Tuberculosis in Tanzania

A study included a large number of participants in Tanzania, mostly adults aged 25–49, with a high proportion being male. Coastal and lake regions had the most participants. A significant portion was HIV positive, and the majority had pulmonary TB. Most patients were self-referred and managed at hospitals, with nearly all treated using community-based DOT and first-line TB treatment. Bacteriological diagnosis was more common.[1]

Newly diagnosed TB patients were the vast majority, while recurrent TB cases were rare. Key risk factors for TB recurrence included older age, male sex, HIV positivity, referral from CTC, bacteriological diagnosis, and facility-based DOT. Patients in Zanzibar had a notably higher recurrence risk. Among recurrent TB cases, some experienced poor treatment outcomes, with death being the most common. Risk factors for poor outcomes included HIV positivity, treatment in certain regions (central, coastal, Zanzibar), bacteriological diagnosis, and facility-based DOT.[1]

Expanding new diagnostic methods and algorithms could enhance tuberculosis detection while reducing delays in treatment initiation. Among available options, the full rollout of Xpert (B1) offers the most significant patient benefits. It decreases the number of visits required for diagnosis, shortens the time to treatment by nearly a week, and reduces diagnostic loss to follow-up, ultimately increasing successful treatment completion. At the health-system level, scaling up Xpert significantly lowers the need for sputum samples and laboratory staff time, easing resource burdens. Additionally, its implementation is expected to have the greatest impact on reducing tuberculosis prevalence, mortality, and incidence. Over a decade, Xpert could prevent tens of thousands of tuberculosis cases and related deaths, particularly improving survival rates for tuberculosis and HIV co-infected patients by expanding access to antiretroviral therapy.[2]

Despite its advantages, Xpert's implementation requires substantial financial investment. However, it remains one of the three most cost-effective diagnostic strategies in Tanzania. Full Xpert rollout is estimated to cost $169 per DALY averted, making it a viable option despite higher initial resource demands. Alternative strategies, such as same-day LED fluorescence microscopy (A3) and standard LED fluorescence microscopy (A2), offer lower-cost solutions at $45 and $29 per DALY averted, respectively. While these approaches may be more affordable, they do not match Xpert's comprehensive benefits in improving patient outcomes and reducing tuberculosis burden. Balancing cost-effectiveness with epidemiological impact will be crucial in determining the optimal diagnostic strategy for widespread implementation.[2] 

References:

1. Njiro, B.J., Kisonga, R., Joachim, C., Sililo, G.A., Nkiligi, E., Ibisomi, L., Chirwa, T. and Francis, J.M., 2024. Epidemiology and treatment outcomes of recurrent tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset. PLOS Neglected Tropical Diseases, 18(2), p.e0011968.

2. Langley, I., Lin, H.H., Egwaga, S., Doulla, B., Ku, C.C., Murray, M., Cohen, T. and Squire, S.B., 2014. Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated modelling approach. The Lancet Global Health, 2(10), pp.e581-e591.