Cost implications of the tuberculosis/HIV co-epidemic and drug treatment of tuberculosis in Zimbabwe

The tuberculosis/HIV co-epidemic substantially increased the tuberculosis caseload in Zimbabwe over the last few years and expedited a change over to more appropriate but expensive antitubercular drug regimens. This study examined the cost implications of these epidemiological changes and the implementation of new drug policies. At 1993 prices, the cost of treating one case of pulmonary tuberculosis on the new regimen, appropriate for high HIV seroprevalence, was US$38, compared with US$21 for the old regimen. In conjunction with an escalating case load, this increased the drug budget requirement from US$210,000 in 1989 to US$750,000 in 1993. Zimbabwe obtained prices which were comparable or lower than international nonprofit procurement agencies. When additional funds were, however, not made available to meet the increased requirement, shortages of antitubercular drugs and other essential drugs prevailed. Actual drug regimens used conformed with recommended national guidelines in only 37% of 300 cases examined. In the rest of the cases, improvised antituberculosis drug regimens and incomplete courses were found, increasing the likelihood of treatment failure, relapse and acquired drug resistance. In 1994, the Government had to secure a loan, specifically to sustain the supply of antitubercular drugs.