patients with tuberculosis are receiving clinical care in managed care organizations as a result of enrollment in Medicaid or Medicare, or coverage under privately purchased insurance policies or employee benefit plans. This represents a change from the system that has been in place for decades, where the clinical care and public health functions concerning treatment and control of tuberculosis occurred primarily in local health departments. The separation of individual patient care from the public health aspects of tuberculosis control has created challenges for managed care administrators, medical providers, and public health officials. To assist in the integration of the goals of managed care and public health with respect to the prevention and control of tuberculosis, we developed a set of model contract specifications for use by purchasers of managed care and by managed care organizations concerning the management of patients with tuberculosis and other related public health issues. These specifications can assist health officials in continuing their leadership roles by ensuring that managed care contracts address public health needs.