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Mohan M, Thangaraj JWV, Pandey S, Sri Lakshmi Priya G, Arunachalam S, Sharma R, Shewade HD, Aishwarya B, Afeeq K, Khatoon A, Gokulvijay B, Sireesha G, Chandra K, Nandhakumar S, Samuel P, Nanditha Viswanathan C, Shanmugasundaram D, Rao R, Murhekar MV, Jeyashree K. Need for operational simplicity and timely disbursal of benefits-a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India. Infect Dis Poverty 2024; 13:36. [PMID: 38783334 PMCID: PMC11112885 DOI: 10.1186/s40249-024-01206-3] [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: 02/16/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme. METHODS We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation. RESULTS Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization. CONCLUSION The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably.
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Affiliation(s)
- Malu Mohan
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Jeromie W V Thangaraj
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumit Pandey
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - G Sri Lakshmi Priya
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | | | - Rahul Sharma
- TB Support Network, WHO Country Office for India, New Delhi, India
| | - Hemant Deepak Shewade
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - B Aishwarya
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - K Afeeq
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Afsana Khatoon
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - B Gokulvijay
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Gude Sireesha
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Kavita Chandra
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - S Nandhakumar
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Prince Samuel
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - C Nanditha Viswanathan
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Devika Shanmugasundaram
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Raghuram Rao
- Central Tuberculosis Division, Government of India, New Delhi, India
| | - Manoj V Murhekar
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Kathiresan Jeyashree
- Indian Council of Medical Research-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India.
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Noia Maciel EL, Negri LDSA, Guidoni LM, Fregona GC, Johansen FDC, Sanchez MN, Moreira ADSR, Diaz-Quijano FA, Tonini M, Zandonade E, Ershova J, Nguhiu P, Baena IG. The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021. PLoS One 2023; 18:e0287961. [PMID: 38091306 PMCID: PMC10718450 DOI: 10.1371/journal.pone.0287961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/19/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. METHODS A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. RESULTS We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). CONCLUSIONS Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maiko Tonini
- University of Brasília, UNB, Brasília, DF, Brazil
| | | | - Julia Ershova
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Peter Nguhiu
- KEMRI- Wellcome Trust Research Program, Health Economics Research Unit, Nairobi, Kenya
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Forse R, Nguyen TT, Dam T, Vo LNQ, Codlin AJ, Caws M, Minh HDT, Nguyen LH, Nguyen HB, Nguyen NV, Lönnroth K, Annerstedt KS. A qualitative assessment on the acceptability of providing cash transfers and social health insurance for tuberculosis-affected families in Ho Chi Minh City, Vietnam. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002439. [PMID: 38055709 DOI: 10.1371/journal.pgph.0002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/09/2023] [Indexed: 12/08/2023]
Abstract
To achieve the Sustainable Development Goal's targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general population has enrolled in its social health insurance (SHI) scheme. However, an estimated 63% of tuberculosis (TB)-affected households in Vietnam still face catastrophic costs and little is known about the optimal strategies to mitigate the costs of TB care for vulnerable families. This study assessed the acceptability of a social protection package containing cash transfers and SHI using individual interviews (n = 19) and focus group discussions (n = 3 groups). Interviews were analyzed through framework analysis. The study's main finding indicated that both conditional and unconditional cash transfers paired with SHI were acceptable, across six dimensions of acceptability. Cash transfers were considered beneficial for mitigating out-of-pocket expenditure, increasing TB treatment adherence, and improving mental health and general well-being, but the value provided was inadequate to fully alleviate the economic burden of the illness. The conditionality of the cash transfers was not viewed by participants as inappropriate, but it increased the workload of the TB program, which brought into question the feasibility of scale-up. SHI was viewed as a necessity by almost all participants, but people with TB questioned the quality of care received when utilizing it for auxiliary TB services. Access to multiple sources of social protection was deemed necessary to fully offset the costs of TB care. Additional research is needed to assess the impact of cash transfer interventions on health and economic outcomes in order to create an enabling policy environment for scale-up.
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Affiliation(s)
- Rachel Forse
- Friends for International TB Relief, Hanoi, Vietnam
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | | | - Thu Dam
- Friends for International TB Relief, Hanoi, Vietnam
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Hanoi, Vietnam
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | - Andrew James Codlin
- Friends for International TB Relief, Hanoi, Vietnam
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Hoa Binh Nguyen
- National Lung Hospital/National TB Control Programme, Hanoi, Vietnam
| | - Nhung Viet Nguyen
- National Lung Hospital/National TB Control Programme, Hanoi, Vietnam
- University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
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Sillah AK, Devoid I, Ndenkeh JJ, Moonga G, Loum I, Touray A, Owolabi O, Sutherland J, Rachow A, Ivanova O, Evans D, Kampmann B. Socio-economic burden of TB and its impact on child contacts in The Gambia. Public Health Action 2023; 13:130-135. [PMID: 38077726 PMCID: PMC10703137 DOI: 10.5588/pha.23.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/17/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. METHODS This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. RESULTS While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001). CONCLUSION Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.
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Affiliation(s)
- A K Sillah
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - I Devoid
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - J J Ndenkeh
- Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - G Moonga
- Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - I Loum
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - A Touray
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - O Owolabi
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - J Sutherland
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B Kampmann
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Charité Centre for Global Health, Charité Universitatsmedizin-Berlin, Berlin, Germany
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5
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Ferreira MRL, Bonfim RO, Bossonario PA, Maurin VP, Valença ABM, Abreu PDD, Andrade RLDP, Fronteira I, Monroe AA. Social protection as a right of people affected by tuberculosis: a scoping review and conceptual framework. Infect Dis Poverty 2023; 12:103. [PMID: 37993962 PMCID: PMC10664497 DOI: 10.1186/s40249-023-01157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Tuberculosis is an infectious disease strongly influenced by social determinants closely associated with cycles of poverty and social exclusion. Within this context, providing social protection for people affected by the disease constitutes a powerful instrument for reducing inequalities and enhancing inclusion and social justice. This study aimed to identify and synthesize strategies and measures aimed at ensuring social protection as a right of people affected by tuberculosis. METHODS This is a scoping review, with searches conducted in six databases in February 2023. We included publications from 2015 onwards that elucidate strategies and measures of social protection aimed at safeguarding the rights to health, nutrition, employment, income, housing, social assistance, and social security for people affected by tuberculosis. These strategies could be implemented through policies, programs, and/or governmental agreements in any given context. The data extracted from the articles underwent descriptive analysis and a narrative synthesis of findings based on the dimensions of social protection. Additionally, we developed a conceptual framework illustrating the organizational and operational aspects of measures and strategies related to each dimension of social protection identified in this review. RESULTS A total of 9317 publications were retrieved from the databases, of which sixty-three publications were included. The study's results highlighted measures and strategies concerning the social protection of people affected by tuberculosis. These measures and strategies revolved around the rights to proper nutrition and nourishment, income, housing, and health insurance, as well as expanded rights encompassing social assistance and social welfare. It was reported that ensuring these rights contributes to improving nutritional status and the quality of life for individuals with tuberculosis, along with reducing catastrophic costs, expanding access to healthcare interventions and services, and fostering TB treatment adherence, thereby leading to higher rates of TB cure. CONCLUSIONS Our findings identify social protection measures as a right for people affected by tuberculosis and have the potential to guide the development of evidence-based social and health policies through collaboration between tuberculosis control programs and governmental entities.
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Affiliation(s)
| | - Rafaele Oliveira Bonfim
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | | | - Paula Daniella de Abreu
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Inês Fronteira
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
- National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Aline Aparecida Monroe
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
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Dave JD, Rupani MP. Advancing Social Protection and Tuberculosis Elimination in India - Beyond Cash Transfers and Towards Addressing Social and Structural Determinants for a Healthier Future; A Response to the Recent Commentaries. Int J Health Policy Manag 2023; 12:8130. [PMID: 37579372 PMCID: PMC10462078 DOI: 10.34172/ijhpm.2023.8130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Jigna D. Dave
- Department of Respiratory Medicine, Government Medical College Bhavnagar, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar, India
| | - Mihir P. Rupani
- Department of Community Medicine, Government Medical College Bhavnagar, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar, India
- Department of Clinical Epidemiology, Division of Health Sciences, ICMR-National Institute of Occupational Health (NIOH), Indian Council of Medical Research (ICMR), Ahmedabad, India
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Ghazy RM, Sallam M, Ashmawy R, Elzorkany AM, Reyad OA, Hamdy NA, Khedr H, Mosallam RA. Catastrophic Costs among Tuberculosis-Affected Households in Egypt: Magnitude, Cost Drivers, and Coping Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032640. [PMID: 36768005 PMCID: PMC9915462 DOI: 10.3390/ijerph20032640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 05/31/2023]
Abstract
Despite national programs covering the cost of treatment for tuberculosis (TB) in many countries, TB patients still face substantial costs. The end TB strategy, set by the World Health Organization (WHO), calls for "zero" TB households to be affected by catastrophic payments by 2025. This study aimed to measure the catastrophic healthcare payments among TB patients in Egypt, to determine its cost drivers and determinants and to describe the coping strategies. The study utilized an Arabic-validated version of the TB cost tool developed by the WHO for estimating catastrophic healthcare expenditure using the cluster-based sample survey with stratification in seven administrative regions in Alexandria. TB payments were considered catastrophic if the total cost exceeded 20% of the household's annual income. A total of 276 patients were interviewed: 76.4% were males, 50.0% were in the age group 18-35, and 8.3% had multidrug-resistant TB. Using the human capital approach, 17.0% of households encountered catastrophic costs compared to 59.1% when using the output approach. The cost calculation was carried out using the Egyptian pound converted to the United States dollars based on 2021 currency values. Total TB cost was United States dollars (USD) 280.28 ± 29.9 with a total direct cost of USD 103 ± 10.9 and a total indirect cost of USD 194.15 ± 25.5. The direct medical cost was the main cost driver in the pre-diagnosis period (USD 150.23 ± 26.89 pre diagnosis compared to USD 77.25 ± 9.91 post diagnosis, p = 0.013). The indirect costs (costs due to lost productivity) were the main cost driver in the post-diagnosis period (USD 4.68 ± 1.18 pre diagnosis compared to USD 192.84 ± 25.32 post diagnosis, p < 0.001). The households drew on multiple financial strategies to cope with TB costs where 66.7% borrowed and 25.4% sold household property. About two-thirds lost their jobs and another two-thirds lowered their food intake. Being female, delay in diagnosis and being in the intensive phase were significant predictors of catastrophic payment. Catastrophic costs were high among TB households in Alexandria and showed wide variation according to the method used for indirect cost estimation. The main cost driver before diagnosis was the direct medical costs, while it was the indirect costs, post diagnosis.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Rasha Ashmawy
- Department of Clinical Research, Maamora Chest Hospital, Alexandria 21923, Egypt
| | | | - Omar Ahmed Reyad
- Internal Medicine and Cardiology Clinical Pharmacy Department, Alexandria University Main Hospital, Alexandria 21526, Egypt
| | - Noha Alaa Hamdy
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Heba Khedr
- MDR-TB Center, Maamora Chest Hospital, Alexandria 21912, Egypt
| | - Rasha Ali Mosallam
- Department of Health Administration and Behavioral Science, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
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Rupani MP, Vyas S. A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India. Sci Rep 2023; 13:150. [PMID: 36600031 PMCID: PMC9811877 DOI: 10.1038/s41598-023-27494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Diabetes is one of the commonest morbidity among patients with tuberculosis (TB). We conducted this study to estimate the costs incurred by patients with TB comorbid with diabetes and to explore the perspectives of program managers as well as patients on the reasons and solutions for the costs incurred due to TB-diabetes. We conducted a descriptive cross-sectional study to estimate costs among 304 patients with TB-diabetes comorbidity registered in the public health system during 2017-2020 in the Bhavnagar region of western India, which was followed by in-depth interviews among program functionaries and patients to explore solutions for reducing the costs. Costs, when exceeded 20% of annual household income, were defined as catastrophic as this cut-off was most significantly related to adverse TB outcomes. Among the 304 patients with TB-diabetes comorbidity, 72% were male and the median (interquartile IQR) monthly family income was Indian rupees (INR) 9000 (8000-11,000) [~ US$ 132 (118-162)]. The median (IQR) total costs due to combined TB-diabetes were INR 1314 (788-3170) [~ US$ 19 (12-47)], while that due to TB were INR 618 (378-1933) [~ US$ 9 (6-28)]. Catastrophic costs due to TB were 4%, which increased to 5% on adding the costs due to diabetes. Health system strengthening, an increase in cash assistance, and other benefits such as a nutritious food kit were suggested for reducing the costs incurred. We conclude that, in addition to a marginal increase in the percentage of catastrophic costs, co-existent diabetes nearly doubled the median total costs incurred among patients with TB. Strengthening the TB-diabetes bi-directional activities, tailoring the cash transfer scheme for comorbid patients, and making the common two-drug combination diabetes tablets available at government drug stores would help TB-diabetes comorbid patients cope with the costs of care.
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Affiliation(s)
- Mihir P. Rupani
- grid.413227.10000 0004 1801 0602Department of Community Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Near ST Bus Stand, Jail Road, Bhavnagar, Gujarat 364001 India ,grid.411877.c0000 0001 2152 424XGujarat University, Ahmedabad, Gujarat 380009 India ,grid.415578.a0000 0004 0500 0771Present Address: Clinical Epidemiology, Division of Health Sciences, ICMR - National Institute of Occupational Health (NIOH), Indian Council of Medical Research, Meghaninagar, near Raksha Shakti University, Ahmedabad, Gujarat 380016 India
| | - Sheetal Vyas
- grid.411877.c0000 0001 2152 424XGujarat University, Ahmedabad, Gujarat 380009 India ,grid.411494.d0000 0001 2154 7601Department of Community Medicine, AMC-MET Medical College, Maninagar, Ahmedabad, Gujarat 380008 India
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Maciel ELN, Negri LDSA, Guidoni LM, Fregona GC, Loureiro RB, Daré IB, Prado TND, Sanchez MN, Diaz-Quijano FA, Tonini M, Zandonade E, Baena IG, Ershova J. Implementation of a methodological protocol for the national survey on tuberculosis catastrophic costs in Brazil. Rev Soc Bras Med Trop 2023; 56:e0493. [PMID: 36820663 PMCID: PMC9957116 DOI: 10.1590/0037-8682-0493-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/02/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
| | | | - Leticia Molino Guidoni
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
| | - Geisa Carlesso Fregona
- Hospital Universitário Cassiano Antônio Moraes, Programa de Tuberculose, Vitória, ES, Brasil
| | - Rafaela Borge Loureiro
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
| | - Isadora Bianchi Daré
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
| | | | - Mauro Niskier Sanchez
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Brasília, DF, Brasil
| | | | - Maiko Tonini
- Ministério da Saúde, Programa Nacional de Tuberculose, Brasília, DF, Brasil
| | - Eliana Zandonade
- Universidade Federal do Espírito Santo, Ciências da Saúde, Departamento de Estatística, Vitória, ES, Brasil
| | | | - Julia Ershova
- U. S. Centers for Disease Control and Prevention, Atlanta, USA
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Fuady A. Closing the Evidence Gap of Cash Transfer for Tuberculosis-Affected Households Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? - A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India". Int J Health Policy Manag 2022; 12:7658. [PMID: 37579478 PMCID: PMC10125063 DOI: 10.34172/ijhpm.2022.7658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/26/2022] [Indexed: 08/16/2023] Open
Abstract
Achieving the targets of eliminating tuberculosis (TB) requires a combination of biomedical, epidemiological, and social approaches. Having hitted by the coronavirus disease 2019 (COVID-19) pandemic which diminishes the financial capacity of TB-affected households, the importance of delivering socioeconomic support to TB-affected household emerges. However, the evidence of TB-related socioeconomic support is still scarce, and some questions are left unanswered. A sequential explanatory mixed-methods study by Dave and Rupani shows that the direct benefit transfer (DBT), a form of cash transfer, to TB-affected households improves TB treatment outcomes in India despite the challenges. Some critical issues remain to be discussed: trading-off between the amount of cash and its sustainability, choosing the most appropriate support packages, detecting, and reaching the target population, and arranging the most effective delivery strategy. Knowledge gap remains to be answered, and a global research agenda and political commitment are critical to encourage more evidence in delivering socioeconomic support for TB control.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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11
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Carballo-Jimenez PP, Datta S, Aguirre-Ipenza R, Saunders MJ, Quevedo Cruz L, Evans CA. Interventions aiming to eliminate catastrophic costs due to tuberculosis: a protocol for a systematic review and meta-analysis. Wellcome Open Res 2022; 7:92. [PMID: 37224318 PMCID: PMC10170179 DOI: 10.12688/wellcomeopenres.17521.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 08/10/2023] Open
Abstract
Background : People with tuberculosis disease and their household members may suffer direct out-of-pocket expenses and indirect costs of lost income. These tuberculosis-related costs can worsen poverty, make tuberculosis treatment completion unaffordable, impair quality of life and increase the risk of death. Costs due to tuberculosis are usually defined as catastrophic if they exceed 20% of the pre-disease annual household income. The World Health Organisation strategy to "End TB" and the United Nations Sustainable Development Goals include the target that no households should face catastrophic costs due to tuberculosis. However, there is limited evidence and policy concerning how this global priority of eliminating catastrophic costs due to tuberculosis should be achieved. This systematic review and meta-analysis aims to address this knowledge gap. Methods : Publications assessing interventions that aimed to eliminate catastrophic costs will be identified by searching three electronic databases (PubMed, Scopus and Web of Science) together with reference lists from pertinent publications. We will screen eligible studies, extract data, and assess the risk of bias with the quality assessment tool from the National Heart, Lung, and Blood Institute. Discrepancies will be resolved by discussion between the reviewers. If we find sufficient comparable studies quantifying strategies to eliminate catastrophic costs then a meta-analysis will be performed. This systematic review and meta-analysis is registered with the PROSPERO database (CRD42022292410). Conclusion : This systematic review and meta-analysis aims to rigorously assess the evidence for strategies to eliminate catastrophic costs due to tuberculosis.
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Affiliation(s)
- Paula P. Carballo-Jimenez
- IFHAD: Innovation For Health And Development, Department of Infectious Disease, Imperial College London, London, UK
- IPSYD: Innovación Por la Salud Y Desarrollo, Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sumona Datta
- IFHAD: Innovation For Health And Development, Department of Infectious Disease, Imperial College London, London, UK
- IPSYD: Innovación Por la Salud Y Desarrollo, Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Matthew J. Saunders
- IFHAD: Innovation For Health And Development, Department of Infectious Disease, Imperial College London, London, UK
- IPSYD: Innovación Por la Salud Y Desarrollo, Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luz Quevedo Cruz
- IFHAD: Innovation For Health And Development, Department of Infectious Disease, Imperial College London, London, UK
- IPSYD: Innovación Por la Salud Y Desarrollo, Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlton A. Evans
- IFHAD: Innovation For Health And Development, Department of Infectious Disease, Imperial College London, London, UK
- IPSYD: Innovación Por la Salud Y Desarrollo, Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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12
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Addo J, Pearce D, Metcalf M, Lundquist C, Thomas G, Barros-Aguirre D, Koh GCKW, Strange M. Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment. BMC Public Health 2022; 22:1717. [PMID: 36085073 PMCID: PMC9462890 DOI: 10.1186/s12889-022-14115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/30/2022] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background
Although tuberculosis (TB) is a curable disease, treatment is complex and prolonged, requiring considerable commitment from patients. This study aimed to understand the common perspectives of TB patients across Brazil, Russia, India, China, and South Africa throughout their disease journey, including the emotional, psychological, and practical challenges that patients and their families face.
Methods
This qualitative market research study was conducted between July 2020 and February 2021. Eight TB patients from each country (n = 40) completed health questionnaires, video/telephone interviews, and diaries regarding their experiences of TB. Additionally, 52 household members were interviewed. Patients at different stages of their TB treatment journey, from a range of socioeconomic groups, with or without TB risk factors were sought. Anonymized data underwent triangulation and thematic analysis by iterative coding of statements.
Results
The sample included 23 men and 17 women aged 13–60 years old, with risk factors for TB reported by 23/40 patients. Although patients were from different countries and cultural backgrounds, experiencing diverse health system contexts, five themes emerged as common across the sample. 1) Economic hardship from loss of income and medical/travel expenses. 2) Widespread stigma, delaying presentation and deeply affecting patients’ emotional wellbeing. 3) TB and HIV co-infection was particularly challenging, but increased TB awareness and accelerated diagnosis. 4) Disruption to family life strained relationships and increased patients’ feelings of isolation and loneliness. 5) The COVID-19 pandemic made it easier for TB patients to keep their condition private, but disrupted access to services.
Conclusions
Despite disparate cultural, socio-economic, and systemic contexts across countries, TB patients experience common challenges. A robust examination of the needs of individual patients and their families is required to improve the patient experience, encourage adherence, and promote cure, given the limitations of current treatment.
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13
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Carballo-Jimenez PP, Datta S, Aguirre-Ipenza R, Saunders MJ, Quevedo Cruz L, Evans CA. A protocol for a systematic review and meta-analysis of strategies to quantify or eliminate catastrophic costs due to tuberculosis. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17521.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The World Health Organization strategy to “End TB” by 2030 includes the milestone of no affected households facing catastrophic costs due to tuberculosis (TB). Costs due to TB are usually defined as catastrophic if they exceed 20% of the pre-disease annual household income. Several countries have conducted national TB cost surveys but strategies to quantify and eliminate catastrophic costs are incompletely defined. Methods: Publications related to strategies to quantify and eliminate catastrophic costs will be identified by searching three electronic databases (PubMed - Medline, Scopus and Web of Science) together with reference lists from pertinent publications. We will screen eligible studies, extract data, and assess the risk of bias with the quality assessment tool from the National Heart, Lung, and Blood Institute. Discrepancies will be resolved by discussion between the reviewers. If we find sufficient comparable studies quantifying strategies to eliminate catastrophic costs then a meta-analysis will be performed. This systematic review and meta-analysis is registered with the PROSPERO database (CRD42022292410). Conclusion: This systematic review and meta-analysis aims to rigorously assess the evidence for strategies to quantify or eliminate catastrophic costs due to TB.
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Ghazy RM, El Saeh HM, Abdulaziz S, Hammouda EA, Elzorkany AM, Khidr H, Zarif N, Elrewany E, Abd ElHafeez S. A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients. Sci Rep 2022; 12:558. [PMID: 35017604 PMCID: PMC8752613 DOI: 10.1038/s41598-021-04345-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34-51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Haider M El Saeh
- Community Medicine Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | | | - Heba Khidr
- Ministry of Health and Population, Alexandria, Egypt
| | - Nardine Zarif
- Ministry of Health and Population, Alexandria, Egypt
| | - Ehab Elrewany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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15
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Timire C, Sandy C, Ferrand RA, Mubau R, Shiri P, Mbiriyawanda O, Mbiba F, Houben RMGJ, Pedrazzoli D, Bond V, Foster N, Kranzer K. Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001027. [PMID: 36962815 PMCID: PMC10021731 DOI: 10.1371/journal.pgph.0001027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
The End TB strategy recommends social protection to mitigate socio-economic impacts of tuberculosis. Zimbabwe started implementing a conditional cash transfer (CCT) programme for people on drug resistant tuberculosis (DR-TB) treatment in 2013. We aimed to determine the proportion of people receiving CCT and effectiveness of CCT in improving treatment outcomes, explore their experiences with registering for CCT and understand the impact of CCT from the perspective of beneficiaries. Data from 2014-2021 were extracted from TB registers and CCT payment records within the National TB Programme. Sixteen in-depth interviews were conducted with people who were completing treatment or had completed treatment within two months. Poisson regression, adjusted for province, year of treatment, age and sex was used to investigate associations between receiving CCT and successful treatment outcomes among people who were in DR-TB care for ≥3 months after treatment initiation. Qualitative data were analyzed using thematic analysis. A total of 481 people were included in the quantitative study. Of these, 53% (254/481) received CCT at some point during treatment. People who exited DR-TB care within three months were 73% less likely to receive CCT than those who did not (prevalence ratio (PR) = 0.27 [95%CI: 0.18-0.41]). Among those who were alive and in care three months after treatment initiation, CCT recipients were 32% more likely to have successful outcomes than those who did not (adjusted PR = 1.32, [95%CI: 1.00-1.75]). Qualitative results revealed lack of knowledge about availability of CCT among people with DR-TB and missed opportunities by healthcare providers to provide information about availability of CCT. Delays and inconsistencies in disbursements of CCT were frequent themes. CCT were associated with successful treatment outcomes. Improvements in coverage, timeliness and predictability of disbursements are recommended.
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Affiliation(s)
- Collins Timire
- Department of Clinical Research, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
- Biomedical Research and Training Institute, The Health Research Unit, Harare, Zimbabwe
| | - Charles Sandy
- National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Biomedical Research and Training Institute, The Health Research Unit, Harare, Zimbabwe
| | - Regina Mubau
- National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Peter Shiri
- National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Obert Mbiriyawanda
- National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Fredrick Mbiba
- Biomedical Research and Training Institute, The Health Research Unit, Harare, Zimbabwe
| | - Rein M G J Houben
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | - Nicola Foster
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Biomedical Research and Training Institute, The Health Research Unit, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
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16
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Ghazy RM, Saeh HME, Abdulaziz S, Hammouda EA, Elzorkany A, Kheder H, Zarif N, Elrewany E, Elhafeez SA. A Systematic Review and Meta-Analysis on Catastrophic Cost incurred by Tuberculosis Patients and their Households.. [DOI: 10.1101/2021.02.27.21252453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundAs one of the World Health Organization (WHO) End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families that face catastrophic costs to 0% by 2020. This systematic review and meta-analysis aimed to estimate the pooled proportion of TB affected households who face catastrophic cost.MethodA search of the online database through September 2020 was performed. A total of 5114 articles were found, of which 29 articles got included in quantitative synthesis. Catastrophic cost is defined if total cost related to TB exceeded 20% of annual pre-TB household income. R software was used to estimate the pooled proportion at 95% confidence intervals (CIs) using the fixed/random-effect models.ResultThe proportion of patients faced catastrophic cost was 43% (95% CI 34-52, I2= 99%); 32% (95% CI 29 – 35, I2= 70%) among drug sensitive, and 80% (95% CI 74-85, I2= 54%) among drug resistant, and 81% (95%CI 78-84%, I2= 0%) among HIV patients. Regarding active versus passive case finding the pooled proportion of catastrophic cost was 12% (95% CI 9-16, I2= 95%) versus 42% (95% CI 35-50, I2= 94%). The pooled proportion of direct cost to the total cost was 45% (95% CI 39-51, I2= 91%). The pooled proportion of patients facing catastrophic health expenditure (CHE) at cut of point of 10% of their yearly income was 45% (95% CI 35-56, I2= 93%) while at 40% of their capacity to pay was 63% (95% CI 40-80, I2= 96%).ConclusionDespite the ongoing efforts, there is a significant proportion of patients facing catastrophic cost, which represent a main obstacle against TB control.PROSPERO registrationCRD42020221283
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Guidoni LM, Negri LDSA, Carlesso GF, Zandonade E, Maciel ELN. Custos catastróficos em pacientes com tuberculose no Brasil: estudo em cinco capitais. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo avaliar o impacto econômico domiciliar do adoecimento pela tuberculose no Brasil. Método pesquisa transversal multicêntrica de 2016 a 2018, em cinco capitais do Brasil, em pacientes diagnosticados com tuberculose. Os custos totais foram a soma dos custos diretos e indiretos incorridos antes e durante o diagnóstico e tratamento. A regressão logística foi utilizada para estudar determinantes de custos catastróficos. A pobreza foi medida como renda familiar per capita diária < U$ 5,5. Resultados trezentos e sessenta e um pacientes foram inscritos no estudo. O custo extrapolação foi de R$3.664,47 (DP: R$ 2.667,67) e o custo total de extrapolação foi de R$22.291,82 (DP: R$ 16.259,50). No geral, 29% dos participantes do estudo foram caracterizados como pobres antes da tuberculose, e 39% depois. Em média, a renda diminuiu em 11% dos participantes e 41% tiveram custos catastróficos. Os determinantes estatisticamente significativos de experimentar custos catastróficos foram: participante ser o chefe da família, vivendo na pobreza antes da tuberculose, desemprego e interrupção do trabalho durante o tratamento (p < 0,05). Conclusão e implicações para a prática embora o tratamento seja financiado pelo governo, a tuberculose continua resultando em custos catastróficos e diminuição da renda para muitas famílias no Brasil.
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Saunders MJ, Evans CA. COVID-19, tuberculosis and poverty: preventing a perfect storm. Eur Respir J 2020; 56:13993003.01348-2020. [PMID: 32444399 PMCID: PMC7243392 DOI: 10.1183/13993003.01348-2020] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is likely to be the defining global health crisis of our generation. As the United Nations Development Programme highlighted in their recent call to action, the impact of this pandemic will extend beyond the immediate medical consequences to have far-reaching and long-lasting social and economic impacts, threatening to disproportionately affect poorer people in poorer countries [1]. Income losses are anticipated to exceed USD 220 billion in developing countries, where many people live day-to-day without access to social protection, and food security is precarious [1]. Strikingly, a recent United Nations study suggested that the social and economic consequences of the COVID-19 pandemic could increase the number of people living in poverty by as much as half a billion, with the majority of these newly poor people living in Africa, South-East Asia, and Central and South America [2]. The global health community must learn from COVID-19 and take action now on tuberculosis and its social determinants, potentially saving millions from a preventable and curable diseasehttps://bit.ly/2LLgLgA
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Affiliation(s)
- Matthew J Saunders
- Dept of Infectious Disease, Imperial College London, London, UK .,Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Perú
| | - Carlton A Evans
- Dept of Infectious Disease, Imperial College London, London, UK.,Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Perú
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19
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Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal. Trop Med Infect Dis 2020; 5:tropicalmed5020098. [PMID: 32532101 PMCID: PMC7345977 DOI: 10.3390/tropicalmed5020098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become “catastrophic”, leading patients to abandon treatment, develop drug-resistance, and die. WHO’s 2015 End TB Strategy recommends eliminating catastrophic costs and providing socioeconomic support for TB-affected people. However, there is negligible evidence to guide the design and implementation of such socioeconomic support, especially in low-income, TB-endemic countries. A national, multi-sectoral workshop was held in Kathmandu, Nepal, on the 11th and 12th September 2019, to develop a shortlist of feasible, locally appropriate socioeconomic support interventions for TB-affected households in Nepal, a low-income country with significant TB burden. The workshop brought together key stakeholders in Nepal including from the Ministry of Health and Population, Department of Health Services, Provincial Health Directorate, Health Offices, National TB Program (NTP); and TB/Leprosy Officers, healthcare workers, community health volunteers, TB-affected people, and external development partners (EDP). During the workshop, participants reviewed current Nepal NTP data and strategy, discussed the preliminary results of a mixed-methods study of the socioeconomic determinants and consequences of TB in Nepal, described existing and potential socioeconomic interventions for TB-affected households in Nepal, and selected the most promising interventions for future randomized controlled trial evaluations in Nepal. This report describes the activities, outcomes, and recommendations from the workshop.
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20
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Zrubka Z, Rashdan O, Gulácsi L. Health Economic Publications From the Middle East and North Africa Region: A Scoping Review of the Volume and Methods of Research. ACTA ACUST UNITED AC 2020. [DOI: 10.36401/jqsh-20-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT
Introduction
We reviewed the scope of countries, diseases, technologies, and methods involved in the health economic evaluations published in the Middle East and North Africa (MENA) region.
Methods
PRISMA guidelines were followed. A PubMed search was conducted up to December 15, 2019. English language full-text articles were included if they reported original research on humans; involved the local population from Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, United Arab Emirates, or Yemen; reported costs; and involved a full or partial health economic analysis comparing alternative health technologies. Data on publication year, country of origin, disease area according to ICD-10, type of health technology, and applied methods were extracted.
Results
From 105 eligible articles, 57.1% were published between 2015 and 2019. Egypt (30.5%) and Saudi Arabia (27.6%) were the most frequently involved countries. Infectious diseases were most often studied (27.6%). The assessed technology was a system (eg, infection control, screening, coverage/access, hospital management, or healthcare delivery program) in 41.9% of studies. Cost-utility analysis (CUA) was the most frequent method (29.5%) and was growing rapidly. Health system perspective was adopted in 52.4% of studies, whereas societal perspective was scarce (8.6%). The majority of studies (46.7%) were published in Scimago Q1 journals. Over half of the studies (54.2%) did not report or did not have a funding source.
Conclusions
From 2015, health economic analysis became more frequent in the MENA region, providing input to value-based health policy and financing. For further growth, in addition to the development of the institutional background, valid and more standardized local cost and outcome data should be available.
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Affiliation(s)
- Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Omar Rashdan
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
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21
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Stracker N, Hanrahan C, Mmolawa L, Nonyane B, Tampi R, Tucker A, West N, Lebina L, Martinson N, Dowdy D. Risk factors for catastrophic costs associated with tuberculosis in rural South Africa. Int J Tuberc Lung Dis 2020; 23:756-763. [PMID: 31315710 DOI: 10.5588/ijtld.18.0519] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec> <title>SETTING</title> Fifty-five public clinics in northern South Africa. </sec> <sec> <title>OBJECTIVE</title> To estimate patient costs and identify the factors associated with catastrophic costs among individuals treated for tuberculosis (TB). </sec> <sec> <title>DESIGN</title> We performed cross-sectional interviews of consecutive patients at public clinics from October 2017 to January 2018. 'Catastrophic costs' were defined as costs totalling ≥20% of annual household income. For participants with no reported income, we considered scenarios where costs were considered non-catastrophic if 1) costs totalled <US$7.70 (ZAR100) or 2) a multidimensional poverty index was above a certain threshold. </sec> <sec> <title>RESULTS</title> Among 327 participants, the estimated mean TB episode costs were US$365 (95%CI 233-498): out-of-pocket costs comprised 58% of costs, wages lost due to health care-seeking represented 26%, and income reduction accounted for 16% of costs. Ninety (28%) participants experienced catastrophic costs, which were associated with clinic travel times of 60-90 min (adjusted prevalence ratio [aPR] 1.7, 95%CI 0.9-3.1), unemployment (aPR 2.0, 95%CI 1.0-4.0) and having fewer household members (aPR 0.6, 95%CI 0.3-1.0). </sec> <sec> <title>CONCLUSIONS</title> In rural South Africa, catastrophic costs from TB are common and associated with distance to clinics, unemployment, and household size. These findings can help tailor social protection programs and enhance service delivery to patients at greatest risk of experiencing financial hardship. </sec>.
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Affiliation(s)
| | | | - L Mmolawa
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - B Nonyane
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R Tampi
- Departments of Epidemiology and
| | | | - N West
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - L Lebina
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - N Martinson
- Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA
| | - D Dowdy
- Departments of Epidemiology and, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA
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22
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Walcott RL, Ingels JB, Corso PS, Zalwango S, Whalen CC, Sekandi JN. There's no such thing as a free TB diagnosis: Catastrophic TB costs in Urban Uganda. Glob Public Health 2020; 15:877-888. [PMID: 32027555 DOI: 10.1080/17441692.2020.1724313] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Identifying and reducing TB-related costs is necessary for achieving the End TB Strategy's goal that no family is burdened with catastrophic costs. This study explores costs during the pre-diagnosis period and assesses the potential for using coping costs as a proxy indicator for catastrophic costs when comprehensive surveys are not feasible. Detailed interviews about TB-related costs and productivity losses were conducted with 196 pulmonary TB patients in Kampala, Uganda. The threshold for catastrophic costs was defined as 20% of household income. Multivariable regression analyses were used to assess the influence of patient characteristics on economic burden, and the positive predictive value (PPV) of coping costs was estimated. Over 40% of patients experienced catastrophic costs, with average (median) pre-diagnosis costs making up 30.6% (14.1%) of household income. Low-income status (AOR = 2.91, 95% CI = 1.29, 6.72), hospitalisation (AOR = 8.66, 95% CI = 2.60; 39.54), and coping costs (AOR = 3.84, 95% CI = 1.81; 8.40) were significantly associated with the experience of catastrophic costs. The PPV of coping costs as an indicator for catastrophic costs was estimated to be 73% (95% CI = 58%, 84%). TB patients endure a substantial economic burden during the pre-diagnosis period, and identifying households that experience coping costs may be a useful proxy measure for identifying catastrophic costs.
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Affiliation(s)
- Rebecca L Walcott
- Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA
| | - Justin B Ingels
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Phaedra S Corso
- Office of Research, Kennesaw State University, Kennesaw, GA, USA
| | - Sarah Zalwango
- Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda
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Muniyandi M, Thomas BE, Karikalan N, Kannan T, Rajendran K, Saravanan B, Vohra V, Okorosobo T, Lönnroth K, Tripathy SP. Association of Tuberculosis With Household Catastrophic Expenditure in South India. JAMA Netw Open 2020; 3:e1920973. [PMID: 32049293 DOI: 10.1001/jamanetworkopen.2019.20973] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE The high household costs associated with tuberculosis (TB) diagnosis and treatment can create barriers to access and adherence, highlighting the urgency of achieving the World Health Organization's End TB Strategy target that no TB-affected households should face catastrophic costs by 2020. OBJECTIVE To estimate the occurrence of catastrophic costs associated with TB diagnosis and treatment and to identify socioeconomic indicators associated with catastrophic costs in a setting where TB control strategies have been implemented effectively. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, 455 patients with TB in the Chennai metropolitan area of South India who were treated under the TB control program between February 2017 and March 2018 were interviewed. Patients were interviewed by trained field investigators at 3 time points: at the initiation of treatment, at the end of the intensive phase of treatment, and at the end of the continuation phase of treatment. A precoded interview schedule was used to collect information on demographic, socioeconomic, and clinical characteristics and direct medical, direct nonmedical, and indirect costs. Data analysis was performed from August 2018 to November 2019. MAIN OUTCOMES AND MEASURES Direct, indirect, and total costs to patients with TB. Catastrophic costs associated with TB were defined as costs exceeding 20% of the household's annual income. A binary response model was used to determine the factors that were significantly associated with catastrophic costs. RESULTS Of 455 patients with TB interviewed, 205 (53%) were aged 19 to 45 years (mean [SD] age, 38.4 [16.0] years), 128 (33%) were female, 72 (19%) were illiterate, 126 (33%) were employed, and 186 (48%) had a single earning member in the family (percentages are based on the 384 patients who were interviewed through the end of the continuation phase of treatment). Sixty-one percent of patients (234 patients) had pulmonary smear positive TB. The proportion of patients with catastrophic costs was 31%. Indirect costs contributed more toward catastrophic cost than did direct costs. Multivariate logistic regression analysis found that unemployment (adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) and higher annual household income (Rs 1-200 000, adjusted odds ratio, 0.4; 95% CI, 0.2-0.7; P = .004; Rs >200 000, adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) were associated with a decreased likelihood of experiencing catastrophic costs. CONCLUSIONS AND RELEVANCE Despite the implementation of free diagnostic and treatment services under a national TB control program, TB-affected households had a high risk of catastrophic costs and further impoverishment. There is an urgent demand to provide additional financial protection for patients with TB.
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Affiliation(s)
- Malaisamy Muniyandi
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Beena Elizabeth Thomas
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Nagarajan Karikalan
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Thiruvengadam Kannan
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Krishnan Rajendran
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Balakrishnan Saravanan
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
| | - Vikram Vohra
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institute, Solna, Sweden
| | - Srikanth Prasad Tripathy
- Department of Health Economics, National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India
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Patel BH, Jeyashree K, Chinnakali P, Vijayageetha M, Mehta KG, Modi B, Chavda PD, Dave PV, Zala CC, Shewade HD, Solanki DM, Kumar AMV. Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study. BMJ Open 2019; 9:e033158. [PMID: 31888934 PMCID: PMC6936995 DOI: 10.1136/bmjopen-2019-033158] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This study aimed to assess the coverage and explore enablers and challenges in implementation of direct benefit transfer (DBT) cash incentive scheme for patients with tuberculosis (TB). DESIGN This is a mixed methods study comprising a quantitative cohort and descriptive qualitative study. SETTING The study was conducted in City TB Centre, Vadodara, Western India. PARTICIPANTS We used routinely collected data under the National TB Programme (NTP) on patients with TB notified between April and September 2018 and initiated on first-line anti-tuberculosis treatment (ATT) to assess the coverage of DBT. We interviewed NTP staff and patients to understand their perceptions. PRIMARY AND SECONDARY OUTCOME MEASURES The study outcomes are receipt of DBT (primary), time to receipt of first instalment of DBT and treatment outcome. RESULTS Among 1826 patients, 771 (42.2%) had received at least one instalment. Significantly more patients from the public sector had received DBT (at least one instalment) compared with those from private sector (adjusted relative risk (adjRR)=16.3; 95% CI 11.6 to 23.0). Among public sector patients, 7.3% (49/671) had received first instalment within 2 months of treatment initiation. Median (IQR) time to receipt of first instalment was 5.2 (3.4, 7.4) months. Treatment in private sector, residing outside city limits and being HIV non-reactive were significantly (p<0.001) associated with longer time to receipt. Timely and sufficient fund release, adequate manpower and adequate logistics in TB centre were the enablers. Inability of patients to open bank accounts due to lack of identity/residence proof, their reluctance to share personal information and inadequate support from private providers were the challenges identified in implementation. CONCLUSION During the early phase of DBT implementation, the coverage was low and there were delays in benefit transfer. Facilitating opening of bank accounts for patients by NTP staff and better support from private providers may improve DBT coverage. Repeat assessment of DBT coverage after streamlining of implementation is recommended.
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Affiliation(s)
| | - Kathiresan Jeyashree
- Scientist-D, ICMR- National Institute of Epidemiology, Chennai, Tamilnadu, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mathavaswami Vijayageetha
- Consultant-II, Division- Online Courses, ICMR- National Institute of Epidemiology, Chennai, Tamilnadu, India
| | | | - Bhavesh Modi
- Community Medicine Department, GMERS Medical College, Gandhinagar, Gujarat, India
| | | | - Paresh V Dave
- Public Health Department, Commissionerate of Health, Health and Family Welfare Department, Government of Gujarat, Gandhinagar, Gujarat, India
| | | | - Hemant Deepak Shewade
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- Operational Research, The Union South-East Asia Office, New Delhi, India
| | - Dipak M Solanki
- Community Medicine Department, MP Shah Government Medical College, Jamnagar, Gujarat, India
| | - Ajay M V Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- Operational Research, The Union South-East Asia Office, New Delhi, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India
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Nirgude AS, Kumar AMV, Collins T, Naik PR, Parmar M, Tao L, Akshaya KM, Raghuveer P, Yatnatti SK, Nagendra N, Nagaraja SB, Habeena S, Mn B, Rao R, Shastri S. 'I am on treatment since 5 months but I have not received any money': coverage, delays and implementation challenges of 'Direct Benefit Transfer' for tuberculosis patients - a mixed-methods study from South India. Glob Health Action 2019; 12:1633725. [PMID: 31328678 PMCID: PMC6713952 DOI: 10.1080/16549716.2019.1633725] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India’s national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives: To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods: This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results: Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion: DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action.
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Affiliation(s)
- Abhay Subhashrao Nirgude
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Ajay M V Kumar
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India.,b Department of Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,c Department of Research, The Union South-East Asia Office , New Delhi , India
| | - Timire Collins
- d Center for Operations Research, International Union Against Tuberculosis and LungDisease , Harare , Zimbabwe
| | - Poonam Ramesh Naik
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Malik Parmar
- e Communicable Disease Section (Tuberculosis), WHO Country Office for India , New Delhi , India
| | - Li Tao
- f National Center for Tuberculosis Control and Prevention, China CDC , Beijing , China
| | - Kibballi Madhukeshwar Akshaya
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Pracheth Raghuveer
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Santosh K Yatnatti
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Navya Nagendra
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Sharath B Nagaraja
- g Department of Community Medicine, ESIC Medical College and PGIMSR , Bengaluru , India
| | - Shaira Habeena
- a Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University) , Mangaluru , India
| | - Badarudeen Mn
- h Health and Family Welfare Department , Mangaluru , India
| | - Ramkrishna Rao
- h Health and Family Welfare Department , Mangaluru , India
| | - Suresh Shastri
- i Karnataka State AIDS Prevention Society and State Tuberculosis Cell , Bangalore , Karnataka , India
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26
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Xu CH, Jeyashree K, Shewade HD, Xia YY, Wang LX, Liu Y, Zhang H, Wang L. Inequity in catastrophic costs among tuberculosis-affected households in China. Infect Dis Poverty 2019; 8:46. [PMID: 31215476 PMCID: PMC6582572 DOI: 10.1186/s40249-019-0564-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited nationally representative studies globally in the post-2015 END tuberculosis (TB) era regarding wealth related inequity in the distribution of catastrophic costs due to TB care. Under the Chinese national tuberculosis programme setting, we aimed to assess extent of equity in distribution of total TB care costs (pre-treatment, treatment and overall) and costs as a proportion of annual household income (AHI), and describe and compare equity in distribution of catastrophic costs (pre-treatment, treatment and overall) across population sub-groups. METHODS Analytical cross-sectional study using data from national TB patient cost survey carried out in 22 counties from six provinces in China in 2017. Drug-susceptible pulmonary TB registered under programme, who had received at least 2 weeks of intensive phase therapy were included. Equity was depicted using concentration curves and concentration indices were compared using dominance test. RESULTS Of 1147 patients, the median cost of pre-treatment, treatment and overall care, were USD 283.5, USD 413.1 and USD 965.5, respectively. Richer quintiles incurred significantly higher pre-treatment and treatment costs compared to poorer quintiles. The distribution of costs as a proportion of AHI and catastrophic costs were significantly pro-poor overall as well as during pre-treatment and treatment phase. All the concentration curves for catastrophic costs (due to pre-treatment, treatment and overall care) stratified by region (east, middle and west), area of residence (urban, rural) and type of insurance (new rural co-operative medical system [NCMS], non-NCMS) also exhibited a pro-poor pattern with statistically significant (P < 0.01) concentration indices. The pro-poor distribution of the catastrophic costs due to TB treatment was significantly more inequitable among rural, compared to urban patients, and NCMS compared to non-NCMS beneficiaries. CONCLUSIONS There is inequity in the distribution of catastrophic costs due to TB care. Universal health coverage, social protection strategies complemented by quality TB care is vital to reduce inequitable distribution of catastrophic costs due to TB care in China.
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Affiliation(s)
- Cai-Hong Xu
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China
| | - Kathiresan Jeyashree
- Velammal Medical College Hospital and Research Institute, Madurai, 625009, India
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, 110016, India
- International Union Against Tuberculosis and Lung Disease (The Union), 75006, Paris, France
- Karuna Trust, Bengaluru, 560041, India
| | - Yin-Yin Xia
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China
| | - Li-Xia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100226, China.
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
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Fuady A, Houweling TAJ, Mansyur M, Burhan E, Richardus JH. Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios. Infect Dis Poverty 2019; 8:10. [PMID: 30709415 PMCID: PMC6359783 DOI: 10.1186/s40249-019-0519-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/13/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The World Health Organization's End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached, we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in Indonesia. METHODS From July to September 2016, we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban, sub-urban and rural area of Indonesia, and those receiving multidrug-resistant (MDR) TB treatment in an Indonesian national referral hospital. Based on the needs assessment, we developed eight scenarios for financial support. We assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic costs. RESULTS We analysed data of 282 TB and 64 MDR-TB patients. The incidences of catastrophic costs in affected households were 36 and 83%, respectively. Patients' primary needs for social protection were financial support to cover costs related to income loss, transportation, and food supplements. The optimum scenario, in which financial support would be provided for these three items, would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%. The patients experiencing catastrophic costs in this scenario would, however, have to pay high remaining costs (median of USD 910; [interquartile range (IQR) 662] in the TB group, and USD 2613; [IQR 3442] in the MDR-TB group). CONCLUSIONS Indonesia's current level of social protection is not sufficient to mitigate the socioeconomic impact of TB. Financial support for income loss, transportation costs, and food-supplement costs will substantially reduce the incidence of catastrophic costs, but financial support alone will not be sufficient to achieve the target of 0% TB-affected households facing catastrophic costs. This would require innovative social-protection policies and higher levels of domestic and external funding.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands. .,Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Respiratory and Pulmonology, Persahabatan Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
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28
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J Carter D, Daniel R, Torrens AW, N Sanchez M, Maciel ELN, Bartholomay P, Barreira DC, Rasella D, Barreto ML, Rodrigues LC, Boccia D. The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil. BMJ Glob Health 2019; 4:e001029. [PMID: 30740248 PMCID: PMC6347926 DOI: 10.1136/bmjgh-2018-001029] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 02/04/2023] Open
Abstract
Background Evidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate. Methods Propensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll. Results The average effect of treatment on the treated was estimated as the difference in TB treatment success rate between matched groups (ie, the control and exposed patients, n=2167). Patients with TB receiving BFP showed a treatment success rate of 10.58 percentage points higher (95% CI 4.39 to 16.77) than patients with TB not receiving BFP. This association was robust to sensitivity analyses. Conclusions This study further confirms a positive relationship between the provision of conditional cash transfers and TB treatment success rate. Further research is needed to understand how to enhance access to social protection so to optimise public health impact.
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Affiliation(s)
- Daniel J Carter
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhian Daniel
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana W Torrens
- Tropical Medicine Department, University of Brasília, Brasília, Brazil
| | | | | | | | - Draurio C Barreira
- National Tuberculosis Programme/Ministry of Health of Brazil, Brasília, Brazil
| | - Davide Rasella
- Centro de Pesquisas Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mauricio L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.,Centro de Integração de Dados de Conhecimentos para Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Centro de Integração de Dados de Conhecimentos para Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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29
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Bothamley G. What next? Basic research, new treatments and a patient-centred approach in controlling tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10026118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Malacarne J, Kolte IV, Freitas LP, Orellana JDY, Souza MLPD, Souza-Santos R, Basta PC. Factors associated with TB in an indigenous population in Brazil: the effect of a cash transfer program. Rev Inst Med Trop Sao Paulo 2018; 60:e63. [PMID: 30379230 PMCID: PMC6201742 DOI: 10.1590/s1678-9946201860063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
The Mato Grosso do Sul State (MS) has the second-largest indigenous population
and the highest incidence rates of TB among indigenous people in Brazil.
However, little is known about the risk factors associated with active TB in
indigenous people in the region, especially regarding socioeconomic factors. The
aim of this study is to assess the effect of the Family Allowance Program (BFP)
and of other predictors of active TB in a high-risk indigenous population in
Brazil. We conducted a case-control study with incident TB cases matched by age
and by village of residence (1:2 proportion) between March 2011 and December
2012. We used a conditional logistic regression for data analysis. A total of
153 cases and 306 controls were enrolled. The final model included the following
risk factors: alcohol consumption (low-risk use OR=2.2; 95% CI 1.1-4.3; risky
use OR=2.4; 95% CI 1.0-6.0; dependent/ damaging use OR=9.1; 95% CI 2.9-29.1);
recent contact with a TB patient (OR=2.0; 95% CI 1.2-3.5); and male sex (OR=1.9;
95% CI 1.1-3.2). BFP participation (OR=0.5; 95% CI 0.3-0.6) and BCG vaccination
(OR=0.5; 95% CI 0.3-0.9) were found to be protective factors against TB.
Although the BFP was not designed to target TB-affected households specifically,
our findings reveal the importance of the BFP in preventing one of the most
important infectious diseases among adults in indigenous villages in Brazil.
This result is in line with the End-TB strategy, which identifies social
protection, poverty alleviation and targeting other determinants of TB as key
actions.
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Affiliation(s)
- Jocieli Malacarne
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ida Viktoria Kolte
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lais Picinini Freitas
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Reinaldo Souza-Santos
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Cesar Basta
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
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31
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Richterman A, Steer-Massaro J, Jarolimova J, Luong Nguyen LB, Werdenberg J, Ivers LC. Cash interventions to improve clinical outcomes for pulmonary tuberculosis: systematic review and meta-analysis. Bull World Health Organ 2018; 96:471-483. [PMID: 29962550 PMCID: PMC6022611 DOI: 10.2471/blt.18.208959] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess cash transfer interventions for improving treatment outcomes of active pulmonary tuberculosis in low- and middle-income countries. METHODS We searched PubMed®, Embase®, Cochrane Library and ClinicalTrials.gov for studies published until 4 August 2017 that reported on cash transfer interventions during the treatment of active pulmonary tuberculosis in low- and middle-income countries. Our primary outcome was a positive clinical outcome, defined as treatment success, treatment completion or microbiologic cure. Using the purchasing power parity conversion factor, we converted the amount of cash received per patient within each study into international dollars (Int$). We calculated odds ratio (OR) for the primary outcome using a random effects meta-analysis. FINDINGS Eight studies met eligibility criteria for review inclusion. Seven studies assessed a tuberculosis-specific intervention, with average amount of cash ranging from Int$ 193-858. One study assessed a tuberculosis-sensitive intervention, with average amount of Int$ 101. Four studies included non-cash co-interventions. All studies showed better primary outcome for the intervention group than the control group. After excluding three studies with high risk of bias, patients receiving tuberculosis-specific cash transfer were more likely to have a positive clinical outcome than patients in the control groups (OR: 1.77; 95% confidence interval: 1.57-2.01). CONCLUSION The evidence available suggests that patients in low- and middle-income countries receiving cash during treatment for active pulmonary tuberculosis are more likely to have a positive clinical outcome. These findings support the incorporation of cash transfer interventions into social protection schemes within tuberculosis treatment programmes.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, United States of America (USA)
| | - Jonathan Steer-Massaro
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, USA
| | - Jana Jarolimova
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Liem Binh Luong Nguyen
- Infection, Antimicrobials, Modelling and Evolution, Unité Mixte de Recherche 1137, INSERM, Paris, France
| | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, USA
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Hsu J, Flores G, Evans D, Mills A, Hanson K. Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring. Int J Equity Health 2018; 17:69. [PMID: 29855334 PMCID: PMC5984475 DOI: 10.1186/s12939-018-0749-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring financial protection against catastrophic health expenditures is important to understand how health financing arrangements in a country protect its population against high costs associated with accessing health services. While catastrophic health expenditures are generally defined to be when household expenditures for health exceed a given threshold of household resources, there is no gold standard with several methods applied to define the threshold and household resources. These different approaches to constructing the indicator might give different pictures of a country's progress towards financial protection. In order for monitoring to effectively provide policy insight, it is critical to understand the sensitivity of measurement to these choices. METHODS This paper examines the impact of varying two methodological choices by analysing household expenditure data from a sample of 47 countries. We assess sensitivity of cross-country comparisons to a range of thresholds by testing for restricted dominance. We further assess sensitivity of comparisons to different methods for defining household resources (i.e. total expenditure, non-food expenditure and non-subsistence expenditure) by conducting correlation tests of country rankings. RESULTS We found country rankings are robust to the choice of threshold in a tenth to a quarter of comparisons within the 5-85% threshold range and this increases to half of comparisons if the threshold is restricted to 5-40%, following those commonly used in the literature. Furthermore, correlations of country rankings using different methods to define household resources were moderate to high; thus, this choice makes less difference from a measurement perspective than from an ethical perspective as different definitions of available household resources reflect varying concerns for equity. CONCLUSIONS Interpreting comparisons from global monitoring based on a single threshold should be done with caution as these may not provide reliable insight into relative country progress. We therefore recommend financial protection against catastrophic health expenditures be measured across a range of thresholds using a catastrophic incidence curve as shown in this paper. We further recommend evaluating financial protection in relation to a country's health financing system arrangements in order to better understand the extent of protection and better inform future policy changes.
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Affiliation(s)
- Justine Hsu
- Department of Health Systems Governance and Financing, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Gabriela Flores
- Department of Health Systems Governance and Financing, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - David Evans
- World Bank, 3 Chemin Louis-Dunant, 1202, Geneva, Switzerland
| | - Anne Mills
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
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Wingfield T, Tovar MA, Datta S, Saunders MJ, Evans CA. Addressing social determinants to end tuberculosis. Lancet 2018; 391:1129-1132. [PMID: 29595481 PMCID: PMC7611140 DOI: 10.1016/s0140-6736(18)30484-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/12/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Tom Wingfield
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK; Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK; Social Medicine, Infectious Diseases and Migration Group, Department of Public Health Science, Karolinksa Institutet, Stockholm, Sweden; LIV-TB, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Marco A Tovar
- Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Diseases and Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - Sumona Datta
- Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Diseases and Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - Matthew J Saunders
- Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Diseases and Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, London, UK
| | - Carlton A Evans
- Innovación Por la Salud Y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Innovation For Health And Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Diseases and Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, London, UK
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Rudgard WE, das Chagas NS, Gayoso R, Barreto ML, Boccia D, Smeeth L, Rodrigues LC, Lönnroth K, Williamson E, Maciel EL. Uptake of governmental social protection and financial hardship during drug-resistant tuberculosis treatment in Rio de Janeiro, Brazil. Eur Respir J 2018; 51:51/3/1800274. [DOI: 10.1183/13993003.00274-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/02/2018] [Indexed: 11/05/2022]
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Shewade HD, Gupta V, Satyanarayana S, Kharate A, Sahai K, Murali L, Kamble S, Deshpande M, Kumar N, Kumar S, Pandey P, Bajpai U, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Nath S, Singh P, Singh K, Singh R, Jayaraman G, Rajeswaran P, Srivastava BK, Biswas M, Mallick G, Bera OP, Jaisingh AJJ, Naqvi AJ, Verma P, Ansari MS, Mishra PC, Sumesh G, Barik S, Mathew V, Lohar MRS, Gaurkhede CS, Parate G, Bale SY, Koli I, Bharadwaj AK, Venkatraman G, Sathiyanarayanan K, Lal J, Sharma AK, Rao R, Kumar AM, Chadha SS. Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis. Glob Health Action 2018; 11:1494897. [PMID: 30173603 PMCID: PMC6129780 DOI: 10.1080/16549716.2018.1494897] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/25/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. OBJECTIVES To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). METHODS In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. RESULTS When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-0.58 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. CONCLUSION ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.
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Affiliation(s)
- Hemant Deepak Shewade
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Vivek Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Atul Kharate
- State TB Cell, Department of Health & Family Welfare, Government of Madhya Pradesh, Bhopal, India
| | - K.N. Sahai
- State TB Cell, Department of Health & Family Welfare, Government of Bihar, Patna, India
| | - Lakshmi Murali
- State TB Cell, Department of Health & Family Welfare, Government of Tamil Nadu, Chennai, India
| | - Sanjeev Kamble
- State TB Cell, Health Department, Government of Maharashtra, Pune, India
| | - Madhav Deshpande
- State TB Cell, Department of Health & Family Welfare, Government of Chattisgarh, Raipur, India
| | - Naresh Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Punjab, Chandigarh, India
| | - Sunil Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram, India
| | - Prabhat Pandey
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - U.N. Bajpai
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Jaya Prasad Tripathy
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Soundappan Kathirvel
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sripriya Pandurangan
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Subrat Mohanty
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Vaibhav Haribhau Ghule
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Karuna D. Sagili
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Banuru Muralidhara Prasad
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Sudhi Nath
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Priyanka Singh
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI), Telangana, India
| | - Ramesh Singh
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - P. Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | | | - Moumita Biswas
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Gayadhar Mallick
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Om Prakash Bera
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | | | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Prafulla Verma
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Prafulla C. Mishra
- Catholic Bishops’ Conference of India-Coalition for AIDS and Related Diseases (CBCI-CARD), New Delhi, India
| | - G. Sumesh
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Sanjeeb Barik
- Emmanuel Hospital Association (EHA), New Delhi, India
| | - Vijesh Mathew
- Catholic Health Association of India (CHAI), Telangana, India
| | | | | | - Ganesh Parate
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Ishwar Koli
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - G. Venkatraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - K. Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Jinesh Lal
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ajay M.V. Kumar
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Sarabjit Singh Chadha
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
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Shete PB, Dowdy DW. Measuring success: The challenge of social protection in helping eliminate tuberculosis. PLoS Med 2017; 14:e1002419. [PMID: 29112688 PMCID: PMC5675305 DOI: 10.1371/journal.pmed.1002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this Perspective on the research article by William Rudgard and colleagues, Priya Shete and coauthor discuss the challenges of measuring the impact of social protection programs such as cash transfers.
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Affiliation(s)
- Priya B. Shete
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - David W. Dowdy
- Department of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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