Costs of TB preventive treatment: insights from five sub-Saharan African countries

BACKGROUND Scaling up TB preventive treatment (TPT) is essential but hindered by operational and financial challenges, including limited cost evidence. This study estimated TPT delivery costs across five sub-Saharan African high-TB-burden countries. METHODS Micro-costing study was conducted from health system perspective across five clinics in Eswatini, Lesotho, Malawi, Uganda, and Tanzania. Data were collected using standardised templates covering overhead, human resources, equipment, consumables, and drugs, using bottom-up and top-down approaches. Human resource time was measured via 648 observations using time-and-motion studies, questionnaires, and timesheets. Costs are reported per patient in 2024 USD. RESULTS Among adults, total cost per individual ranged from US$27 to US$59 for 3 months of isoniazid plus rifapentine (3HP) and from US$22 to US$67 for 6 months of isoniazid (6H). Among children, the cost of 6H ranged from US$32 to US$80, while 3 months of daily rifampicin plus isoniazid (3RH) ranged from US$27 to US$46. Human resources and drugs were the principal cost drivers, accounting for the majority of total costs across all countries. Consultation for TPT initiation and adherence monitoring was the most time-consuming and costly activity. CONCLUSION TPT implementation costs extend significantly beyond drug prices. National programmes must adopt full-cost accounting that prioritises workforce efficiency and service integration to ensure sustainable scale-up. .