Clinical and economic aspects of the efficiency of treatment of patients with coinfection HIV/tuberculosis in the Republic of Karelia

The aim of the study is to analyze the impact of combined pathology of HIV and tuberculosis on the effectiveness of tuberculosis treatment and assess direct budgetary costs for the treatment of patients with combined infection of HIV and tuberculosis in the Republic of Karelia.

Materials and methods. A retrospective analysis of the results of tuberculosis (TB) treatment was conducted among 228 newly diagnosed patients with HIV and TB co-infection in the Republic of Karelia from 2001 to 2022. The results of tuberculosis chemotherapy were analyzed as a comparison group, among 228 newly diagnosed HIV-negative tuberculosis patients.

Results and discussion. Significantly lower rates of chemotherapy effectiveness in patients with HIV and TB co-infection (52.2%) than in HIV-negative TB patients (64%) (p < 0.05) were associated with significantly higher mortality (25.4%) than in the group with TB and HIV-negative status (15%) (p < 0.05) and a higher rate of treatment interruptions (15.8% and 13.2%). Additional reasons for high mortality in the group with HIV and TB co-infection were the causes of death from HIV infection in 29 (50%) of 58 people, as a result of its late diagnosis and low adherence to antiretroviral therapy (ART). The highest budget costs in combination with low treatment effectiveness, high mortality, and frequent interruptions from treatment were observed in the group of patients with co-infection of HIV and tuberculosis with MDR MBT (multi-drug-resistant MBT) and pre-XDR (multi-drug-resistant MBT and drug resistance to ofloxacin) — up to 1,404.2 thousand rubles per 1 effectively cured person in 2023 prices. The costs of ART ranged from 17.1 to 57.1 thousand rubles, which was from 3.9 to 5.4% in the structure of costs for the treatment of patients with HIV and tuberculosis. In the structure of costs, a significant place was occupied by costs associated with a long stay of patients in hospital from 105.4 to 127.5 bed-days, which was from 234.3 to 283.4 thousand rubles per 1 patient, which was largely due to the lack of rapid molecular genetic methods for determining drug resistance to the main anti-tuberculosis drugs, delays in the correction of effective chemotherapy, and shortcomings in the organization of chemotherapy at the place of residence.

Conclusion. The reserves for reducing budget costs, reducing mortality and increasing the effectiveness of treatment of patients with co-infection of HIV and tuberculosis are measures to improve the detection and monitoring of patients with HIV, increasing their adherence to ART, the introduction of rapid molecular genetic methods for determining drug resistance of MBT in tuberculosis patients and improving the organization of chemotherapy for TB patients at their place of residence.

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