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Viney K, Islam T, Hoa NB, Morishita F, Lönnroth K. The Financial Burden of Tuberculosis for Patients in the Western-Pacific Region. Trop Med Infect Dis 2019; 4:tropicalmed4020094. [PMID: 31212985 PMCID: PMC6631110 DOI: 10.3390/tropicalmed4020094] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023] Open
Abstract
The End Tuberculosis (TB) Strategy has the ambitious goal of ending the global TB epidemic by the year 2030, which is aligned to the Sustainable Development Goals. One of three high level indicators of the Strategy is the “catastrophic costs” indicator, which aims to determine the proportion of TB-affected households that incur TB-care related costs equivalent to 20% or more of their annual household income. The target is that zero percentage of TB-affected households will incur catastrophic costs related to TB care by the year 2020. In the Western Pacific Region of the World Health Organization, it is a priority to determine the financial burden of TB and then act to mitigate it. To date, eight countries in the Region have conducted nationally representative TB patient cost surveys to determine the costs of TB care. The results from four countries that have completed these surveys (i.e., Fiji, Mongolia, the Philippines, and Vietnam) indicate that between 35% and 70% of TB patients face catastrophic costs related to their TB care. With these results in mind, significant additional efforts are needed to ensure financial risk protection for TB patients, expand Universal Health Coverage, and improve access to social protection interventions. A multi-sectoral approach is necessary to achieve this ambitious goal by the year 2020.
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Affiliation(s)
- Kerri Viney
- Centre for TB Research, Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden.
- Research School of Population Health, Australian National University, Canberra 2600, Australia.
| | - Tauhidul Islam
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, 1000 Manila, Philippines.
| | - Nguyen Binh Hoa
- Vietnam National TB Programme, Ministry of Health, Hanoi 124302, Vietnam.
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France.
| | - Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, 1000 Manila, Philippines.
| | - Knut Lönnroth
- Centre for TB Research, Department of Public Health Sciences, Karolinska Institutet, 17177 Stockholm, Sweden.
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Shamu S, Kuwanda L, Farirai T, Guloba G, Slabbert J, Nkhwashu N. Study on knowledge about associated factors of Tuberculosis (TB) and TB/HIV co-infection among young adults in two districts of South Africa. PLoS One 2019; 14:e0217836. [PMID: 31170200 PMCID: PMC6553726 DOI: 10.1371/journal.pone.0217836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
South Africa ranks third among 22 high burden countries in the world. TB which remains a leading cause of death causes one in five adult deaths in South Africa. An in-depth understanding of knowledge, attitudes and practices of young people towards TB is required to implement meaningful interventions. We analysed young men and women (18-24 years)'s TB knowledge including TB/HIV coinfections, testing rates and factors associated with them. A cross sectional cluster-based household survey was conducted in two provinces. Participants completed computer-assisted self-interviews on TB knowledge, testing history and TB/HIV coinfections. A participant was regarded as knowledgeable of TB if s/he correctly answered the WHO-adopted TB knowledge questions. We built three multivariate regression models in Stata 13.0 to assess factors associated with knowing TB alone, testing alone and both knowing and testing for TB. 1955 participants were interviewed (89.9% response rate). Their median age was 20 years (IQR19-22). Sixteen percent (16.2%) of the participants were social grant recipients, 55% were enrolled in a school/college and 5% lived in substandard houses. A total of 72% had knowledge of TB, 21% underwent screening tests for TB and 14.7% knew and tested for TB. Factors associated with TB knowledge were being female, younger, a student, social grant recipient, not transacting sex and having positive attitudes towards people living with HIV (PLWH). Factors associated with TB testing were being a student, receiving a social grant, living in OR Tambo district, HIV knowledge and having a family member with TB history. Factors associated with both TB knowledge and testing were being female, a student, using the print media, living in OR Tambo district and having a family member with a TB history. The study demonstrates the importance of demographic factors (gender, economic status, family TB history, and location) and HIV factors in explaining TB knowledge and testing. We recommend extending community TB testing services to increase testing.
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Affiliation(s)
- Simukai Shamu
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Locadiah Kuwanda
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Thato Farirai
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Geoffrey Guloba
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Jean Slabbert
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
| | - Nkhensani Nkhwashu
- Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa
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Ngwira LG, Dowdy DW, Khundi M, Barnes GL, Nkhoma A, Choko AT, Murowa M, Chaisson RE, Corbett EL, Fielding K. Delay in seeking care for tuberculosis symptoms among adults newly diagnosed with HIV in rural Malawi. Int J Tuberc Lung Dis 2019; 22:280-286. [PMID: 29471905 PMCID: PMC5824850 DOI: 10.5588/ijtld.17.0539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
SETTING: Ten primary health clinics in rural Thyolo District, Malawi. OBJECTIVE : Tuberculosis (TB) is a common initial presentation of human immunodeficiency virus (HIV) infection. We investigated the time from TB symptom onset to HIV diagnosis to describe TB health-seeking behaviour in adults newly diagnosed with HIV. DESIGN : We asked adults (⩾18 years) about the presence and duration of TB symptoms at the time of receiving a new HIV diagnosis. Associations with delayed health seeking (defined as >30 and >90 days from the onset of TB symptoms) were evaluated using multivariable logistic regression. RESULTS : TB symptoms were reported by 416 of 1265 participants (33%), of whom 36% (150/416) had been symptomatic for >30 days before HIV testing. Most participants (260/416, 63%) were below the poverty line (US$0.41 per household member per day). Patients who first sought care from informal providers had an increased odds of delay of >30 days (adjusted odds ratio [aOR] 1.6, 95%CI 0.9–2.8) or 90 days (aOR 2.0, 95%CI 1.1–3.8). CONCLUSIONS : Delayed health seeking for TB-related symptoms was common. Poverty was ubiquitous, but had no clear relationship to diagnostic delay. HIV-positive individuals who first sought care from informal providers were more likely to experience diagnostic delays for TB symptoms.
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Affiliation(s)
- L G Ngwira
- HIV & TB Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, UK
| | - D W Dowdy
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, Maryland, Department of Epidemiology, Department of International Health, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA
| | - M Khundi
- HIV & TB Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - G L Barnes
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - A Nkhoma
- HIV & TB Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - A T Choko
- HIV & TB Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - M Murowa
- Ministry of Health, Lilongwe, Malawi
| | - R E Chaisson
- Center for TB Research, Johns Hopkins School of Medicine, Baltimore, Maryland, Department of Epidemiology, Department of International Health, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA
| | - E L Corbett
- HIV & TB Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - K Fielding
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
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Osman M, Welte A, Dunbar R, Brown R, Hoddinott G, Hesseling AC, Marx FM. Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study. Int J Infect Dis 2019; 85:57-63. [PMID: 31132472 DOI: 10.1016/j.ijid.2019.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A high risk of tuberculosis (TB), chronic lung disease, and mortality have been reported among people with a history of previous TB treatment, but data from high-incidence settings remain limited. The aim of this study was to characterize general morbidity and mortality among adults who had successfully completed TB treatment in the past 5 years in a high-incidence setting in South Africa. METHODS Adults (≥18 years) who had completed treatment for pulmonary TB between 2013 and 2017 were randomly selected from TB treatment registers. Household visits were conducted to locate and interview former TB (FTB) patients, and bacteriological testing for TB was offered. Additional data sources were used to ascertain the vitality status of FTB patients who could not be located. RESULTS Addresses were located for 200 of the 223 FTB patients sampled and 89 FTB patients were contacted of whom 51 agreed to be interviewed. Approximately half reported persistent respiratory symptoms, such as shortness of breath and wheezing, and repeated lung infections. One (3.6%) of 28 patients who provided a sputum sample had culture-positive TB and another two were currently on re-treatment for TB. Fifteen deaths post treatment were ascertained, resulting in a standardized mortality ratio of 3.8 (95% confidence interval 2.3-6.3) after successful TB treatment relative to the general population. CONCLUSIONS In this high-incidence setting, locating and interviewing FTB patients was challenging. The study findings are consistent with a high rate of respiratory disease, including recurrent TB, and substantially elevated mortality among FTB patients.
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Affiliation(s)
- Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; DST-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Alex Welte
- DST-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rosemary Brown
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; DST-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
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Tefera F, Barnabee G, Sharma A, Feleke B, Atnafu D, Haymanot N, O’Malley G, Feleke G. Evaluation of facility and community-based active household tuberculosis contact investigation in Ethiopia: a cross-sectional study. BMC Health Serv Res 2019; 19:234. [PMID: 31010427 PMCID: PMC6477729 DOI: 10.1186/s12913-019-4074-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/08/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND No established strategy for household tuberculosis (TB) contact investigation (HTCI) exists in Ethiopia. We implemented integrated, active HTCI model into two hospitals and surrounding community health services to determine yield of active HTCI of all forms of TB and explore factors associated with active TB diagnosis in household contacts (HHCs). METHODS Case managers obtained HHC information from index cases at TB/DOTS clinic and liaised with health extension workers (HEWs) who screened HHCs for TB at household and referred contacts under five and presumptive cases for diagnostic investigation. RESULTS From 363 all forms TB index cases, 1509 (99%) HHCs were screened and 809 (54%) referred, yielding 19 (1.3%) all forms TB cases. HTCI of sputum smear-positive pulmonary TB (SS + PTB) index cases produced yield of 4.3%. HHCs with active TB were more likely to be malnourished (OR: 3.39, 95%CI: 1.19-9.64), live in households with SS + PTB index case (OR: 7.43, 95%CI: 1.64-33.73) or TB history (OR: 4.18, 95%CI: 1.51-11.55). CONCLUSION Active HTCI of all forms of TB cases produced comparable or higher yield than reported elsewhere. HTCI contributes to improved and timely case detection of Tuberculosis among population who may not seek health care due to minimal symptoms or access issues. Active HTCI can successfully be implemented through integrated approach with existing community TB programs for better coordination and efficiency. Referral criteria should include factors significantly associated with active disease.
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Affiliation(s)
- Fana Tefera
- Centers for Disease Control and Prevention- Ethiopia (CDC-Ethiopia), US Embassy, Entoto Road, P.O. Box 19284, Addis Ababa, Ethiopia
| | - Gena Barnabee
- University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
| | - Anjali Sharma
- University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
| | - Beniam Feleke
- Centers for Disease Control and Prevention- Ethiopia (CDC-Ethiopia), US Embassy, Entoto Road, P.O. Box 19284, Addis Ababa, Ethiopia
| | - Daniel Atnafu
- International Training and Education Center for Health (I-TECH Ethiopia), Addis Ababa, Ethiopia
| | | | - Gabrielle O’Malley
- University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
| | - Getachew Feleke
- International Training and Education Center for Health (I-TECH Ethiopia), Addis Ababa, Ethiopia
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Mhalu G, Hella J, Mhimbira F, Said K, Mosabi T, Mlacha YP, Schindler C, Gagneux S, Reither K, de Hoogh K, Weiss MG, Zemp E, Fenner L. Pathways and associated costs of care in patients with confirmed and presumptive tuberculosis in Tanzania: A cross-sectional study. BMJ Open 2019; 9:e025079. [PMID: 31005914 PMCID: PMC6528007 DOI: 10.1136/bmjopen-2018-025079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess pathways and associated costs of seeking care from the onset of symptoms to diagnosis in patients with confirmed and presumptive tuberculosis (TB). DESIGN Cross-sectional study. SETTING District hospital in Dar es Salaam, Tanzania. PARTICIPANTS Bacteriologically confirmed TB and presumptive TB patients. PRIMARY AND SECONDARY OUTCOME MEASURES We calculated distance in metres and visualised pathways to healthcare up to five visits for the current episode of sickness. Costs were described by medians and IQRs, with comparisons by gender and poverty status. RESULTS Of 100 confirmed and 100 presumptive TB patients, 44% of confirmed patients sought care first at pharmacies after the onset of symptoms, and 42% of presumptive patients did so at hospitals. The median visits made by confirmed patients was 2 (range 1-5) and 2 (range 1-3) by presumptive patients. Patients spent a median of 31% of their monthly household income on health expenditures for all visits. The median total direct costs were higher in confirmed compared with presumptive patients (USD 27.4 [IQR 18.7-48.4] vs USD 19.8 [IQR 13.8-34.0], p=0.02), as were the indirect costs (USD 66.9 [IQR 35.5-150.0] vs USD 46.8 [IQR 20.1-115.3], p<0.001). The indirect costs were higher in men compared with women (USD 64.6 [IQR 31.8-159.1] vs USD 55.6 [IQR 25.1-141.1], p<0.001). The median total distance from patients' household to healthcare facilities for patients with confirmed and presumptive TB was 2338 m (IQR 1373-4122) and 2009 m (IQR 986-2976) respectively. CONCLUSIONS Patients with confirmed TB have complex pathways and higher costs of care compared with patients with presumptive TB, but the costs of the latter are also substantial. Improving access to healthcare and ensuring integration of different healthcare providers including private, public health practitioners and patients themselves could help in reducing the complex pathways during healthcare seeking and optimal healthcare utilisation.
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Affiliation(s)
- Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jerry Hella
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Francis Mhimbira
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Khadija Said
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Yeromin P Mlacha
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sébastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mitchell G Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Mhalu G, Weiss MG, Hella J, Mhimbira F, Mahongo E, Schindler C, Reither K, Fenner L, Zemp E, Merten S. Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study. BMC Health Serv Res 2019; 19:217. [PMID: 30953502 PMCID: PMC6451234 DOI: 10.1186/s12913-019-4030-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. METHODS In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. RESULTS Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17). CONCLUSION Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.
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Affiliation(s)
- Grace Mhalu
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mitchell G. Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jerry Hella
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Francis Mhimbira
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Enos Mahongo
- Ifakara Health Institute, Dar es Salaam and Bagamoyo, Tanzania
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Krasavin M, Lukin A, Vedekhina T, Manicheva O, Dogonadze M, Vinogradova T, Zabolotnykh N, Rogacheva E, Kraeva L, Sharoyko V, Tennikova TB, Dar'in D, Sokolovich E. Attachment of a 5-nitrofuroyl moiety to spirocyclic piperidines produces non-toxic nitrofurans that are efficacious in vitro against multidrug-resistant Mycobacterium tuberculosis. Eur J Med Chem 2019; 166:125-135. [PMID: 30703656 DOI: 10.1016/j.ejmech.2019.01.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 01/31/2023]
Abstract
A selectively antimycobacterial compound belonging to the nitrofuran class of antimicrobials has been developed via conjugation of the nitrofuran moiety to a series of spirocyclic piperidines through an amide linkage. It proved to have comparable activity against drug-sensitive (H37Rv) strain as well as multidrug-resistant, patient-derived strains of Mycobacterium tuberculosis. The compound is druglike, showed no appreciable cytotoxicity toward human retinal pigment epithelial cell line ARPE-19 in concentrations up to 100 μM and displayed low toxicity when evaluated in mice.
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Affiliation(s)
- Mikhail Krasavin
- Saint Petersburg State University, Saint Petersburg, 199034, Russian Federation.
| | - Alexei Lukin
- Lomonosov Institute of Fine Chemical Technologies, MIREA - Russian Technological University, Moscow, 119571, Russian Federation
| | - Tatiana Vedekhina
- Lomonosov Institute of Fine Chemical Technologies, MIREA - Russian Technological University, Moscow, 119571, Russian Federation
| | - Olga Manicheva
- Saint Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Prospekt, Saint Petersburg, 191036, Russian Federation
| | - Marine Dogonadze
- Saint Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Prospekt, Saint Petersburg, 191036, Russian Federation
| | - Tatiana Vinogradova
- Saint Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Prospekt, Saint Petersburg, 191036, Russian Federation
| | - Natalia Zabolotnykh
- Saint Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Prospekt, Saint Petersburg, 191036, Russian Federation
| | - Elizaveta Rogacheva
- Pasteur Institute of Epidemiology and Microbiology, 14 Mira Street, Saint Petersburg, 197101, Russian Federation
| | - Liudmila Kraeva
- Pasteur Institute of Epidemiology and Microbiology, 14 Mira Street, Saint Petersburg, 197101, Russian Federation
| | - Vladimir Sharoyko
- Saint Petersburg State University, Saint Petersburg, 199034, Russian Federation
| | - Tatiana B Tennikova
- Saint Petersburg State University, Saint Petersburg, 199034, Russian Federation
| | - Dmitry Dar'in
- Saint Petersburg State University, Saint Petersburg, 199034, Russian Federation
| | - Evgeny Sokolovich
- Saint Petersburg State University, Saint Petersburg, 199034, Russian Federation; Saint Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky Prospekt, Saint Petersburg, 191036, Russian Federation
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59
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Rachow A, Ivanova O, Wallis R, Charalambous S, Jani I, Bhatt N, Kampmann B, Sutherland J, Ntinginya NE, Evans D, Lönnroth K, Niemann S, Schaible UE, Geldmacher C, Sanne I, Hoelscher M, Churchyard G. TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB - a study protocol. BMC Pulm Med 2019; 19:4. [PMID: 30616617 PMCID: PMC6323671 DOI: 10.1186/s12890-018-0777-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 12/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background Up to fifty percent of microbiologically cured tuberculosis (TB) patients may be left with permanent, moderate or severe pulmonary function impairment. Very few studies have systematically examined pulmonary outcomes in patients to understand the pathophysiologic basis and long-term socio-economic consequences of this injury. The planned multi-country, multi-centre observational TB cohort study, aims to advance the understanding of the clinical, microbiological, immunological and socio-economic risk factors affecting long-term outcome of pulmonary TB. It will also determine the occurrence of reversible and irreversible socio-economic consequences to patients, their households and the health sector related to pulmonary TB disease and its treatment. Methods We will enrol up to 1.600 patients with drug sensitive and multidrug-resistant pulmonary TB who are treated according to the local standard of care by the respective National TB Program. Recruitment is taking place at the time of TB diagnosis at four African study clinics located in The Gambia, Mozambique, South Africa and Tanzania. The primary outcome is the proportion of TB patients with severe lung impairment measured by spirometry at 24 months after TB treatment initiation. Biological samples, including sputum, urine and blood, for studying host- and pathogenic risk factors will be collected longitudinally and examined in a nested case-control fashion. A standardized quality of life questionnaire will be used together with a novel version of WHO’s generic patient cost instrument which has been adapted for the longitudinal study design. Discussion This study is an integral part of an overall strategy to fill a knowledge gap needed to improve TB treatment outcomes globally. The main scientific goal is to identify the major pathogenic mechanisms associated with poor TB treatment outcomes, so that such pathways can be interrupted to avert long term TB sequelae. National as well as supra-national stakeholders and decision makers have been integrated early in the study planning process to inform future treatment guidelines and national health policies. Trial registration ClinicalTrials.gov: NCT03251196, August 16, 2017. Electronic supplementary material The online version of this article (10.1186/s12890-018-0777-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany. .,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
| | | | | | - Ilesh Jani
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - Nilesh Bhatt
- Instituto Nacional de Saúde (INS), Ministry of Health, Maputo, Mozambique
| | - Beate Kampmann
- Medical Research Council Unit The Gambia, Banjul, The Gambia.,Department of Medicine, Imperial College London, London, UK
| | | | | | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ian Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Gavin Churchyard
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Advancing Care and Treatment for TB/HIV, South African Medical Research Council, Parktown, Johannesburg, South Africa
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A Spatial Analysis Framework to Monitor and Accelerate Progress towards SDG 3 to End TB in Bangladesh. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2018. [DOI: 10.3390/ijgi8010014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Global efforts to end the tuberculosis (TB) epidemic by 2030 (SDG3.3) through improved TB case detection and treatment have not been effective to significantly reduce the global burden of the TB epidemic. This study presents an analytical framework to evaluate the use of TB case notification rates (CNR) to monitor and to evaluate TB under-detection and under-diagnoses in Bangladesh. Local indicators of spatial autocorrelation (LISA) were calculated to assess the presence and scale of spatial clusters of TB CNR across 489 upazilas in Bangladesh. Simultaneous autoregressive models were fit to the data to identify associations between TB CNR and poverty, TB testing rates and retreatment rates. CNRs were found to be significantly spatially clustered, negatively correlated to poverty rates and positively associated to TB testing and retreatment rates. Comparing the observed pattern of CNR with model-standardized rates made it possible to identify areas where TB under-detection is likely to occur. These results suggest that TB CNR is an unreliable proxy for TB incidence. Spatial variations in TB case notifications and subnational variations in TB case detection should be considered when monitoring national TB trends. These results provide useful information to target and prioritize context specific interventions.
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Prasanna T, Jeyashree K, Chinnakali P, Bahurupi Y, Vasudevan K, Das M. Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India. Glob Health Action 2018; 11:1477493. [PMID: 29902134 PMCID: PMC6008578 DOI: 10.1080/16549716.2018.1477493] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.
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Affiliation(s)
- Thirunavukkarasu Prasanna
- a Department of Community Medicine and Family Medicine , All India Institute of Medical Sciences , Jodhpur , India.,b Department of Community Medicine , Indira Gandhi Medical College and Research Institute, Govt. of Puducherry Institution , Puducherry , India
| | - Kathiresan Jeyashree
- c Department of Community Medicine , Velammal Medical College Hospital and Research Institute , Madurai , India
| | - Palanivel Chinnakali
- d Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry , India
| | - Yogesh Bahurupi
- b Department of Community Medicine , Indira Gandhi Medical College and Research Institute, Govt. of Puducherry Institution , Puducherry , India
| | - Kavita Vasudevan
- b Department of Community Medicine , Indira Gandhi Medical College and Research Institute, Govt. of Puducherry Institution , Puducherry , India
| | - Mrinalini Das
- e Médecins Sans Frontières (MSF)/Doctors Without Borders , New Delhi , India
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Shelby T, Meyer AJ, Ochom E, Turimumahoro P, Babirye D, Katamba A, Davis JL, Armstrong-Hough M. Social determinants of tuberculosis evaluation among household contacts: a secondary analysis. Public Health Action 2018; 8:118-123. [PMID: 30271727 PMCID: PMC6147061 DOI: 10.5588/pha.18.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/25/2018] [Indexed: 12/25/2022] Open
Abstract
Setting: Seven public sector tuberculosis (TB) units and surrounding communities in Kampala, Uganda. Objective: To evaluate the influence of household-level socio-economic characteristics on completion of TB evaluation during household contact investigation. Design: A cross-sectional study nested within the control arm of a randomized, controlled trial evaluating home-based sputum collection and short messaging service communications. We used generalized estimating equations to estimate the association between completion of TB evaluation and socio-economic determinants. Results: Of 116 household contacts referred to clinics for TB evaluation, 32 (28%) completed evaluation. Completing evaluation was strongly clustered by household. Controlling for individual symptoms, contacts from households earning below-median income (adjusted risk ratio [aRR] 0.28, 95%CI 0.09-0.88, P = 0.029) and contacts from households in which the head of household had no more than primary-level education (aRR 0.40, 95%CI 0.18-0.89, P = 0.025) were significantly less likely to complete evaluation for TB. Conclusion: Socio-economic factors such as low income and education increase the risk that household contacts of TB patients will experience barriers to completing TB evaluation themselves. Further research is needed to identify specific mechanisms by which these underlying social determinants modify the capability and motivation of contacts to complete contact investigation.
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Affiliation(s)
- T Shelby
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - A J Meyer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
| | - M Armstrong-Hough
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
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63
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Falisse JB, Masino S, Ngenzebuhoro R. Indigenous medicine and biomedical health care in fragile settings: insights from Burundi. Health Policy Plan 2018; 33:483-493. [PMID: 29452365 DOI: 10.1093/heapol/czy002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/12/2022] Open
Abstract
This study contributes to the health policy debate on medical systems integration by describing and analysing the interactions between health-care users, indigenous healers, and the biomedical public health system, in the so far rarely documented case of post-conflict Burundi. We adopt a mixed-methods approach combining (1) data from an existing survey on access to health-care, with 6,690 individuals, and (2) original interviews and focus groups conducted in 2014 with 121 respondents, including indigenous healers, biomedical staff, and health-care users. The findings reveal pluralistic patterns of health-care seeking behaviour, which are not primarily based on economic convenience or level of education. Indigenous healers' diagnosis is shown to revolve around the concept of 'enemy' and the need for protection against it. We suggest ways in which this category may intersect with the widespread experience of trauma following the civil conflict. Finally, we find that, while biomedical staff displays ambivalent attitudes towards healers, cross-referrals occasionally take place between healers and health centres. These findings are interpreted in light of the debate on health systems integration in Sub-Saharan Africa. In particular, we discuss policy options regarding healers' accreditation, technical training, management of cross-referrals as well as of herb-drug interactions; and we emphasise healers' psychological support role in helping communities deal with trauma. In this respect, we argue that the experience of conflict, and the experiences and conceptualizations of mental and physical illness, need to be taken into account when devising appropriate public or international health policy responses.
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Affiliation(s)
- Jean-Benoît Falisse
- Centre of African Studies, School of Social and Political Science, University of Edinburgh, 15a George Square, EH8 9LD Edinburgh, UK
| | - Serena Masino
- Department of Economics and Quantitative Methods, University of Westminster, 35 Marylebone Road, London NW1 5LS, UK
| | - Raymond Ngenzebuhoro
- Faculté de Médecine, Aix-Marseille Université, 58 boulevard Charles Livon, 13284 Marseille 7, France
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Cohen DB, Phiri M, Banda H, Squire SB, Namakhoma I, Desmond N. A qualitative evaluation of hospital versus community-based management of patients on injectable treatments for tuberculosis. BMC Public Health 2018; 18:1127. [PMID: 30223808 PMCID: PMC6142700 DOI: 10.1186/s12889-018-6015-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients being treated for recurrent or multidrug-resistant tuberculosis (TB) require long courses of injectable anti-tuberculous agents. In order to maintain strong TB control programmes, it is vital that the experiences of people who receive long-term injectables for TB are well understood. To investigate the feasibility of a novel model of care delivery, a clinical trial (The TB-RROC Study) was conducted at two central hospitals in Malawi. Hospital-based care was compared to a community-based approach for patients on TB retreatment in which 'guardians' (patient-nominated lay people) were trained to deliver injections to patients at home. This study is the qualitative evaluation of the TB-RROC trial. It examines the experiences of people receiving injectables as part of TB treatment delivered in hospital and community-based settings. METHODS A qualitative evaluation of the TB-RROC intervention was conducted using phenomenographic methods. Trial participants were purposively sampled, and in-depth interviews were conducted with patients and guardians in both arms of the trial. Key informant interviews and observations in the wards and community were performed. Thematic content analysis was used to derive analytical themes. RESULTS Fourteen patients, 12 guardians and 9 key informants were interviewed. Three key themes relating to TB retreatment emerged: medical experiences (including symptoms, treatment, and HIV); the effects of the physical environment (conditions on the ward, disruption to daily routines and livelihoods); and trust (in other people, the community and in the health system). Experiences were affected by the nature of a person's prior role in their community and resulted in a range of emotional responses. Patients and guardians in the community benefited from better environment, social interactions and financial stability. Concerns were expressed about the potential for patients' health or relationships to be adversely affected in the community. These potential concerns were rarely realised. CONCLUSIONS Guardian administered intramuscular injections were safe and well received. Community-based care offered many advantages over hospital-based care for patients receiving long-term injectable treatment for TB and their families.
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Affiliation(s)
- D. B. Cohen
- Malawi Liverpool Wellcome Clinical Research Programme, Box 30096, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembrooke Place, Liverpool, L3 5PH UK
- University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX UK
| | - M. Phiri
- Malawi Liverpool Wellcome Clinical Research Programme, Box 30096, Blantyre 3, Malawi
| | - H. Banda
- REACH Trust, Box 1597, Lilongwe, Malawi
| | - S. B. Squire
- Liverpool School of Tropical Medicine, Pembrooke Place, Liverpool, L3 5PH UK
| | | | - N. Desmond
- Malawi Liverpool Wellcome Clinical Research Programme, Box 30096, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembrooke Place, Liverpool, L3 5PH UK
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Nascimben J, Cubbison C, Lape EC, Katz JN. Strategies for Managing the Costs of Chronic Illness in the Context of Limited Financial Resources: A Qualitative Study in Dominican Persons With Arthritis. Arthritis Care Res (Hoboken) 2018; 71:1379-1386. [PMID: 30171806 DOI: 10.1002/acr.23742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Persons who reside in low- and middle-income countries often have insufficient resources to pay for treatments prescribed for their medical conditions. The aim of this study was to determine, using qualitative methods, how patients with arthritis in the Dominican Republic manage the costs associated with chronic illnesses. METHODS We conducted individual interviews with 17 Dominican adults with advanced arthritis who were undergoing total knee replacement or total hip replacement at a hospital in Santo Domingo, Dominican Republic. Interviewers followed a moderator's guide with questions pertaining to the financial demands of arthritis treatment and the strategies participants used to pay for treatments. Interviews were audio recorded, transcribed verbatim, and translated into English. We used thematic analysis to identify salient themes. RESULTS The thematic analysis suggested that health system factors (such as the extent of reimbursement for medications available in the public health care system) along with personal factors (such as disposable income) shaped individuals' experiences of managing chronic illness. These systemic and personal factors contributed to a sizeable gap between the cost of care and the amount most participants were able to pay. Participants managed this resource gap using a spectrum of strategies ranging from acceptance (or, "making do with less") to resourcefulness (or, "finding more"). Participants were aided by strong community bonds and religiously oriented resilience. CONCLUSION This qualitative study illuminates the range of strategies Dominican individuals with limited resources use to obtain health care and manage chronic illness. The findings raise hypotheses that warrant further study and could help guide provider-patient conversations regarding treatment adherence.
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Affiliation(s)
| | - Caroline Cubbison
- Massachusetts General Hospital, Boston Massachusetts and Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Emma C Lape
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Sweeney S, Mukora R, Candfield S, Guinness L, Grant AD, Vassall A. Measuring income for catastrophic cost estimates: Limitations and policy implications of current approaches. Soc Sci Med 2018; 215:7-15. [PMID: 30196149 PMCID: PMC6171470 DOI: 10.1016/j.socscimed.2018.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/29/2022]
Abstract
There is increasing global policy interest in estimating catastrophic costs incurred by households because of ill health, and growing need for information on disease-specific household cost data. There are several methodological approaches used to estimate income and no current consensus on the best method for estimating income in the context of a survey at the health facility. We compared six different approaches to estimate catastrophic cost among patients attending a health facility in South Africa. We used patient cost and income data collected June 2014-March 2015 from 66 participants enrolled in a clinical trial in South Africa (TB FastTrack) to explore the variation arising from different income estimation approaches and compared the number of households encountering catastrophic costs derived for each approach. The total proportion of households encountering catastrophic costs varied from 0% to 36%, depending on the estimation method. Self-reported mean annual income was significantly lower than permanent income estimated using an asset linking approach, or income estimated using the national average. A disproportionate number of participants adopting certain coping strategies, including selling assets and taking loans, were unable to provide self-reported income data. We conclude that the rapid methods for estimating income among patients attending a health facility are currently inconsistent. Further research on methods for measuring income, comparing the current recommended methods to 'gold standard' methods in different settings, should be done to identify the most appropriate measurement method.
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Affiliation(s)
- Sedona Sweeney
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Sophie Candfield
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Lorna Guinness
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Vassall
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
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Krasavin M, Lukin A, Vedekhina T, Manicheva O, Dogonadze M, Vinogradova T, Zabolotnykh N, Rogacheva E, Kraeva L, Yablonsky P. Conjugation of a 5-nitrofuran-2-oyl moiety to aminoalkylimidazoles produces non-toxic nitrofurans that are efficacious in vitro and in vivo against multidrug-resistant Mycobacterium tuberculosis. Eur J Med Chem 2018; 157:1115-1126. [DOI: 10.1016/j.ejmech.2018.08.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
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Pedrazzoli D, Siroka A, Boccia D, Bonsu F, Nartey K, Houben R, Borghi J. How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana. Trop Med Int Health 2018; 23:870-878. [PMID: 29851223 DOI: 10.1111/tmi.13085] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is known as a disease of the poor. Despite TB diagnosis and care usually being offered for free, TB patients can still face substantial costs, especially in the context of multi-drug resistance (MDR). The End TB Strategy calls for zero TB-affected families incurring 'catastrophic' costs due to TB by 2025. This paper examines, by MDR status, the level and composition of costs incurred by TB-affected households during care seeking and treatment; assesses the affordability of TB care using catastrophic and impoverishment measures; and describes coping strategies used by TB-affected households to pay for TB care. METHODS A nationally representative survey of TB patients at public health facilities across Ghana. RESULTS We enrolled 691 patients (66 MDR). The median expenditure for non-MDR TB was US$429.6 during treatment, vs. US$659.0 for MDR patients (P-value = 0.001). Catastrophic costs affected 64.1% of patients. MDR patients were pushed significantly further over the threshold for catastrophic payments than DS patients. Payments for TB care led to a significant increase in the proportion of households in the study sample that live below the poverty line at the time of survey compared to pre-TB diagnosis. Over half of patients undertook coping strategies. CONCLUSION TB patients in Ghana incur substantial costs, despite free diagnosis and treatment. High rates of catastrophic costs and coping strategies in both non-MDR and MDR patients show that new policies are urgently needed to ensure TB care is actually affordable for TB patients.
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Affiliation(s)
- Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Siroka
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank Bonsu
- National Tuberculosis Control Programme, Ghana Health Service, Accra, Ghana
| | | | - Rein Houben
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Tadesse S, Enqueselassie F, Hagos S. Spatial and space-time clustering of tuberculosis in Gurage Zone, Southern Ethiopia. PLoS One 2018; 13:e0198353. [PMID: 29870539 PMCID: PMC5988276 DOI: 10.1371/journal.pone.0198353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Spatial targeting is advocated as an effective method that contributes for achieving tuberculosis control in high-burden countries. However, there is a paucity of studies clarifying the spatial nature of the disease in these countries. This study aims to identify the location, size and risk of purely spatial and space-time clusters for high occurrence of tuberculosis in Gurage Zone, Southern Ethiopia during 2007 to 2016. MATERIALS AND METHODS A total of 15,805 patient data that were retrieved from unit TB registers were included in the final analyses. The spatial and space-time cluster analyses were performed using the global Moran's I, Getis-Ord [Formula: see text] and Kulldorff's scan statistics. RESULTS Eleven purely spatial and three space-time clusters were detected (P <0.001).The clusters were concentrated in border areas of the Gurage Zone. There were considerable spatial variations in the risk of tuberculosis by year during the study period. CONCLUSIONS This study showed that tuberculosis clusters were mainly concentrated at border areas of the Gurage Zone during the study period, suggesting that there has been sustained transmission of the disease within these locations. The findings may help intensify the implementation of tuberculosis control activities in these locations. Further study is warranted to explore the roles of various ecological factors on the observed spatial distribution of tuberculosis.
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Affiliation(s)
- Sebsibe Tadesse
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fikre Enqueselassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seifu Hagos
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Asres A, Jerene D, Deressa W. Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:15. [PMID: 29784037 PMCID: PMC5963051 DOI: 10.1186/s41043-018-0146-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/08/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients. METHODS A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost. RESULTS Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7-318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43-184.22) and US$93.75 (56.91-141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23-48.31) and US$35.02 (0-70.04). Patient delay days (p < 0.001), provider delay days (p < 0.001), number of healthcare facilities visited until TB diagnosis (p < 0.001), and TB diagnosis at private facilities (p = 0.02) independently predicted increased pre-diagnosis cost. Similarly, rural residence (p < 0.001), hospitalization during anti-TB treatment (p < 0.001), patient delay days (p < 0.001), and provider delay days (p < 0.001) predicted increased post-diagnosis costs. CONCLUSION TB patients incur substantial cost for care seeking and treatment despite "free service" for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.
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Affiliation(s)
- Abyot Asres
- Department of Public Health, College of Health Sciences, Mizan-Tepi University, PO Box 260, Mizan Aman, Ethiopia
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Degu Jerene
- Management Sciences for Health, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Wickett E, Peralta-Santos A, Beste J, Micikas M, Toe F, Rogers J, Jabateh L, Wagenaar BH. Treatment outcomes of TB-infected individuals attending public sector primary care clinics in rural Liberia from 2015 to 2017: a retrospective cohort study. Trop Med Int Health 2018. [PMID: 29524302 DOI: 10.1111/tmi.13049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES In June 2015, Partners in Health (PIH) and the Liberian Ministry of Health began a community health worker (CHW) programme containing food support, reimbursement of transport and social assistance to address gaps in tuberculosis (TB) treatment exacerbated by the 2014-2015 Ebola virus disease (EVD) epidemic. The purpose of this article was to analyse the performance of routine clinical TB care and the effects of this CHW programme. METHODS Retrospective cohort study utilising data from TB patient registers at a census of all health facilities treating TB in the south-east region of Liberia from January 2015 - April 2017. Competing risks Cox regression analyses were used to generate subhazard ratios (sHR) analysing factors associated with rates of TB cure (smear negative), treatment completion (no smear), lost to follow-up (LTFU) and death. RESULTS LTFU rates decreased 76% pre- vs. post-CHW intervention, from 14.6% in pre-intervention to 3.4% post-intervention (P < 0.001). Although the post-intervention had better cure rates (sHR 1.07, CI 0.58-1.9), treatment completion (sHR 1.53, CI 1.00 2.39) and lower death rates (sHR 0.64, CI 0.34-1.2), statistical significance was not reached. Younger patients had significantly lower death and cure rates, while older patients had higher LTFU and cure rates. Overall, 31% of patients were cured, 44% completed treatment without a confirmatory smear, 5% were LTFU, 9% died, 0.5% failed treatment, and 10% transferred out. CONCLUSIONS In challenging environments, LTFU can be reduced by CHW accompaniment and socio-economic assistance to patients with TB. Approaches are needed to improve cure verification in young patients and reduce mortality.
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Affiliation(s)
| | - André Peralta-Santos
- Department of Global Health, University of Washington, Seattle, WA, USA.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jason Beste
- Partners in Health, Monrovia, Liberia.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Bradley H Wagenaar
- Partners in Health, Monrovia, Liberia.,Department of Global Health, University of Washington, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
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Santos E, Felgueiras Ó, Oliveira O, Duarte R. The Effect of a Basic Basket on Tuberculosis Treatment Outcome in the Huambo Province, Angola. Arch Bronconeumol 2018; 54:167-168. [DOI: 10.1016/j.arbres.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/29/2022]
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73
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van Gemert FA, Kirenga BJ, Gebremariam TH, Nyale G, de Jong C, van der Molen T. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa. Expert Rev Respir Med 2018; 12:227-237. [PMID: 29298106 DOI: 10.1080/17476348.2018.1423964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In most low and middle-income countries, chronic obstructive pulmonary disease (COPD) is on the rise. Areas covered: Unfortunately, COPD is a neglected disease in these countries. Taking sub-Saharan Africa as an example, in rural areas, COPD is even unknown regarding public awareness and public health planning. Programs for the management of COPD are poorly developed, and the quality of care is often of a low standard. Inhaled medication is often not available or not affordable. Tobacco smoking is the most common encountered risk factor for COPD. However, in sub-Saharan Africa, household air pollution is another major risk factor for the development of COPD. Communities are also exposed to a variety of other risk factors, such as low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human-immunodeficiency virus and tuberculosis. All these factors contribute to the high burden of poor respiratory health in sub-Saharan Africa. Expert commentary: A silent growing epidemic of COPD seems to be unravelling. Therefore, prevention and intervention programs must involve all the stakeholders and start as early as possible. More research is needed to describe, define and inform treatment approaches, and natural history of biomass-related COPD.
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Affiliation(s)
- Frederik A van Gemert
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
| | - Bruce J Kirenga
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda.,c Department of Medicine , Makerere University , Kampala , Uganda
| | - Tewodros Haile Gebremariam
- d Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine , Addis Ababa University, College of Health Science , Addis Ababa , Ethiopia
| | - George Nyale
- e Respiratory and Infectious Disease Unit , Kenyatta National Referral & Teaching Hospital , Nairobi , Kenya.,f Kenya Association of Physicians for Tuberculosis and other Lung Disease (KAPTLD) , Nairobi , Kenya
| | - Corina de Jong
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Thys van der Molen
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
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74
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Datiko DG, Yassin MA, Theobald SJ, Blok L, Suvanand S, Creswell J, Cuevas LE. Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study. BMJ Glob Health 2017; 2:e000390. [PMID: 29209537 PMCID: PMC5704104 DOI: 10.1136/bmjgh-2017-000390] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/14/2017] [Accepted: 10/06/2017] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis (TB) is a major cause of death in Ethiopia. One of the main barriers for TB control is the lack of access to health services. Methods We evaluated a diagnostic and treatment service for TB based on the health extension workers (HEW) of the Ethiopian Health Extension Programme in Sidama Zone, with 3.5 million population. We added the services to the HEW routines and evaluated their effect over 4.5 years. 1024 HEWs were trained to identify individuals with symptoms of TB, request sputum samples and prepare smears. Smears were transported to designated laboratories. Individuals with TB were offered treatment at home or the local health post. A second zone (Hadiya) with 1.2 million population was selected as control. We compared TB case notification rates (CNR) and treatment outcomes in the zones 3 years before and 4.5 years after intervention. Results HEWs identified 216 165 individuals with symptoms and 27 918 (12%) were diagnosed with TB. Smear-positive TB CNR increased from 64 (95% CI 62.5 to 65.8) to 127 (95% CI 123.8 to 131.2) and all forms of TB increased from 102 (95% CI 99.1 to 105.8) to 177 (95% CI 172.6 to 181.0) per 100 000 population in the first year of intervention. In subsequent years, the smear-positive CNR declined by 9% per year. There was no change in CNR in the control area. Treatment success increased from 76% before the intervention to 95% during the intervention. Patients lost to follow-up decreased from 21% to 3% (p<0.001). Conclusion A community-based package significantly increased case finding and improved treatment outcome. Implementing this strategy could help meet the Ethiopian Sustainable Development Goal targets.
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Affiliation(s)
| | - Mohammed A Yassin
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Sally J Theobald
- Faculty of Clinical Sciences and International Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucie Blok
- Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | | | | | - Luis E Cuevas
- Faculty of Clinical Sciences and International Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Mudzengi D, Sweeney S, Hippner P, Kufa T, Fielding K, Grant AD, Churchyard G, Vassall A. The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa. Health Policy Plan 2017; 32:iv48-iv56. [PMID: 28204500 PMCID: PMC5886108 DOI: 10.1093/heapol/czw183] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This study describes the post-diagnosis care-seeking costs incurred by people living with TB and/or HIV and their households, in order to identify the potential benefits of integrated care. METHODS We conducted a cross-sectional study with 454 participants with TB or HIV or both in public primary health care clinics in Ekurhuleni North Sub-District, South Africa. We collected information on visits to health facilities, direct and indirect costs for participants and for their guardians and caregivers. We define 'integration' as receipt of both TB and HIV services at the same facility, on the same day. Costs were presented and compared across participants with TB/HIV, TB-only and HIV-only. Costs exceeding 10% of participant income were considered catastrophic. RESULTS Participants with both TB and HIV faced a greater economic burden (US$74/month) than those with TB-only (US$68/month) or HIV-only (US$40/month). On average, people with TB/HIV made 18.4 visits to health facilities, more than TB-only participants or HIV-only participants who made 16 and 5.1 visits, respectively. However, people with TB/HIV had fewer standalone TB (10.9) and HIV (2.2) visits than those with TB-only (14.5) or HIV-only (4.4). Although people with TB/HIV had access to 'integrated' services, their time loss was substantially higher than for other participants. Overall, 55% of participants encountered catastrophic costs. Access to official social protection schemes was minimal. CONCLUSIONS People with TB/HIV in South Africa are at high risk of catastrophic costs. To some extent, integration of services reduces the number of standalone TB and HIV of visits to the health facility. It is however unlikely that catastrophic costs can be averted by service integration alone. Our results point to the need for timely social protection, particularly for HIV-positive people starting TB treatment.
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Affiliation(s)
- Don Mudzengi
- The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Piotr Hippner
- The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa
| | - Tendesayi Kufa
- The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Alison D Grant
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Gavin Churchyard
- The Aurum Institute, Johannesburg, 29 Queens Road, Parktown Johannesburg, Gauteng, 2193 South Africa
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Feasibility and Effectiveness of Tuberculosis Active Case-Finding among Children Living with Tuberculosis Relatives: a Cross-Sectional Study in Guinea-Bissau. Mediterr J Hematol Infect Dis 2017; 9:e2017059. [PMID: 29181136 PMCID: PMC5667531 DOI: 10.4084/mjhid.2017.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background and objectives The World Health Organization End tuberculosis (TB) Strategy, approved in 2014, aims at a 90% reduction in TB deaths and an 80% reduction in TB incidence rate by 2030. One of the suggested interventions is the systematic screening of people with suspected TB, belonging to specific risk groups. The Hospital Raoul Follereau (HRF) in Bissau, Guinea-Bissau, is the National Reference Hospital for Tuberculosis and Lung Disease of the country. We performed an active case-finding program among pediatric age family members and cohabitants of admitted adult TB patients, from January to December 2013. Methods Newly admitted adult patients with a diagnosis of TB were invited to bring their family members or cohabitants in childhood age for clinical evaluation in a dedicated outpatient setting within the hospital compound. All the children brought to our attention underwent a medical examination and chest x-ray. In children with clinical and/or radiologic finding consistent with pulmonary TB, a sputum-smear was requested. Results All admitted adult patients accepted to bring their children cohabitants. In total, 287 children were examined in 2013. Forty-four patients (15%) were diagnosed with TB. The number needed to screen (NNS) to detect one case of TB was 7. 35 patients (80%) had pulmonary TB; 2 of them were sputum smear-positive. No adjunctive personnel cost was necessary for the intervention. Conclusions A hospital-based TB active case-finding program targeted to high-risk groups like children households of severely ill admitted patients with TB can successfully be implemented in a country with limited resources.
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Laokri S. Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care. Front Med (Lausanne) 2017; 4:130. [PMID: 28890891 PMCID: PMC5575342 DOI: 10.3389/fmed.2017.00130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Background There is a massive global momentum to progress toward the sustainable development and universal health coverage goals. However, effective policies to health-care coverage can only emerge through high-quality services delivered to empowered care users by means of strong local health systems and a translational standpoint. Health policies aimed at removing user fees for a defined health-care package may fail at reaching desired results if not applied with system thinking. Method Secondary data analysis of two country-based cost-of-illness studies was performed to gain knowledge in informed decision-making toward enhanced access to care in the context of resource-constraint settings. A scoping review was performed to map relevant experiences and evidence underpinning the defined research area, the economic burden of illness. Findings Original studies reflected on catastrophic costs to patients because of care services use and related policy gaps. Poverty diseases such as tuberculosis (TB) may constitute prime examples to assess the extent of effective high-priority health-care coverage. Our findings suggest that a share of the economic burden of illness can be attributed to implementation failures of health programs and supply-side features, which may highly impair attainment of the global stated goals. We attempted to define and discuss a knowledge development framework for effective policy-making and foster system levers for integrated care. Discussion Bottlenecks to effective policy persist and rely on interrelated patterns of health-care coverage. Health system performance and policy responsiveness have to do with collaborative work among all health stakeholders. Public–private mix strategies may play a role in lowering the economic burden of disease and solving some policy gaps. We reviewed possible added value and pitfalls of collaborative approaches to enhance dynamic local knowledge development and realize integration with the various health-care silos. Conclusion Despite a large political commitment and mobilization efforts from funding, the global development goal of financial protection for health—newly adopted in TB control as no TB-affected household experiencing catastrophic expenditure—may remain aspirational. To enhance effective access to care for all, innovative opportunities in patient-centered and collaborative practices must be taken. Further research is greatly needed to optimize the use of locally relevant knowledge, networks, and technologies.
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Affiliation(s)
- Samia Laokri
- School of Public Health, Health Policy and Systems - International Health, Université Libre de Bruxelles, Brussels, Belgium.,School of Public Health and Tropical Medicine, Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, United States.,Institute for Interdisciplinary Innovation in Healthcare (13h), Université Libre de Bruxelles, Brussels, Belgium
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Gois PHF, Ferreira D, Olenski S, Seguro AC. Vitamin D and Infectious Diseases: Simple Bystander or Contributing Factor? Nutrients 2017; 9:E651. [PMID: 28672783 PMCID: PMC5537771 DOI: 10.3390/nu9070651] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Vitamin D (VD) is a fat-soluble steroid essential for life in higher animals. It is technically a pro-hormone present in few food types and produced endogenously in the skin by a photochemical reaction. In recent decades, several studies have suggested that VD contributes to diverse processes extending far beyond mineral homeostasis. The machinery for VD production and its receptor have been reported in multiple tissues, where they have a pivotal role in modulating the immune system. Similarly, vitamin D deficiency (VDD) has been in the spotlight as a major global public healthcare burden. VDD is highly prevalent throughout different regions of the world, including tropical and subtropical countries. Moreover, VDD may affect host immunity leading to an increased incidence and severity of several infectious diseases. In this review, we discuss new insights on VD physiology as well as the relationship between VD status and various infectious diseases such as tuberculosis, respiratory tract infections, human immunodeficiency virus, fungal infections and sepsis. Finally, we critically review the latest evidence on VD monitoring and supplementation in the setting of infectious diseases.
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Affiliation(s)
- Pedro Henrique França Gois
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
- Nephrology Department, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
| | - Daniela Ferreira
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
| | - Simon Olenski
- Nephrology Department, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
| | - Antonio Carlos Seguro
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
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New nitrofurans amenable by isocyanide multicomponent chemistry are active against multidrug-resistant and poly-resistant Mycobacterium tuberculosis. Bioorg Med Chem 2017; 25:1867-1874. [DOI: 10.1016/j.bmc.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 02/03/2023]
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Yuan L, Zhang H, Zhou C, Jiang W, Zhao Q, Biao X. Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China. BMC Infect Dis 2017; 17:71. [PMID: 28086753 PMCID: PMC5237123 DOI: 10.1186/s12879-016-2108-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 12/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants. METHODS A cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences. RESULTS Totally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ 2 = 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY). CONCLUSION CTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.
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Affiliation(s)
- Li Yuan
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China
| | - Hui Zhang
- National Center for TB Control and Prevention, National center for TB control and prevention, 155 Changbai Road, Beijing, 102206, China
| | - Changming Zhou
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China
| | - Weili Jiang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China. .,Centre for Global Health, Department of Public Health Science (IHCAR), Karolinska Institutet, S-171 77, Stockholm, Sweden.
| | - Xu Biao
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.,Centre for Global Health, Department of Public Health Science (IHCAR), Karolinska Institutet, S-171 77, Stockholm, Sweden
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von Braun A, Sekaggya-Wiltshire C, Scherrer AU, Magambo B, Kambugu A, Fehr J, Castelnuovo B. Early virological failure and HIV drug resistance in Ugandan adults co-infected with tuberculosis. AIDS Res Ther 2017; 14:1. [PMID: 28086929 PMCID: PMC5237283 DOI: 10.1186/s12981-016-0128-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose This cross-sectional study took place in the integrated tuberculosis (TB) clinic of a large outpatient clinic for HIV-infected patients in Kampala, Uganda. The purpose of this study was to describe the proportion of TB/HIV co-infected adults with virological failure, type and frequency of HIV drug resistance-associated mutations, and the proportion of patients with suboptimal efavirenz levels. Methods HIV-1 plasma viral loads, CD4 cell count measurements, and efavirenz serum concentrations were done in TB/HIV co-infected adults. Genotypic resistance testing was performed in case of confirmed virological failure. Results After a median time on ART of 6 months, virological failure was found in 22/152 patients (14.5%). Of 147 participants with available efavirenz serum concentration, 26 (17.6%) had at least one value below the reference range, including 20/21 (95.2%) patients with confirmed virological failure. Genotypic resistance testing was available for 16/22 (72.7%) patients, of which 15 (93.8%) had at least one major mutation, most commonly M184V (81.2%) and K103NS (68.8%). Conclusion We found a high proportion of TB/HIV co-infected patients with virological failure, the majority of which had developed relevant resistance-mutations after a median time on anti-retroviral treatment (ART) of 6 months. Virological monitoring should be prioritized in TB/HIV co-infected patients in resource-limited settings.
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Sullivan BJ, Esmaili BE, Cunningham CK. Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth. Glob Health Action 2017; 10:1290317. [PMID: 28598771 PMCID: PMC5496082 DOI: 10.1080/16549716.2017.1290317] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/30/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood. OBJECTIVE Timely initiation of tuberculosis (TB) treatment is critical to reducing disease transmission and improving patient outcomes. The aim of this paper is to describe patient- and system-level barriers to TB treatment initiation specifically for children and youth in sub-Saharan Africa through systematic review of the literature. DESIGN This review was conducted in October 2015 in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six databases were searched to identify studies where primary or secondary objectives were related to barriers to TB treatment initiation and which included children or youth 0-24 years of age. RESULTS A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children. CONCLUSIONS Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes.
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Affiliation(s)
| | - B. Emily Esmaili
- Duke Global Health Institute
- Department of Science and Society, Duke University, Durham, NC, USA
| | - Coleen K. Cunningham
- Duke Global Health Institute
- School of Medicine, Duke University, Durham, NC, USA
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83
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HIV/AIDS-Related Problems in Low- and Middle-Income Countries. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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84
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Sabiiti W. Beyond the Numbers: Interpreting WHO's Global Tuberculosis Report 2016 to Inform TB Policy and Practice in the East African Community. East Afr Health Res J 2017; 1:2-7. [PMID: 34308153 PMCID: PMC8279170 DOI: 10.24248/eahrj-d-16-00364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/05/2017] [Indexed: 01/05/2023] Open
Abstract
By 2000, 5 East African Community (EAC) member states-Uganda, Kenya, Tanzania, Rwanda, and Burundi-had adopted the World Health Organization's (WHO's) policy of directly observed treatment short-course (DOTS) for tuberculosis (TB). This policy is meant to speed up the control of TB through effective diagnosis and treatment. However, the rate of reduction of TB burden has been slow, and as of 2016, 3 EAC member states-Uganda, Kenya, and Tanzania-are still categorised as high TB burden countries. We analysed WHO's Global Tuberculosis Report 2016 and drew key lessons to inform policy and practice for effective control of TB. From the report, we acknowledge the existence of national TB control policies operationalised through national TB control programmes in all EAC member states. However, we found persistent underfinancing of the TB control programmes; low national coverage of TB diagnostic and treatment services, meaning that many TB cases are most likely going undetected; and deaths due to lack of treatment. We also found poor reporting practices; for example, there was no data on the number of cases detected with rapid diagnostics in Uganda and Tanzania, which was unexpected since there are more than 170 Xpert MTB/RIF machines for rapid diagnosis of TB in the 2 countries. We recommend comprehensive implementation of existing TB policy, including adequate financing, universal access to diagnosis and treatment, and socioeconomic empowerment of affected communities, all of which are critical for ending TB in East Africa and the world at large.
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85
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Samuel B, Volkmann T, Cornelius S, Mukhopadhay S, MejoJose, Mitra K, Kumar AMV, Oeltmann JE, Parija S, Prabhakaran AO, Moonan PK, Chadha VK. Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India. ACTA ACUST UNITED AC 2016; 4:213-219. [PMID: 28042591 PMCID: PMC5201187 DOI: 10.4236/jtr.2016.44023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Poverty and poor nutrition are associated with the risk of developing tuberculosis (TB). Socioeconomic factors may interfere with anti-tuberculosis treatment compliance and its outcome. We examined whether providing nutritional support (monthly supply of rice and lentil beans) to TB patients who live below the poverty line was associated with TB treatment outcome. Methods This was a retrospective cohort study of sputum smear-positive pulmonary TB patients living below the poverty line (income of <$1.25 per day) registered for anti-tuberculosis treatment in two rural districts of West Bengal, India during 2012 to 2013. We compared treatment outcomes among patients who received nutritional support with those who did not. A log-binomial regression model was used to assess the relation between nutritional support and unsuccessful treatment outcome (loss-to-follow-up, treatment failure and death). Results Of 173 TB patients provided nutritional support, 15 (9%) had unsuccessful treatment outcomes, while 84 (21%) of the 400 not provided nutrition support had unsuccessful treatment outcomes (p < 0.001). After adjusting for age, sex and previous treatment, those who received nutritional support had a 50% reduced risk of unsuccessful treatment outcome than those who did not receive nutritional support (Relative Risk: 0.51; 95% Confidence Intervals: 0.30 - 0.86). Conclusion Under programmatic conditions, monthly rations of rice and lentils were associated with lower risk of unsuccessful treatment outcome among impoverished TB patients. Given the relatively small financial commitment needed per patient ($10 per patient per month), the national TB programme should consider scaling up nutritional support among TB patients living below the poverty line.
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Affiliation(s)
| | - Tyson Volkmann
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - MejoJose
- World Vision India, New Delhi, India
| | | | - Ajay M V Kumar
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | | | | | | | | | - Vineet K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
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86
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Wingfield T, Tovar MA, Huff D, Boccia D, Montoya R, Ramos E, Lewis JJ, Gilman RH, Evans CA. The economic effects of supporting tuberculosis-affected households in Peru. Eur Respir J 2016; 48:1396-1410. [PMID: 27660507 PMCID: PMC5091496 DOI: 10.1183/13993003.00066-2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 06/24/2016] [Indexed: 01/24/2023]
Abstract
The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention.The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months.From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22-38%) versus 42% (95% CI 34-51%)). The mitigation impact was higher among poorer households.The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies.
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Affiliation(s)
- Tom Wingfield
- Innovation for Health and Development (IFHAD), Section of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
- The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Marco A Tovar
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
- IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Doug Huff
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Delia Boccia
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
- Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosario Montoya
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
| | - Eric Ramos
- IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James J Lewis
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
- Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlton A Evans
- Innovation for Health and Development (IFHAD), Section of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
- IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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87
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Getahun B, Wubie M, Dejenu G, Manyazewal T. Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis. Infect Dis Poverty 2016; 5:93. [PMID: 27799063 PMCID: PMC5088676 DOI: 10.1186/s40249-016-0187-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients. METHODS A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients' Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables. RESULTS Of the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient's household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684). CONCLUSION Despite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care.
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Affiliation(s)
- Belete Getahun
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Moges Wubie
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu
- Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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88
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Wingfield T, Tovar MA, Huff D, Boccia D, Montoya R, Ramos E, Lewis JJ, Gilman RH, Evans CA. The economic effects of supporting tuberculosis-affected households in Peru. Eur Respir J 2016. [PMID: 27660507 DOI: 10.1183/13993003.00066–2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention.The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months.From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22-38%) versus 42% (95% CI 34-51%)). The mitigation impact was higher among poorer households.The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies.
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Affiliation(s)
- Tom Wingfield
- Innovation for Health and Development (IFHAD), Section of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK .,Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.,The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Marco A Tovar
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.,IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Doug Huff
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.,Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Delia Boccia
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.,Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosario Montoya
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
| | - Eric Ramos
- IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James J Lewis
- Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.,Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlton A Evans
- Innovation for Health and Development (IFHAD), Section of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK.,Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.,IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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89
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Zhou C, Long Q, Chen J, Xiang L, Li Q, Tang S, Huang F, Sun Q, Lucas H, Huan S. The effect of NCMS on catastrophic health expenditure and impoverishment from tuberculosis care in China. Int J Equity Health 2016; 15:172. [PMID: 27756368 PMCID: PMC5069881 DOI: 10.1186/s12939-016-0463-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/12/2016] [Indexed: 12/04/2022] Open
Abstract
Background Health expenditure for tuberculosis (TB) care often pushes households into catastrophe and poverty. New Cooperative Medical Scheme (NCMS) aims to protect households from catastrophic health expenditure (CHE) and impoverishment in rural China. This article assesses the effect of NCMS on relieving CHE and impoverishment from TB care in rural China. Methods Three hundred fourty-seven TB cases are included in the analysis. We analyze the incidence and intensity of CHE and poverty, and assess the protective effect of NCMS by comparing the CHE and impoverishment before and after reimbursement. Results After out-of-pocket (OOP) payment for TB care, 16.1 % of non-poor fall below poverty line. The NCMS reduces the incidence of CHE and impoverishment by 11.5 % and 7.3 %. After reimbursement, 46.7 % of the households still experience CHE and 35.4 % are below the poverty line. The NCMS relieves the mean gap, mean positive gap, poverty gap and normalized positive gap by 44.5 %, 51.0 %, US$115.8 and 31.6 % respectively. Conclusions The NCMS has partial effect on protecting households from CHE and impoverishment from TB care. The limited protection could be enhanced by redesigning benefit coverage to improve the “height” of the NCMS and representing fee-for-service with alternative payment mechanisms. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0463-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chengchao Zhou
- Department of Social Medicine and Health Service Management, School of Public Health, Shandong University, Jinan, China.,Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Shandong University, Jinan, China.,Key Laboratory of Health Economic and Policy Research, NHFPC, Shandong University, Wen-hua-xi Road No. 44, Jinan City, 250012, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Jiaying Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Li
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Fei Huang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Qiang Sun
- Key Laboratory of Health Economic and Policy Research, NHFPC, Shandong University, Wen-hua-xi Road No. 44, Jinan City, 250012, China. .,Center for Health Management and Policy, Shandong University, Jinan, China.
| | - Henry Lucas
- Institute of Development Studies, Sussex University, Brighton, UK
| | - Shitong Huan
- Bill & Melinda Gates Foundation Beijing Office, Beijing, China
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90
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Mburu G, Restoy E, Kibuchi E, Holland P, Harries AD. Detention of People Lost to Follow-Up on TB Treatment in Kenya: The Need for Human Rights-Based Alternatives. Health Hum Rights 2016; 18:43-54. [PMID: 27780998 PMCID: PMC5070679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Adherence to treatment is a key element for global TB control. Public health laws can be used to enforce isolation, adherence, and completion of TB treatment. However, the practical application of public health laws can potentially range from voluntary measures to involuntary detention approaches. This paper explores the potential risks and impacts of using detention approaches to enforce TB treatment adherence. In August 2015, we conducted a literature search regarding the application of public health laws to enforce adherence to TB treatment globally, and specifically in Kenya. Texts were analyzed using narrative synthesis. Results indicated that in Kenya, people lost to follow-up on TB treatment were frequently detained in prisons. However, incarceration and detention approaches curtail the rights to health, informed consent, privacy, freedom from non-consensual treatment, freedom from inhumane and degrading treatment, and freedom of movement of people lost to follow-up. Detention could also worsen social inequalities and lead to a paradoxical increase in TB incidence. We suggest the incorporation of less intrusive solutions in legislation and policies. These include strengthening health systems to reduce dependency on prisons as isolation spaces, decentralizing TB treatment to communities, enhancing treatment education, revising the public health laws, and addressing socioeconomic and structural determinants associated with TB incidence and loss to follow-up.
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Affiliation(s)
- Gitau Mburu
- Senior Advisor for HIV and Health Systems at the International HIV/AIDS Alliance, Brighton, United Kingdom
| | - Enrique Restoy
- Senior Human Rights Advisor at the International HIV/AIDS Alliance, Brighton, United Kingdom
| | - Evaline Kibuchi
- Chief National Coordinator of the Stop TB Partnership, Kenya
| | - Paula Holland
- Lecturer in Public Health in the Division of Health Research at Lancaster University, United Kingdom
| | - Anthony D. Harries
- Senior Advisor and Director of the Department of Research at the International Union Against Tuberculosis and Lung Disease, Paris, France, and an honorary professor at the London School of Hygiene and Tropical Medicine, London, United Kingdom
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91
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Dowdy DW, Houben R, Cohen T, Pai M, Cobelens F, Vassall A, Menzies NA, Gomez GB, Langley I, Squire SB, White R. Impact and cost-effectiveness of current and future tuberculosis diagnostics: the contribution of modelling. Int J Tuberc Lung Dis 2016; 18:1012-8. [PMID: 25189546 PMCID: PMC4436823 DOI: 10.5588/ijtld.13.0851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The landscape of diagnostic testing for tuberculosis (TB) is changing rapidly, and stakeholders need urgent guidance on how to develop, deploy and optimize TB diagnostics in a way that maximizes impact and makes best use of available resources. When decisions must be made with only incomplete or preliminary data available, modelling is a useful tool for providing such guidance. Following a meeting of modelers and other key stakeholders organized by the TB Modelling and Analysis Consortium, we propose a conceptual framework for positioning models of TB diagnostics. We use that framework to describe modelling priorities in four key areas: Xpert® MTB/RIF scale-up, target product profiles for novel assays, drug susceptibility testing to support new drug regimens, and the improvement of future TB diagnostic models. If we are to maximize the impact and cost-effectiveness of TB diagnostics, these modelling priorities should figure prominently as targets for future research.
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Affiliation(s)
- D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R Houben
- Department of Infectious Disease Epidemiology and TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK
| | - T Cohen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - M Pai
- Department of Epidemiology and Biostatistics & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - F Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - A Vassall
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - N A Menzies
- Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, USA
| | - G B Gomez
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - I Langley
- Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S B Squire
- Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R White
- Department of Infectious Disease Epidemiology and TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK
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92
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Shete PB, Haguma P, Miller CR, Ochom E, Ayakaka I, Davis JL, Dowdy DW, Hopewell P, Katamba A, Cattamanchi A. Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda. Int J Tuberc Lung Dis 2016; 19:912-7. [PMID: 26162356 DOI: 10.5588/ijtld.14.0166] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Six district-level government health centers in rural Uganda and the surrounding communities. OBJECTIVE To determine pathways to care and associated costs for patients with chronic cough referred for tuberculosis (TB) evaluation in Uganda. DESIGN We conducted a cross-sectional study, surveying 64 patients presenting with chronic cough and undergoing first-time sputum evaluation at government clinics. We also surveyed a random sample of 114 individuals with chronic cough in surrounding communities. We collected information on previous health visits for the cough as well as costs associated with the current visit. RESULTS Eighty per cent of clinic patients had previously sought care for their cough, with a median of three previous visits (range 0-32, interquartile range [IQR] 2-5). Most (n = 203, 88%) visits were to a health facility that did not provide TB microscopy services, and the majority occurred in the private sector. The cost of seeking care for the current visit alone represented 28.8% (IQR 9.1-109.5) of the patients' median monthly household income. CONCLUSION Most patients seek health care for chronic cough, but do so first in the private sector. Engagement of the private sector and streamlining TB diagnostic evaluation are critical for improving case detection and meeting global TB elimination targets.
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Affiliation(s)
- P B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - P Haguma
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - C R Miller
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - E Ochom
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - I Ayakaka
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J L Davis
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - P Hopewell
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - A Katamba
- Infectious Diseases Research Collaboration, Kampala, Uganda; School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
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93
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Sweeney S, Vassall A, Foster N, Simms V, Ilboudo P, Kimaro G, Mudzengi D, Guinness L. Methodological Issues to Consider When Collecting Data to Estimate Poverty Impact in Economic Evaluations in Low-income and Middle-income Countries. HEALTH ECONOMICS 2016; 25 Suppl 1:42-52. [PMID: 26774106 PMCID: PMC5066802 DOI: 10.1002/hec.3304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/14/2015] [Accepted: 11/11/2015] [Indexed: 05/06/2023]
Abstract
Out-of-pocket spending is increasingly recognized as an important barrier to accessing health care, particularly in low-income and middle-income countries (LMICs) where a large portion of health expenditure comes from out-of-pocket payments. Emerging universal healthcare policies prioritize reduction of poverty impact such as catastrophic and impoverishing healthcare expenditure. Poverty impact is therefore increasingly evaluated alongside and within economic evaluations to estimate the impact of specific health interventions on poverty. However, data collection for these metrics can be challenging in intervention-based contexts in LMICs because of study design and practical limitations. Using a set of case studies, this letter identifies methodological challenges in collecting patient cost data in LMIC contexts. These components are presented in a framework to encourage researchers to consider the implications of differing approaches in data collection and to report their approach in a standardized and transparent way.
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Affiliation(s)
- Sedona Sweeney
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Vassall
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Victoria Simms
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Godfather Kimaro
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Lorna Guinness
- London School of Hygiene & Tropical Medicine, London, UK
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94
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Trajman A, Bastos ML, Belo M, Calaça J, Gaspar J, Dos Santos AM, Dos Santos CM, Brito RT, Wells WA, Cobelens FG, Vassall A, Gomez GB. Shortened first-line TB treatment in Brazil: potential cost savings for patients and health services. BMC Health Serv Res 2016; 16:27. [PMID: 26800677 PMCID: PMC4722708 DOI: 10.1186/s12913-016-1269-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs. We estimated potential savings from a societal perspective in Brazil following the introduction of a hypothetical four-month regimen for tuberculosis treatment. METHODS Data were gathered in ten randomly selected health facilities in Rio de Janeiro. Health service costs were estimated using an ingredient approach. Patient costs were estimated from a questionnaire administered to 126 patients. Costs per visits and per case treated were analysed according to the type of therapy: self-administered treatment (SAT), community- and facility-directly observed treatment (community-DOT, facility-DOT). RESULTS During the last 2 months of treatment, the largest savings could be expected for community-DOT; on average USD 17,351-18,203 and USD 43,660-45,856 (bottom-up and top-down estimates) per clinic. Savings to patients could also be expected as the median (interquartile range) patient-related costs during the two last months were USD 108 (13-291), USD 93 (36-239) and USD 11 (7-126), respectively for SAT, facility-DOT and community-DOT. CONCLUSION Introducing a four-month regimen may result in significant cost savings for both the health service and patients, especially the poorest. In particular, a community-DOT strategy, including treatment at home, could maximise health services savings while limiting patient costs. Our cost estimates are likely to be conservative because a 4-month regimen could hypothetically increase the proportion of patients cured by reducing the number of patients defaulting and we did not include the possible cost benefits from the subsequent prevention of costs due to downstream transmission averted and rapid clinical improvement with less side effects in the last two months.
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Affiliation(s)
- Anete Trajman
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. .,McGill University, Montreal, Canada. .,Tuberculosis Scientific League, Rio de Janeiro, Brazil.
| | - Mayara Lisboa Bastos
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Tuberculosis Scientific League, Rio de Janeiro, Brazil
| | - Marcia Belo
- Tuberculosis Scientific League, Rio de Janeiro, Brazil.,Souza Marques Foundation, Rio de Janeiro, Brazil
| | | | - Júlia Gaspar
- Tuberculosis Scientific League, Rio de Janeiro, Brazil
| | | | | | | | - William A Wells
- Global Alliance for TB Drug Development, New York, USA.,Current address: United States Agency for International Development, Washington, DC, USA
| | - Frank G Cobelens
- Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriela B Gomez
- Amsterdam Institute for Global Health and Development and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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95
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Andrews JR, Basu S, Dowdy DW, Murray MB. The epidemiological advantage of preferential targeting of tuberculosis control at the poor. Int J Tuberc Lung Dis 2016; 19:375-80. [PMID: 25859990 DOI: 10.5588/ijtld.14.0423] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis (TB) remains disproportionately concentrated among the poor, yet known determinants of TB reactivation may fail to explain observed disparities in disease rates according to wealth. Reviewing data on TB disparities in India and the wealth distribution of known TB risk factors, we describe how social mixing patterns could be contributing to TB disparities. Wealth-assortative mixing, whereby individuals are more likely to be in contact with others from similar socio-economic backgrounds, amplifies smaller differences in risk of TB, resulting in large population-level disparities. As disparities and assortativeness increase, TB becomes more difficult to control, an effect that is obscured by looking at population averages of epidemiological parameters, such as case detection rates. We illustrate how TB control efforts may benefit from preferential targeting toward the poor. In India, an equivalent-scale intervention could have a substantially greater impact if targeted at those living below the poverty line than with a population-wide strategy. In addition to potential efficiencies in targeting higher-risk populations, TB control efforts would lead to a greater reduction in secondary TB cases per primary case diagnosed if they were preferentially targeted at the poor. We highlight the need to collect programmatic data on TB disparities and explicitly incorporate equity considerations into TB control plans.
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Affiliation(s)
- J R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - S Basu
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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96
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97
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Ramma L, Cox H, Wilkinson L, Foster N, Cunnama L, Vassall A, Sinanovic E. Patients' costs associated with seeking and accessing treatment for drug-resistant tuberculosis in South Africa. Int J Tuberc Lung Dis 2015; 19:1513-9. [PMID: 26614194 PMCID: PMC6548556 DOI: 10.5588/ijtld.15.0341] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING South Africa is one of the world's 22 high tuberculosis (TB) burden countries, with the second highest number of notified rifampicin-resistant TB (R(R)-TB) and multidrug-resistant TB (MDR-TB) cases. OBJECTIVE To estimate patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB in South Africa. DESIGN Patients diagnosed with R(R)-TB/MDR-TB and accessing care at government health care facilities were surveyed using a structured questionnaire. Direct and indirect costs associated with accessing R(R)-TB/MDR-TB care were estimated at different treatment durations for each patient. RESULTS A total of 134 patients were surveyed: 84 in the intensive phase and 50 in the continuation phase of treatment, 82 in-patients and 52 out-patients. The mean monthly patient costs associated with the diagnosis and treatment of R(R)-TB/MDR-TB were higher during the intensive phase than the continuation phase (US$235 vs. US$188) and among in-patients than among out-patients (US$269 vs. US$122). Patients in the continuation phase and those accessing care as out-patients reported higher out-of-pocket costs than other patients. Most patients did not access social protection for costs associated with R(R)-TB/MDR-TB illness. CONCLUSION Despite free health care, patients bear high costs when accessing diagnosis and treatment services for R(R)-TB/MDR-TB; appropriate social protection mechanisms should be provided to assist them in coping with these costs.
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Affiliation(s)
- L Ramma
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - H Cox
- Division of Medical Microbiology, and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - L Wilkinson
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | - N Foster
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L Cunnama
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - A Vassall
- London School of Hygiene & Tropical Medicine, London, UK
| | - E Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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98
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Mekonnen D, Derbie A, Desalegn E. TB/HIV co-infections and associated factors among patients on directly observed treatment short course in Northeastern Ethiopia: a 4 years retrospective study. BMC Res Notes 2015; 8:666. [PMID: 26559922 PMCID: PMC4642760 DOI: 10.1186/s13104-015-1664-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022] Open
Abstract
Background
Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading independent global causes of death among patients with infectious diseases. Additionally, due to the shared immune defense mechanisms, they are the leading cause of co-morbidities globally. However, little information was found regarding the proportion of TB/HIV co-infection in the study area. Thus, this study determined the proportion and associated factors of TB/HIV co-infection. Methods All TB patients treated from January/2011 to December/2014 were included in this study. Data were collected from three health centers namely; Kobo, Robit and Gobiye. Data were entered, cleared, and analyzed using SPSS version 20. Frequency, percentage, median and range were used to present the data. To assess the associated factors, logistic regression was employed. Results Of the total 990 TB patients enrolled in the study, 98.2 % were screened for HIV; of these, 24.3 % were co-infected with TB and HIV. The odds of having TB/HIV co-infection were 3.4 times higher among in the age group of 25–45 years compared to older (≥45 years) age TB patients (OR = 3.4; 95 % CI 2–5). Moreover, the odds of having TB/HIV co-infection were 2.8 and 1.7 times higher among smear positive and smear negative patients with pulmonary TB respectively than patients with extra pulmonary TB. Of 236 co-infected patients, 71.2 % took co-trimoxazole preventive therapy and 76.3 % took antiretroviral treatment. Conclusion TB/HIV co-infection is one of the serious public health problems in the study area. Thus, Collaborative TB/HIV activities that reduce the co-morbidities and mortalities should be addressed.
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Affiliation(s)
- Daniel Mekonnen
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. .,Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Awoke Derbie
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Endalkachew Desalegn
- Amhara National Regional State Health Bureau, Research and Technology Transfer Core Process, Bahir Dar, Ethiopia.
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99
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Dheda K, Theron G, Welte A. Cost-effectiveness of Xpert MTB/RIF and investing in health care in Africa. LANCET GLOBAL HEALTH 2015; 2:e554-6. [PMID: 25304623 DOI: 10.1016/s2214-109x(14)70305-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Keertan Dheda
- Lung Infection and Immunity Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Grant Theron
- Lung Infection and Immunity Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, Cape Town, South Africa
| | - Alex Welte
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
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100
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Madan J, Lönnroth K, Laokri S, Squire SB. What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India. BMC Health Serv Res 2015; 15:476. [PMID: 26493155 PMCID: PMC4618866 DOI: 10.1186/s12913-015-1138-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/09/2015] [Indexed: 11/15/2022] Open
Abstract
Background Tuberculosis (TB) is a major global public health problem which affects poorest individuals the worst. A high proportion of patients incur ‘catastrophic costs’ which have been shown to result in severe financial hardship and adverse health outcomes. Data on catastrophic cost incidence is not routinely collected, and current definitions of this indicator involve several practical and conceptual barriers to doing so. We analysed data from TB programmes in India (Bangalore), Bangladesh and Tanzania to determine whether dissaving (the sale of assets or uptake of loans) is a useful indicator of financial hardship. Methods Data were obtained from prior studies of TB patient costs in Bangladesh (N = 96), Tanzania (N = 94) and Bangalore (N = 891). These data were analysed using logistic and linear multivariate regression to determine the association between costs (absolute and relative to income) and both the presence of dissaving and the amounts dissaved. Results After adjusting for covariates such as age, sex and rural/urban location, we found a significant positive association between the occurrence of dissaving and total costs incurred in Tanzania and Bangalore. We further found that, for patients in Bangalore an increase in dissaving of $10 USD was associated with an increase in the cost-income ratio of 0.10 (p < 0.001). For low-income patients in Bangladesh, an increase in dissaving of $10 USD was associated with an increase in total costs of $7 USD (p <0.001). Conclusions Dissaving is potentially a convenient proxy for catastrophic costs that does not require usage of complex patient cost questionnaires. It also offers an informative indicator of financial hardship in its own right, and could therefore play an important role as an indicator to monitor and evaluate the impact of financial protection and service delivery interventions in reducing hardship and facilitating universal health coverage. Further research is required to understand the patterns and types of dissaving that have the strongest relationship with financial hardship and clinical outcomes in order to move toward evidence-based policy making.
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Affiliation(s)
- Jason Madan
- Division of Health Sciences, Warwick Medical School, Coventry, UK. .,Collaboration for Applied Health Research and Delivery, Liverpool School of Tropical Medicine and Warwick Medical School, Liverpool and Coventry, UK.
| | - Knut Lönnroth
- Global TB Programme, World Health Organisation, Geneva, Switzerland. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Samia Laokri
- Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA. .,Hoover Fellow of the Belgian American Educational Fund (BAEF), Brussels, Belgium.
| | - Stephen Bertel Squire
- Collaboration for Applied Health Research and Delivery, Liverpool School of Tropical Medicine and Warwick Medical School, Liverpool and Coventry, UK. .,Hoover Fellow of the Belgian American Educational Fund (BAEF), Brussels, Belgium. .,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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