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Kim HW, Min J, Ko Y, Oh JY, Jeong YJ, Lee EH, Yang B, Koo HK, Lee SS, Park JS, Park KJ, Chang JH, Joh J, Lee MK, Kim JS. Risk of loss to follow-up among tuberculosis patients in South Korea: whom should we focus on? Front Public Health 2023; 11:1247772. [PMID: 37927864 PMCID: PMC10622659 DOI: 10.3389/fpubh.2023.1247772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction In South Korea, public-private mix (PPM) has been a key strategy in national tuberculosis (TB) control program. This study aimed to identify rate of loss to follow-up (LTFU) among TB patients in nationwide PPM institutions and their risk factors. Methods A nationwide prospective observational study including drug susceptible TB patients diagnosed from the 1st day to the 10th day of every month between July 2018 and December 2020 in PPM institutions was designed. Multivariable survival models in which death and failure were designated as events with competing risk were used to investigate risk factors for LTFU. Results A total of 14,942 patients were included. Of them, 356 (2.4%) had an LTFU. Risk factors for LTFU were: underweight patients (adjusted hazard ratio (aHR): 1.47, 95% CI: 1.12-1.92), patients living alone (aHR: 1.43, 95% CI: 1.16-1.76), heavy drinkers (aHR: 1.67, 95% CI: 1.16-2.39), those with malignancy (aHR: 1.49, 95% CI: 1.07-2.05), foreigners (aHR: 5.96, 95% CI: 4.51-7.89), and those with previous TB history reported as an unfavorable outcome (aHR: 4.43, 95% CI: 2.77-7.08). Effect of age on LTFU was not significant. Brief interruption of anti-TB treatment (less than two months) in current session was associated with subsequent LTFU [adjusted odds ratio: 13.09 (10.29-16.66)]. Conclusion Identifying vulnerability of patients such as living alone, being heavy alcoholics, being foreigners or having previous TB history reported as an unfavorable outcome is required. Thorough case management for these vulnerable groups could be feasible with collaboration between public and private sectors.
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Affiliation(s)
- Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun-Jeong Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Eun Hye Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kwang Joo Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Joonsung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Marley G, Zou X, Nie J, Cheng W, Xie Y, Liao H, Wang Y, Tao Y, Tucker JD, Sylvia S, Chou R, Wu D, Ong J, Tang W. Improving cascade outcomes for active TB: A global systematic review and meta-analysis of TB interventions. PLoS Med 2023; 20:e1004091. [PMID: 36595536 PMCID: PMC9847969 DOI: 10.1371/journal.pmed.1004091] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/18/2023] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To inform policy and implementation that can enhance prevention and improve tuberculosis (TB) care cascade outcomes, this review aimed to summarize the impact of various interventions on care cascade outcomes for active TB. METHODS AND FINDINGS In this systematic review and meta-analysis, we retrieved English articles with comparator arms (like randomized controlled trials (RCTs) and before and after intervention studies) that evaluated TB interventions published from January 1970 to September 30, 2022, from Embase, CINAHL, PubMed, and the Cochrane library. Commentaries, qualitative studies, conference abstracts, studies without standard of care comparator arms, and studies that did not report quantitative results for TB care cascade outcomes were excluded. Data from studies with similar comparator arms were pooled in a random effects model, and outcomes were reported as odds ratio (OR) with 95% confidence interval (CI) and number of studies (k). The quality of evidence was appraised using GRADE, and the study was registered on PROSPERO (CRD42018103331). Of 21,548 deduplicated studies, 144 eligible studies were included. Of 144 studies, 128 were from low/middle-income countries, 84 were RCTs, and 25 integrated TB and HIV care. Counselling and education was significantly associated with testing (OR = 8.82, 95% CI:1.71 to 45.43; I2 = 99.9%, k = 7), diagnosis (OR = 1.44, 95% CI:1.08 to 1.92; I2 = 97.6%, k = 9), linkage to care (OR = 3.10, 95% CI = 1.97 to 4.86; I2 = 0%, k = 1), cure (OR = 2.08, 95% CI:1.11 to 3.88; I2 = 76.7%, k = 4), treatment completion (OR = 1.48, 95% CI: 1.07 to 2.03; I2 = 73.1%, k = 8), and treatment success (OR = 3.24, 95% CI: 1.88 to 5.55; I2 = 75.9%, k = 5) outcomes compared to standard-of-care. Incentives, multisector collaborations, and community-based interventions were associated with at least three TB care cascade outcomes; digital interventions and mixed interventions were associated with an increased likelihood of two cascade outcomes each. These findings remained salient when studies were limited to RCTs only. Also, our study does not cover the entire care cascade as we did not measure gaps in pre-testing, pretreatment, and post-treatment outcomes (like loss to follow-up and TB recurrence). CONCLUSIONS Among TB interventions, education and counseling, incentives, community-based interventions, and mixed interventions were associated with multiple active TB care cascade outcomes. However, cost-effectiveness and local-setting contexts should be considered when choosing such strategies due to their high heterogeneity.
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Affiliation(s)
- Gifty Marley
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Xia Zou
- Global Health Research Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Juan Nie
- Department of Research and Education, Guangzhou Concord Cancer Center, Guangzhou, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Yewei Xie
- University of North Carolina Project-China, Guangzhou, China
| | - Huipeng Liao
- University of North Carolina Project-China, Guangzhou, China
| | - Yehua Wang
- University of North Carolina Project-China, Guangzhou, China
| | - Yusha Tao
- University of North Carolina Project-China, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Health and Tropical Medicine, London, United Kingdom
| | - Sean Sylvia
- University of North Carolina Project-China, Guangzhou, China
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Roger Chou
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Health and Tropical Medicine, London, United Kingdom
| | - Jason Ong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- * E-mail:
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Kim HW, Park S, Min J, Sun J, Shin AY, Ha JH, Park JS, Lee SS, Lipman M, Abubakar I, Stagg HR, Kim JS. Hidden loss to follow-up among tuberculosis patients managed by public-private mix institutions in South Korea. Sci Rep 2022; 12:12362. [PMID: 35859107 PMCID: PMC9300674 DOI: 10.1038/s41598-022-16441-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
In South Korea, public-private mix (PPM) was launched in 2011. This retrospective cohort study sought to determine the rate of loss to follow-up (LTFU) among drug-susceptible tuberculosis (DS-TB) patients in all nationwide PPM institutions, and the risk factors for LTFU. National notification data for DS-TB patients diagnosed between August 2011 and July 2014 in PPM institutions were analysed. Determination of LTFU included detection of instances where patients were transferred out, but when they did not attend at other TB centres in the following two months. Univariable and multivariable competing risk models were used to determine risk factors for LTFU. 73,046 patients with 78,485 records were enrolled. Nominally, 3426 (4.4%) of records were LTFU. However, after linking the multiple records in each patient, the percentage of LTFU was 12.3% (9004/73,046). Risk factors for LTFU were: being foreign-born (3.13 (95% CI 2.77-3.53)), prior LTFU (2.31 (2.06-2.59)) and greater distance between the patient's home and the TB centre (4.27 (4.03-4.53)). 'Transfer-out' was a risk factor in patients managed by treatment centres close to home (1.65 (1.49-1.83)), but protective for those attending centres further (0.77 (0.66-0.89)) or far-away (0.52 (0.46-0.59)) from home. By considering the complete picture of a patient's interactions with healthcare, we identified a much higher level of LTFU than previously documented. This has implications for how outcomes of treatment are reported and argues for a joined-up national approach for the management and surveillance of TB patients, in nations with similar healthcare systems.
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Affiliation(s)
- Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiyu Sun
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ah Young Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jick Hwan Ha
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Marc Lipman
- UCL-TB, University College London, London, UK
- Division of Medicine, UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Helen R Stagg
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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The positive externalities of migrant-based TB control strategy in a Chinese urban population with internal migration: a transmission-dynamic modeling study. BMC Med 2021; 19:95. [PMID: 33874940 PMCID: PMC8055441 DOI: 10.1186/s12916-021-01968-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large-scale rural-to-urban migration has changed the epidemiology of tuberculosis (TB) in large Chinese cities. We estimated the contribution of TB importation, reactivation of latent infection, and local transmission to new TB cases in Shanghai, and compared the potential impact of intervention options. METHODS We developed a transmission dynamic model of TB for Songjiang District, Shanghai, which has experienced high migration over the past 25 years. We calibrated the model to local demographic data, TB notifications, and molecular epidemiologic studies. We estimated epidemiological drivers as well as future outcomes of current TB policies and compared this base-case scenario with scenarios describing additional targeted interventions focusing on migrants or vulnerable residents. RESULTS The model captured key demographic and epidemiological features of TB among migrant and resident populations in Songjiang District, Shanghai. Between 2020 and 2035, we estimate that over 60% of TB cases will occur among migrants and that approximately 43% of these cases will result from recent infection. While TB incidence will decline under current policies, we estimate that additional interventions-including active screening and preventive treatment for migrants-could reduce TB incidence by an additional 20% by 2035. CONCLUSIONS Migrant-focused TB interventions could produce meaningful health benefits for migrants, as well as for young residents who receive indirect protection as a result of reduced TB transmission in Shanghai. Further studies to measure cost-effectiveness are needed to evaluate the feasibility of these interventions in Shanghai and similar urban centers experiencing high migration volumes.
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Odayar J, Myer L. Transfer of primary care patients receiving chronic care: the next step in the continuum of care. Int Health 2020; 11:432-439. [PMID: 31081907 DOI: 10.1093/inthealth/ihz014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/11/2019] [Indexed: 12/26/2022] Open
Abstract
The burden of chronic conditions is increasing rapidly in low- and middle-income countries. Chronic conditions require long-term and continuous care, including for patients transferring between facilities. Patient transfer is particularly important in the context of health service decentralization, which has led to increasing numbers of primary care facilities at which patients can access care, and high levels of migration, which suggest that patients might require care at multiple facilities. This article provides a critical review of existing evidence regarding transfer of stable patients receiving primary care for chronic conditions. Patient transfer has received limited consideration in people living with HIV, with growing concern that patients who transfer are at risk of poor outcomes; this appears similar for people with TB, although studies are few. There are minimal data on transfer of patients with non-communicable diseases, including diabetes. Patient transfer for chronic conditions has thus received surprisingly little attention from researchers; considering the potential risks, more research is urgently required regarding reasons for and outcomes of transfers, transfer processes and interventions to optimize transfers, for different chronic conditions. Ultimately, it is the responsibility of health systems to facilitate successful transfers, and this issue requires increased attention from researchers and policy-makers.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Zhou Y, Chen C, Jiang H, Pan HQ, Zhu LM, Lu W. High admission rates and heavy inpatient service costs of urban tuberculosis patients in eastern China. BMC Health Serv Res 2019; 19:47. [PMID: 30658635 PMCID: PMC6339337 DOI: 10.1186/s12913-019-3892-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis patients often experience hospitalization. Inpatient services may result in high medical expenditures. It is important to explore the hospitalization rates of tuberculosis patients and the potential factors that are associated with admission rates and inpatient service expenditures. METHODS Data from patients diagnosed and treated at the No.3 hospital of Zhenjiang City from Apr. 2014 to Mar. 2015 were obtained. Univariate and multivariate statistical analyses were applied for the analysis of potential factors associated with admission rates, average length of stay and cost. RESULTS A total of 356 tuberculosis patients were treated at the No.3 hospital of Zhenjiang City. A total of 221 of the 356 patients were hospitalized. Sputum smear test results and type of health insurance were the potential factors associated with hospitalization rates. The average admission was (1.26 ± 0.64) per patient. The average length of stay of inpatients was 29.99 ± 25.83 days. Age, occupation, and sputum smear test were related to the average length of stay. The average total cost to inpatients was 13007.91 ± 5205.58 CNY. The sputum smear test results, type of health insurance, occupation and age were the main potential factors associated with TB inpatient expenditures. CONCLUSIONS The admission rate of tuberculosis patients was high. Despite advances in TB insurance policies, there were substantial costs associated with TB diagnosis and treatment. TB patients still face a heavy financial burden. Health care providers should revise the service package and reform the health insurance regulations to ensure that TB patients receive appropriate care.
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Affiliation(s)
- Yang Zhou
- Department of Chronic Disease Control and Prevention, Centers for Disease Control and Prevention of Jiangsu Province, 172 Jiangsu Road, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Cheng Chen
- Department of Chronic Disease Control and Prevention, Centers for Disease Control and Prevention of Jiangsu Province, 172 Jiangsu Road, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Hui Jiang
- Centers for Disease Control and Prevention of Zhenjiang City, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Hong-Qiu Pan
- No.3 Hospital of Zhenjiang City, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Li-Mei Zhu
- Department of Chronic Disease Control and Prevention, Centers for Disease Control and Prevention of Jiangsu Province, 172 Jiangsu Road, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Wei Lu
- Department of Chronic Disease Control and Prevention, Centers for Disease Control and Prevention of Jiangsu Province, 172 Jiangsu Road, Nanjing, 210009, Jiangsu Province, People's Republic of China.
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Zhu M, Han G, Takiff HE, Wang J, Ma J, Zhang M, Liu S. Times series analysis of age-specific tuberculosis at a rapid developing region in China, 2011-2016. Sci Rep 2018; 8:8727. [PMID: 29880836 PMCID: PMC5992177 DOI: 10.1038/s41598-018-27024-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/21/2018] [Indexed: 12/23/2022] Open
Abstract
The city of Shenzhen has recently experienced extraordinary economic growth accompanied by a huge internal migrant influx. We investigated the local dynamics of tuberculosis (TB) epidemiology in the Nanshan District of Shenzhen to provide insights for TB control strategies for this district and other rapidly developing regions in China. We analyzed the age-specific incidence and number of TB cases in the Nanshan District from 2011 to 2016. Over all, the age-standardized incidence of TB decreased at an annual rate of 3.4%. The incidence was lowest amongst the age group 0-14 and showed no increase in this group over the six-year period (P = 0.587). The fastest decreasing incidence was among the 15-24 age group, with a yearly decrease of 13.3% (β = 0.867, P < 0.001). In contrast, the TB incidence increased in the age groups 45-54, 55-54, and especially in those aged ≥65, whose yearly increase was 13.1% (β = 1.131, P < 0.001). The peak time of TB case presentation was in April, May, and June for all age groups, except in August for the 45-54 cohort. In the rapidly developing Nanshan District, TB control policies targeted to those aged 45 years and older should be considered. The presentation of TB cases appears to peak in the spring months.
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Affiliation(s)
- Minmin Zhu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China.
| | - Guiyuan Han
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - Howard Eugene Takiff
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China.,Institut Pasteur, Unité de Génétique Mycobacterienne, Paris, 75015, France.,Instituto Venezolano de Investigaciones Cientificas, Caracas, Venezuela
| | - Jian Wang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - Jianping Ma
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - Min Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - Shengyuan Liu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China.
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Chen S, Zhang H, Pan Y, Long Q, Xiang L, Yao L, Lucas H. Are free anti-tuberculosis drugs enough? An empirical study from three cities in China. Infect Dis Poverty 2015; 4:47. [PMID: 26510711 PMCID: PMC4625923 DOI: 10.1186/s40249-015-0080-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/10/2015] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis (TB) patients in China still face a number of barriers in seeking diagnosis and treatment. There is evidence that the economic burden on TB patients and their households discourages treatment compliance. Methods A cross-sectional study was conducted in three cities of China. Patients were selected using probability proportional to size (PPS) cluster sampling of rural townships or urban streets, followed by list sampling from a patient register. Data were collected using a questionnaire survey, key informant interviews and focus group discussions with TB patients to gain an understanding of the economic burden of TB and implications of this burden for treatment compliance. Results A total of 797 TB patients were surveyed, of which 60 were interviewed in-depth following the survey. More than half had catastrophic health expenditure. TB patients with higher household incomes were less likely to report non-compliance (OR 0.355, 95 % CI 0.140–0.830) and patients who felt that the economic burden relating to TB treatment was high more likely to report non-compliance (OR 3.650, 95 % CI 1.278–12.346). Those who had high costs for transportation, lodging and food were also more likely to report non-compliance (OR 4.150, 95 % CI 1.804–21.999). The findings from the qualitative studies supported those from the survey. Conclusion The economic burden associated with seeking diagnosis and treatment remains a barrier for TB patients in China. Reducing the cost of treatment and giving patients subsidies for transportation, lodging and food is likely to improve treatment compliance. Improving doctors’ salary system to cut off the revenue-oriented incentive, and expanding current insurance’s coverage can be helpful to reduce patients’ actual burden or anticipated burden. Future research on this issue is needed. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0080-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shanquan Chen
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Hui Zhang
- National Center for TB Control and Prevention, China CDC, Beijing, PR China. .,Chinese Center for Disease Control and Prevention, Beijing, PR China.
| | - Yao Pan
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Qian Long
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Global Health Research Center, Duke Kunshan University, Kunshan, China.
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
| | - Lan Yao
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
| | - Henry Lucas
- Institute of Development Studies, Sussex University, Brighton, UK.
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Li X, Li T, Tan S. Males, ages ≥ 45 years, businessperson, floating population, and rural residents may be considered high-risk groups for tuberculosis infection in Guangzhou, China: a review of 136,394 tb confirmed cases. Rev Inst Med Trop Sao Paulo 2014; 55:366-8. [PMID: 24037294 PMCID: PMC4105077 DOI: 10.1590/s0036-46652013000500013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Xueqiu Li
- Guangzhou Chest Hospital, Guangdong Province, China,
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