Am. J. Respir. Crit. Care Med.,
Volume 160, Number 1, July 1999, 178-185
Tuberculosis Prevention in Methadone
Maintenance Clinics
Effectiveness and Cost-Effectiveness
DAVID C.
SNYDER,
E. ANTONIO
PAZ,
JANET C.
MOHLE-BOETANI,
ROBERT
FALLSTAD,
ROSA LEE
BLACK,
and
DANIEL P.
CHIN
California Department of Health Services, Tuberculosis Control Branch, Berkeley; Francis J. Curry National Tuberculosis Center,
San Francisco; San Francisco Department of Public Health, Tuberculosis Control Program, San Francisco; and California
Department of Health Services, Disease Investigations and Surveillance Branch, Berkeley, California
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.
