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Lin K, Xiang L. Factors Associated with Non-Adherence to Treatment Among Migrants with MDR-TB in Wuhan, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:727-737. [PMID: 38559871 PMCID: PMC10981374 DOI: 10.2147/rmhp.s448706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Multidrug resistant tuberculosis (MDR-TB) has attracted increasing attention in achieving the global goal of tuberculosis (TB) control. China has the second largest TB burden worldwide and has been experiencing large-scale domestic migration. This study aims to explore the effect of migrants on non-adherence to MDR-TB treatment. Materials and Methods A cross-sectional study was carried out in Wuhan, China. The exposure cases were migrants who were not locally registered in the residence registration system. The control cases were local residents. Non-adherence cases were patients who were lost follow-up or refused treatment. Chi-square and t-test were used to compare variables between migrants and local residents. Logistic regression models using enter method were used to determine the relationship between migration and non-adherence to treatment. Moderation and medication effects on the association between migrant status and non-adherence were also explored. Results We studied 73 migrants and 219 local residents. The migrants, who did not to adhere to treatment (55, 75.3%), was far higher than that of local residents (89, 40.6%). Migrants with MDR-TB had 10.38-times higher difficulty in adhering to treatment (adjusted OR = 10.38, 95% CI 4.62-25.28) than local residents. This additional likelihood was moderated by age and treatment registration group. Migration had an indirect association with non-adherence to treatment via social medial insurance (adjusted OR = 1.05, 95% CI 1.01-1.13). Conclusion There a significant increased likelihood of non-adherence to treatment among migrants with MDR-TB, highlighting the importance of improving treatment adherence in this population. Migration prevented migrants from gaining access to social medical insurance and indirectly reduced their likelihood of adherence to treatment.
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Affiliation(s)
- Kunhe Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Li Xiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- HUST Base of National Institute of Healthcare Security, Wuhan, People’s Republic of China
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Emery JC, Dodd PJ, Banu S, Frascella B, Garden FL, Horton KC, Hossain S, Law I, van Leth F, Marks GB, Nguyen HB, Nguyen HV, Onozaki I, Quelapio MID, Richards AS, Shaikh N, Tiemersma EW, White RG, Zaman K, Cobelens F, Houben RMGJ. Estimating the contribution of subclinical tuberculosis disease to transmission: An individual patient data analysis from prevalence surveys. eLife 2023; 12:e82469. [PMID: 38109277 PMCID: PMC10727500 DOI: 10.7554/elife.82469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2023] [Indexed: 12/20/2023] Open
Abstract
Background Individuals with bacteriologically confirmed pulmonary tuberculosis (TB) disease who do not report symptoms (subclinical TB) represent around half of all prevalent cases of TB, yet their contribution to Mycobacterium tuberculosis (Mtb) transmission is unknown, especially compared to individuals who report symptoms at the time of diagnosis (clinical TB). Relative infectiousness can be approximated by cumulative infections in household contacts, but such data are rare. Methods We reviewed the literature to identify studies where surveys of Mtb infection were linked to population surveys of TB disease. We collated individual-level data on representative populations for analysis and used literature on the relative durations of subclinical and clinical TB to estimate relative infectiousness through a cumulative hazard model, accounting for sputum-smear status. Relative prevalence of subclinical and clinical disease in high-burden settings was used to estimate the contribution of subclinical TB to global Mtb transmission. Results We collated data on 414 index cases and 789 household contacts from three prevalence surveys (Bangladesh, the Philippines, and Viet Nam) and one case-finding trial in Viet Nam. The odds ratio for infection in a household with a clinical versus subclinical index case (irrespective of sputum smear status) was 1.2 (0.6-2.3, 95% confidence interval). Adjusting for duration of disease, we found a per-unit-time infectiousness of subclinical TB relative to clinical TB of 1.93 (0.62-6.18, 95% prediction interval [PrI]). Fourteen countries across Asia and Africa provided data on relative prevalence of subclinical and clinical TB, suggesting an estimated 68% (27-92%, 95% PrI) of global transmission is from subclinical TB. Conclusions Our results suggest that subclinical TB contributes substantially to transmission and needs to be diagnosed and treated for effective progress towards TB elimination. Funding JCE, KCH, ASR, NS, and RH have received funding from the European Research Council (ERC) under the Horizon 2020 research and innovation programme (ERC Starting Grant No. 757699) KCH is also supported by UK FCDO (Leaving no-one behind: transforming gendered pathways to health for TB). This research has been partially funded by UK aid from the UK government (to KCH); however, the views expressed do not necessarily reflect the UK government's official policies. PJD was supported by a fellowship from the UK Medical Research Council (MR/P022081/1); this UK-funded award is part of the EDCTP2 programme supported by the European Union. RGW is funded by the Wellcome Trust (218261/Z/19/Z), NIH (1R01AI147321-01), EDTCP (RIA208D-2505B), UK MRC (CCF17-7779 via SET Bloomsbury), ESRC (ES/P008011/1), BMGF (OPP1084276, OPP1135288 and INV-001754), and the WHO (2020/985800-0).
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Affiliation(s)
- Jon C Emery
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Peter J Dodd
- School of Health and Related Research, University of SheffieldSheffieldUnited Kingdom
| | - Sayera Banu
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | | | - Frances L Garden
- South West Sydney Clinical Campuses, University of New South WalesSydneyAustralia
- Ingham Institute of Applied Medical ResearchSydneyAustralia
| | - Katherine C Horton
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Shahed Hossain
- James P. Grant School of Public Health, BRAC UniversityDhakaBangladesh
| | - Irwin Law
- Global Tuberculosis Programme, World Health OrganizationGenevaSwitzerland
| | - Frank van Leth
- Department of Health Sciences, VU UniversityAmsterdamNetherlands
- Amsterdam Public Health Research InstituteAmsterdamNetherlands
| | - Guy B Marks
- South West Sydney Clinical Campuses, University of New South WalesSydneyAustralia
- Woolcock Institute of Medical ResearchSydneyAustralia
| | - Hoa Binh Nguyen
- National Lung Hospital, National Tuberculosis Control ProgramHa NoiViet Nam
| | - Hai Viet Nguyen
- National Lung Hospital, National Tuberculosis Control ProgramHa NoiViet Nam
| | - Ikushi Onozaki
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis AssociationTokyoJapan
| | | | - Alexandra S Richards
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Nabila Shaikh
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Sanofi PasteurReadingUnited Kingdom
| | | | - Richard G White
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, University of AmsterdamAmsterdamNetherlands
| | - Rein MGJ Houben
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
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Odonkor SNNT, Koranteng F, Appiah-Danquah M, Dini L. Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001286. [PMID: 37556426 PMCID: PMC10411819 DOI: 10.1371/journal.pgph.0001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
To facilitate the drive towards Universal Health Coverage (UHC) several countries in West Africa have adopted National Health Insurance (NHI) schemes to finance health services. However, safeguarding insured populations against catastrophic health expenditure (CHE) and impoverishment due to health spending still remains a challenge. This study aims to describe the extent of financial risk protection among households enrolled under NHI schemes in West Africa and summarize potential learnings. We conducted a systematic review following the PRISMA guidelines. We searched for observational studies published in English between 2005 and 2022 on the following databases: PubMed/Medline, Web of Science, CINAHL, Embase and Google Scholar. We assessed the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two independent reviewers assessed the studies for inclusion, extracted data and conducted quality assessment. We presented our findings as thematic synthesis for qualitative data and Synthesis Without Meta-analysis (SWiM) for quantitative data. We published the study protocol in PROSPERO with ID CRD42022338574. Nine articles were eligible for inclusion, comprising eight cross-sectional studies and one retrospective cohort study published between 2011 and 2021 in Ghana (n = 8) and Nigeria (n = 1). While two-thirds of the studies reported a positive (protective) effect of NHI enrollment on CHE at different thresholds, almost all of the studies (n = 8) reported some proportion of insured households still encountered CHE with one-third reporting more than 50% incurring CHE. Although insured households seemed better protected against CHE and impoverishment compared to uninsured households, gaps in the current NHI design contributed to financial burden among insured populations. To enhance financial risk protection among insured households and advance the drive towards UHC, West African governments should consider investing more in NHI research, implementing nationwide compulsory NHI programmes and establishing multinational subregional collaborations to co-design sustainable context-specific NHI systems based on solidarity, equity and fair financial contribution.
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Affiliation(s)
- Sydney N. N. T. Odonkor
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Appiah-Danquah
- Department of Surgery, NES Healthcare, Parkside Hospital, London, Wimbledon, United Kingdom
| | - Lorena Dini
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Zhao R, Miao W, Li B. The Relation Between Trace Elements and Latent Tuberculosis Infection: a Study Based on National Health and Nutritional Examination Survey 2011-2012. Biol Trace Elem Res 2023; 201:1080-1089. [PMID: 35482174 DOI: 10.1007/s12011-022-03240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/05/2022] [Indexed: 02/07/2023]
Abstract
This study aimed to analyze the potential association between trace elements and latent tuberculosis infection (LTBI) based on the data from the National Health and Nutritional Examination Survey (NHANES) during 2011-2012. In this cross-sectional study, tuberculin skin testing (TST) and QuantiFERON®-TB Gold In-Tube (QFT-GIT) were utilized to screen for LTBI. Participants with positive results of TST or/and QFT-GIT were defined as LTBI. Weighted univariate and multivariate logistic regression analyses were used to explore the association between trace elements and LTBI. Subgroup analyses were conducted according to gender, age, birthplace, race, and health insurance holding status. A total of 6064 participants were included in this study, of whom 655 (10.80%) participants were with positive results of LTBI. Weighted multivariable analysis demonstrated that zinc [odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.82-0.97] and selenium (OR = 0.31; 95%CI, 0.13-0.70) in the serum may be associated with a reduced risk of LTBI. In different concentrations of zinc and selenium, serum zinc concentration of 12.56-13.99 μmol/l (vs. < 11.23 μmol/l; OR = 0.37, 95% CI, 0.20-0.67) was related to a reduced risk of LTBI, while no significant difference was observed under different selenium levels (P > 0.05). Subgroup analyses indicated that the role of zinc and selenium in reducing TB risk may be more significant in males, people aged 21-64, people born in the USA, people with health insurance, and non-Hispanic Whites. Maintaining serum zinc and selenium levels may help reduce the risk of LTBI and indirectly help people prevent TB.
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Affiliation(s)
- Rui Zhao
- Department of Respiratory and Critical Care Medicine, Chifeng Municipal Hospital, Chifeng, 024000, People's Republic of China
| | - Wei Miao
- Department of Endocrinology, Chifeng Municipal Hospital, Chifeng, 024000, People's Republic of China
| | - Baohua Li
- Department of Infectious Disease, Dingxi People's Hospital, No. 22 Anding Road, Dingxi, 743000, People's Republic of China.
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Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Razzaq S, Zahidie A, Fatmi Z. Estimating the pre- and post-diagnosis costs of tuberculosis for adults in Pakistan: household economic impact and costs mitigating strategies. Glob Health Res Policy 2022; 7:22. [PMID: 35858877 PMCID: PMC9301862 DOI: 10.1186/s41256-022-00259-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan. METHODS We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The costs were estimated during pre-diagnostic and post-diagnostic phase which includes diagnostic, treatment, and hospitalization phases. A descriptive analysis including mean and standard deviation (± SD), median and interquartile range (IQR), and frequencies and proportions (%) was employed. RESULTS Out of 516 TB patients, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient during the pre-diagnostic, diagnostic, treatment and hospitalization periods were estimated at USD63.8/ PKR7,377, USD24/ PKR2,755, USD10.5/ PKR1,217, and USD349.0/ PKR40,300, respectively. The total household median cost was estimated at USD129.2/ PKR14,919 per patient. The median indirect cost was estimated at USD52.0/ PKR5,950 per patient. Of total, 54.1% of patients preferred and consulted private providers in the first place at the onset of symptoms, while, 36% attended public healthcare services, 5% and 4.1% went to dispensary and pharmacy, respectively, as a first point of care. CONCLUSIONS TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB programs. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan towards reducing the burden.
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Affiliation(s)
- Shama Razzaq
- Health Services Academy, Opposite National Institute of Health (NIH), Islamabad, Pakistan
| | - Aysha Zahidie
- Aga Khan University, Community Health Sciences Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zafar Fatmi
- Aga Khan University, Community Health Sciences Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
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