1
|
Tucker JD. Financing infectious disease services in hospitals: a common public good. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00607-8. [PMID: 39312916 DOI: 10.1016/s1473-3099(24)00607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| |
Collapse
|
2
|
Folliero V, Ferravante C, Iovane V, Salvati A, Crescenzo L, Perna R, Corvino G, Della Rocca MT, Panetta V, Tranfa A, Greco G, Baldoni T, Pagnini U, Finamore E, Giurato G, Nassa G, Coppola M, Atripaldi L, Greco R, D'Argenio A, Foti MG, Abate R, Del Giudice A, Sarnelli B, Weisz A, Iovane G, Pinto R, Franci G, Galdiero M. Whole Genome Sequence Dataset of Mycobacterium tuberculosis Strains from Patients of Campania Region. Sci Data 2024; 11:220. [PMID: 38374088 PMCID: PMC10876956 DOI: 10.1038/s41597-024-03032-6] [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: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Tuberculosis (TB) is one of the deadliest infectious disorders in the world. To effectively TB manage, an essential step is to gain insight into the lineage of Mycobacterium tuberculosis (MTB) and the distribution of drug resistance. Although the Campania region is declared a cluster area for the infection, to contribute to the effort to understand TB evolution and transmission, still poorly known, we have generated a dataset of 159 genomes of MTB strains, from Campania region collected during 2018-2021, obtained from the analysis of whole genome sequence. The results show that the most frequent MTB lineage is the 4 according for 129 strains (81.11%). Regarding drug resistance, 139 strains (87.4%) were classified as multi susceptible, while the remaining 20 (12.58%) showed drug resistance. Among the drug-resistance strains, 8 were isoniazid-resistant MTB, 4 multidrug-resistant MTB, while only one was classified as pre-extensively drug-resistant MTB. This dataset expands the existing available knowledge on drug resistance and evolution of MTB, contributing to further TB-related genomics studies to improve the management of this disease.
Collapse
Affiliation(s)
- Veronica Folliero
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Ferravante
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy
- Molecular Pathology and Medical Genomics Program, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Valentina Iovane
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Naples, Italy
| | - Annamaria Salvati
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy
- Molecular Pathology and Medical Genomics Program, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Laura Crescenzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy
| | - Rossella Perna
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- Laboratory of Microbiology and Virology, Ospedali dei Colli, Naples, Italy
| | - Giusy Corvino
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
- UOC Microbiology - Ospedale Cardinale Ascalesi, ASL NA1, Naples, Italy
| | - Maria T Della Rocca
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
- UOSD Microbiology - AORN Sant 'Anna and San Sebastiano, Caserta, Italy
| | - Vittorio Panetta
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
- UOSD Microbiology - AORN Sant 'Anna and San Sebastiano, Caserta, Italy
| | - Alessandro Tranfa
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- UOC Microbiology and Virology- San Giuseppe Moscati Hospital, Avellino, Italy
| | - Giuseppe Greco
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
- Clinical Pathology and Microbiology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Teresa Baldoni
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
- Laboratory of Microbiology and Virology, Ospedali dei Colli, Naples, Italy
| | - Ugo Pagnini
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Emiliana Finamore
- UOC Virology and Microbiology - University Hospital AOU "Luigi Vanvitelli", Naples, Italy
| | - Giorgio Giurato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy
| | - Giovanni Nassa
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy
| | | | - Luigi Atripaldi
- Laboratory of Microbiology and Virology, Ospedali dei Colli, Naples, Italy
| | - Rita Greco
- UOSD Microbiology - AORN Sant 'Anna and San Sebastiano, Caserta, Italy
| | - Annamaria D'Argenio
- UOC Microbiology and Virology- San Giuseppe Moscati Hospital, Avellino, Italy
| | - Maria Grazia Foti
- UOC Microbiology and Virology- San Giuseppe Moscati Hospital, Avellino, Italy
| | - Rosamaria Abate
- UOC Microbiology - Ospedale Cardinale Ascalesi, ASL NA1, Naples, Italy
| | | | - Bruno Sarnelli
- UOC Microbiology - Ospedale Cardinale Ascalesi, ASL NA1, Naples, Italy
| | - Alessandro Weisz
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy
- Molecular Pathology and Medical Genomics Program, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Giuseppe Iovane
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Renato Pinto
- UOD Prevenzione e Sanità Pubblica Veterinaria, Direzione Generale Tutela della Salute - Regione Campania, Naples, Italy
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi, SA, Italy.
- Clinical Pathology and Microbiology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy.
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
- UOC Virology and Microbiology - University Hospital AOU "Luigi Vanvitelli", Naples, Italy.
| |
Collapse
|
3
|
Ramos JP, Vieira M, Pimentel C, Argel M, Barbosa P, Duarte R. Building bridges: multidisciplinary teams in tuberculosis prevention and care. Breathe (Sheff) 2023; 19:230092. [PMID: 37719241 PMCID: PMC10501709 DOI: 10.1183/20734735.0092-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/07/2023] [Indexed: 09/19/2023] Open
Abstract
People with or affected by tuberculosis (TB) experience complex social and cultural constraints that may affect treatment outcomes by impeding access to proper care or by hindering treatment adherence. Low levels of health literacy which leads to inadequate disease information; stigma, discrimination and other forms of prejudice that may result in marginalisation and ostracisation; and socioeconomic vulnerabilities that hamper one's capacity to access essential goods or increase the risk of exposure to the disease are some of the barriers highlighted. These complex hurdles are also disproportionately felt by people with or affected by TB due to gender-related inequalities that need to be properly addressed. Additionally, TB prevention and care should encompass interventions aimed at improving and promoting mental health, given that mental unhealth may further thwart treatment adherence and success. A multifaceted and multidisciplinary approach to TB is required to answer these complex barriers.
Collapse
Affiliation(s)
- João Pedro Ramos
- Departamento de Estudos das Populações, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Mariana Vieira
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | | | | | - Pedro Barbosa
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Raquel Duarte
- Departamento de Estudos das Populações, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Unidade de Investigaçao Clínica da Administraçao Regional de Saúde do Norte, Porto, Portugal
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
4
|
Yamanaka T, Garfin AMC, Gaviola DMG, Arao RM, Morishita F, Hiatt T, Nishikiori N, Yadav RP. Scoring tools to identify TB patients facing catastrophic costs in the Philippines. Public Health Action 2023; 13:53-59. [PMID: 37359062 PMCID: PMC10290262 DOI: 10.5588/pha.23.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND This study was to meet a practical need to design a simple tool to identify TB patients who may potentially be facing catastrophic costs while seeking TB care in the public sector. Such a tool may help prevent and address catastrophic costs among individual patients. METHODS We used data from the national TB patient cost survey in the Philippines. We randomly allocated TB patients to either the derivation or validation sample. Using adjusted odds ratios (ORs) and β coefficients of logistic regression, we developed four scoring systems to identify TB patients who may be facing catastrophic costs from the derivation sample. We validated each scoring system in the validation sample. RESULTS We identified a total of 12 factors as predictive indicators associated with catastrophic costs. Using all 12 factors, the β coefficients-based scoring system (area under the curve [AUC] 0.783, 95% CI 0.754-0.812) had a high validity. Even with seven selected factors with OR > 2.0, the validity remained in the acceptable range (β coefficients-based: AUC 0.767, 95% CI 0.737-0.798). CONCLUSION The β coefficients-based scoring systems in this analysis can be used to identify those at high risk of facing catastrophic costs due to TB in the Philippines. Operational feasibility needs to be investigated further to implement this in routine TB surveillance.
Collapse
Affiliation(s)
- T Yamanaka
- World Health Organization (WHO), Global Tuberculosis Programme, Geneva, Switzerland
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - A M C Garfin
- National TB Control Programme, Department of Health, Manila, The Philippines
| | - D M G Gaviola
- National TB Control Programme, Department of Health, Manila, The Philippines
| | - R M Arao
- Health Policy Development Programme (HPDP) UPecon Foundation, Inc., Quezon City, The Philippines
| | - F Morishita
- WHO Regional Office for the Western Pacific, Manila, The Philippines
| | - T Hiatt
- WHO Country Office, Manila, The Philippines
| | - N Nishikiori
- World Health Organization (WHO), Global Tuberculosis Programme, Geneva, Switzerland
| | - R P Yadav
- WHO Country Office, Manila, The Philippines
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Jops P, Cowan J, Kupul M, Trumb RN, Graham SM, Bauri M, Nindil H, Bell S, Keam T, Majumdar S, Pomat W, Marais B, Marks GB, Kaldor J, Vallely A, Kelly-Hanku A. Beyond patient delay, navigating structural health system barriers to timely care and treatment in a high burden TB setting in Papua New Guinea. Glob Public Health 2023; 18:2184482. [PMID: 36883701 DOI: 10.1080/17441692.2023.2184482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Tuberculosis (TB) is a major public health issue in Papua New Guinea, with incidence rates particularly high in the South Fly District of Western Province. We present three case studies, along with additional vignettes, that were derived from interviews and focus groups carried out between July 2019 and July 2020 of people living in rural areas of the remote South Fly District depicting their challenges accessing timely TB diagnosis and care; most services within the district are only offered offshore on Daru Island. The findings detail that rather than 'patient delay' attributed to poor health seeking behaviours and inadequate knowledge of TB symptoms, many people were actively trying to navigate structural barriers hindering access to and utilisation of limited local TB services. The findings highlight a fragile and fragmented health system, a lack of attention given to primary health services, and undue financial burdens placed on people living in rural and remote areas associated with costly transportation to access functioning health services. We conclude that a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in Papua New Guinea.
Collapse
Affiliation(s)
- Paula Jops
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - John Cowan
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Martha Kupul
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Richard Nake Trumb
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stephen M Graham
- Burnet Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Mathias Bauri
- Western Provincial Health Authority, Daru, Papua New Guinea
| | - Herolyn Nindil
- National TB Program, National Department of Health, Port Moresby, Papua New Guinea
| | - Stephen Bell
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Tess Keam
- Burnet Institute, Melbourne, Australia
| | - Suman Majumdar
- Burnet Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - William Pomat
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ben Marais
- Sydney Institute for Infectious Diseases (Sydney ID), University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, Australia.,Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Andrew Vallely
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| |
Collapse
|
7
|
Aia P, Viney K, Kal M, Kisomb J, Yasi R, Wangchuk LZ, Islam T, Jadambaa N, Rehan R, Nishikori N, Labelle S, Ershova J. The economic burden of TB faced by patients and affected families in Papua New Guinea. Int J Tuberc Lung Dis 2022; 26:934-941. [PMID: 36163675 PMCID: PMC11285074 DOI: 10.5588/ijtld.21.0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The costs associated with TB disease can be catastrophic for patients, affecting health and socioeconomic outcomes. Papua New Guinea (PNG) is a high TB burden country and the costs associated with TB are unknown.METHODS We undertook a national survey of TB patients to determine the magnitude of costs associated with TB in PNG, the proportion of households with catastrophic costs and cost drivers. We used a cluster sampling approach and recruited TB patients from health facilities. Descriptive statistics were used to analyse the costs and cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs.RESULTS We interviewed 1,000 TB patients; 19 (1.9%) of them had multidrug-resistant TB (MDR-TB). Costs due to TB were attributable to income loss (64.4%), non-medical (29.9%) and medical (5.7%) expenses. Catastrophic costs were experienced by 33.9% (95% CI 31.0-36.9) of households and were associated with MDR-TB (aOR 4.47, 95% CI 1.21-16.50), hospitalization (aOR 3.94, 95% CI 2.69-5.77), being in the poorest (aOR 3.52, 95% CI 2.43-5.10) or middle wealth tertiles (aOR 1.51, 95% CI 1.03-2.21) or being employed (aOR 2.02, 95% CI 1.43-2.89).CONCLUSION The costs due to TB disease were catastrophic for one third of TB-affected households in PNG. Current support measures could be continued, while new cost mitigation interventions may be considered where needed.
Collapse
Affiliation(s)
- P Aia
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | - K Viney
- The Karolinska Institutet, Stockholm, Sweden, Australian National University, Canberra ACT, Australia, Global TB Programme, World Health Organization (WHO), Geneva, Switzerland
| | - M Kal
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | - J Kisomb
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | - R Yasi
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | | | - T Islam
- WHO Regional Office for the Western Pacific, Manila, The Philippines
| | - N Jadambaa
- WHO Papua New Guinea Country Office, Port Moresby, Papua New Guinea
| | - R Rehan
- WHO Papua New Guinea Country Office, Port Moresby, Papua New Guinea
| | - N Nishikori
- Global TB Programme, World Health Organization (WHO), Geneva, Switzerland
| | - S Labelle
- Global TB Programme, World Health Organization (WHO), Geneva, Switzerland
| | - J Ershova
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
8
|
Nuttall C, Fuady A, Nuttall H, Dixit K, Mansyur M, Wingfield T. Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework. Infect Dis Poverty 2022; 11:101. [PMID: 36138434 PMCID: PMC9502609 DOI: 10.1186/s40249-022-01021-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prevention of tuberculosis (TB)-related stigma is vital to achieving the World Health Organisation's End TB Strategy target of eliminating TB. However, the process and impact evaluation of interventions to reduce TB-stigma are limited. This literature review aimed to examine the quality, design, implementation challenges, and successes of TB-stigma intervention studies and create a novel conceptual framework of pathways to TB-stigma reduction. METHOD We searched relevant articles recorded in four scientific databases from 1999 to 2022, using pre-defined inclusion and exclusion criteria, supplemented by the snowball method and complementary grey literature searches. We assessed the quality of studies using the Crowe Critical Appraisal Tool, then reviewed study characteristics, data on stigma measurement tools used, and interventions implemented, and designed a conceptual framework to illustrate the pathways to TB-stigma reduction in the interventions identified. RESULTS Of 14,259 articles identified, eleven met inclusion criteria, of which three were high quality. TB-stigma reduction interventions consisted mainly of education and psychosocial support targeted predominantly toward three key populations: people with TB, healthcare workers, and the public. No psychosocial interventions for people with TB set TB-stigma reduction as their primary or co-primary aim. Eight studies on healthcare workers and the public reported a decrease in TB-stigma attributed to the interventions. Despite the benefits, the interventions were limited by a dearth of validated stigma measurement tools. Three of eight studies with quantitative stigma measurement questionnaires had not been previously validated among people with TB. No qualitative studies used previously validated methods or tools to qualitatively evaluate stigma. On the basis of these findings, we generated a conceptual framework that mapped the population targeted, interventions delivered, and their potential effects on reducing TB-stigma towards and experienced by people with TB and healthcare workers involved in TB care. CONCLUSIONS Interpretation of the limited evidence on interventions to reduce TB-stigma is hampered by the heterogeneity of stigma measurement tools, intervention design, and outcome measures. Our novel conceptual framework will support mapping of the pathways to impacts of TB-stigma reduction interventions.
Collapse
Affiliation(s)
- Charlotte Nuttall
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, 10310 Jakarta, Indonesia
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, 3015GD Rotterdam, The Netherlands
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, 10430 Jakarta, Indonesia
| | - Holly Nuttall
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Kritika Dixit
- Social Medicine, Infectious Diseases, and Migration (SIM) Group, Department of Public Health Sciences, Karolinska Institute, 10653 Stockholm, Sweden
- Birat Nepal Medical Trust, Lazimpat Road, Lazimpat, Kathmandu, 44600 Nepal
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, 10310 Jakarta, Indonesia
| | - Tom Wingfield
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
- Social Medicine, Infectious Diseases, and Migration (SIM) Group, Department of Public Health Sciences, Karolinska Institute, 10653 Stockholm, Sweden
- Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP UK
| |
Collapse
|
9
|
du Preez K, Gabardo BMA, Kabra SK, Triasih R, Lestari T, Kal M, Tsogt B, Dorj G, Purev E, Nguyen TA, Naidoo L, Mvusi L, Schaaf HS, Hesseling AC, de Oliveira Rossoni AM, Carvalho ACC, Cardoso CAA, Sant’Anna CC, Orti DGD, Costa FD, Vega LR, Sant’Anna MDFP, Hoa NB, Phuc PH, Fiogbe AA, Affolabi D, Badoum G, Ouédraogo AR, Saouadogo T, Combary A, Kuate Kuate A, Prudence BNA, Magassouba AS, Bangoura AM, Soumana A, Hermana G, Gando H, Fall N, Gning B, Dogo MF, Mbitikon O, Deffense M, Zimba K, Chabala C, Sekadde MP, Luzze H, Turyahabwe S, Dongo JP, Lopes C, dos Santos M, Francis JR, Arango-Loboguerrero M, Perez-Velez CM, Koura KG, Graham SM. Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries. Pathogens 2022; 11:196. [PMID: 35215139 PMCID: PMC8878304 DOI: 10.3390/pathogens11020196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality-over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy-practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.
Collapse
Affiliation(s)
- Karen du Preez
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Betina Mendez Alcântara Gabardo
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Rina Triasih
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
| | - Trisasi Lestari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (R.T.); (T.L.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia;
| | - Margaret Kal
- National Department of Health, Port Moresby 131, Papua New Guinea;
| | | | - Gantsetseg Dorj
- Tuberculosis Surveillance and Research Department, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Enkhtsetseg Purev
- Tuberculosis Clinic, National Center for Communicable Diseases, Ulaanbaatar 210648, Mongolia;
| | - Thu Anh Nguyen
- Woolcock Institute of Medical Research, Ha Noi 100000, Vietnam;
| | - Lenny Naidoo
- Health Department, Cape Town 8000, South Africa;
| | - Lindiwe Mvusi
- National TB Control & Management Cluster, National Department of Health, Pretoria 0187, South Africa;
| | - Hendrik Simon Schaaf
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Anneke C. Hesseling
- Desmond Tutu Tuberculosis Center, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (H.S.S.); (A.C.H.)
| | - Andrea Maciel de Oliveira Rossoni
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Anna Cristina Calçada Carvalho
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
- Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21045-900, Brazil
| | - Claudete Aparecida Araújo Cardoso
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Clemax Couto Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | - Danielle Gomes Dell’ Orti
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Fernanda Dockhorn Costa
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Liliana Romero Vega
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
| | - Maria de Fátima Pombo Sant’Anna
- Pediatric Tuberculosis Working Group, Ministry of Health, Brasilia 70304-008, Brazil; (B.M.A.G.); (A.M.d.O.R.); (A.C.C.C.); (C.A.A.C.); (C.C.S.); (D.G.D.O.); (F.D.C.); (L.R.V.); (M.d.F.P.S.)
- Brazilian Network of Tuberculosis Research, REDE TB—Rede Brasileira de Pesquisas em Tuberculose, Rio de Janeiro 21941-909, Brazil
| | | | - Phan Huu Phuc
- National Pediatric Hospital, Ha Noi 100000, Vietnam;
| | - Attannon Arnauld Fiogbe
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
| | - Dissou Affolabi
- National Tuberculosis Program, Cotonou 03 BP 2819, Benin;
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou 03 BP 2819, Benin
| | - Gisèle Badoum
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Abdoul Risgou Ouédraogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Health Sciences Unit, University Joseph Ki-Zerbo, Ouagadougou 03 BP 7047, Burkina Faso
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Tandaogo Saouadogo
- Ministry of Health National Tuberculosis Program, Ouagadougou 03 BP 7047, Burkina Faso;
| | - Adjima Combary
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | - Albert Kuate Kuate
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Yaoundé BP 6000, Cameroon;
| | | | - Aboubakar Sidiki Magassouba
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Conakry 63570, Guinea;
| | | | - Alphazazi Soumana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Niamey 22 646, Niger
| | - Georges Hermana
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Hervé Gando
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Nafissatou Fall
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Barnabé Gning
- National Tuberculosis Program, Dakar 12000, Senegal;
| | - Mohammed Fall Dogo
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Lomé BP 526, Togo
| | - Olivia Mbitikon
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- National Tuberculosis Program, Bangui BP 729, Central African Republic;
| | - Manon Deffense
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
| | - Kevin Zimba
- Lusaka Provincial Health Office, Ministry of Health, Lusaka 10101, Zambia;
| | - Chishala Chabala
- Department of Pediatrics and Child Health, School of Medicine, University of Zambia, Lusaka 10101, Zambia;
- Children’s Hospital, University Teaching Hospitals, Lusaka 10101, Zambia
| | | | - Henry Luzze
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala 7025, Uganda; (M.P.S.); (H.L.); (S.T.)
| | | | - Constantino Lopes
- National Tuberculosis Program, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | - Milena dos Santos
- Hospital Nacional Guido Valadares, Ministerio da Saude, Dili NM 87109, Timor-Leste;
| | | | | | - Carlos M. Perez-Velez
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ 85721, USA;
| | - Kobto Ghislain Koura
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- COMUE Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, 75006 Paris, France
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou 03 BP 351, Benin
| | - Stephen M. Graham
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France; (A.A.F.); (G.B.); (A.R.O.); (A.C.); (A.K.K.); (A.S.M.); (A.S.); (G.H.); (N.F.); (M.F.D.); (O.M.); (M.D.); (K.G.K.); (S.M.G.)
- Department of Pediatrics, Murdoch Childrens Research Institute, University of Melbourne Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| |
Collapse
|
10
|
Gilmour B, Xu Z, Bai L, Alene KA, Clements ACA. The impact of ethnic minority status on tuberculosis diagnosis and treatment delays in Hunan Province, China. BMC Infect Dis 2022; 22:90. [PMID: 35081919 PMCID: PMC8790941 DOI: 10.1186/s12879-022-07072-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a major public health challenge in China. Understanding TB management delays within the context of China's unique ethnic diversity may be of value in tackling the disease. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays. METHODS This retrospective cohort study was conducted on patients diagnosed with TB in Hunan Province, China between 2013 and 2018. Diagnosis delay was defined as the time interval between the onset of symptoms and the date of diagnosis. Treatment delay was defined as the time interval between diagnosis and treatment commencement. Univariable and multivariable logistic regression models were used to identify factors associated with TB diagnosis and treatment delay, including ethnic minority status. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to assess the strength of association between the dependant and independent variables. RESULTS A total of 318,792 TB patients were included in the study with a mean age of 51.7 years (SD 17.7). The majority of patients were male (72.6%) and Han ethnicity (90.6%). The odds of experiencing diagnosis delay (> 21 days) were significantly higher for Tujia (AOR: 1.46, 95% CI: 1.41, 1.51), Miao (AOR: 1.31, 95% CI: 1.26, 1.37), Dong (AOR: 1.97, 95% CI: 1.85, 2.11), Yao (AOR: 1.27, 95% CI: 1.17, 1.37), and Bai (AOR: 1.45, 95% CI: 1.22, 1.74) ethnic minorities compared to the Han majority. The odds of experiencing treatment delay (> 15 days) were significantly lower for five of the seven ethnic minority groups relative to the Han majority: Tujia (AOR 0.92, 95% CI 0.88, 0.96), Miao (AOR 0.74, 95% CI 0.70, 0.79), Dong (AOR 0.87, 95% CI 0.81, 0.95), Yao (AOR 0.20, 95% CI 0.17, 0.24) and 'other' (ethnic minorities that individually represented < 0.1% of the patient population) (AOR 0.70, 955 CI 0.51, 0.97). CONCLUSIONS This study shows ethnic minority status to be a significant risk factor in diagnosis delay, but for it to reduce the odds of treatment delay. Further research is required to determine the underlying causes of diagnosis delay within ethnic minority populations.
Collapse
Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Western Australia, Kent St, Bentley, WA, 6102, Australia.
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China.,TB Control Institute of Hunan Province, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Western Australia, Kent St, Bentley, WA, 6102, Australia.,Telethon Kids Institute, Nedlands, WA, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Western Australia, Kent St, Bentley, WA, 6102, Australia.,Telethon Kids Institute, Nedlands, WA, Australia
| |
Collapse
|
11
|
Long Q, Guo L, Jiang W, Huan S, Tang S. Ending tuberculosis in China: health system challenges. Lancet Public Health 2021; 6:e948-e953. [DOI: 10.1016/s2468-2667(21)00203-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/22/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022]
|
12
|
Vo LNQ, Forse RJ, Codlin AJ, Dang HM, Van Truong V, Nguyen LH, Nguyen HB, Nguyen NV, Sidney-Annerstedt K, Lonnroth K, Squire SB, Caws M, Worrall E, de Siqueira-Filha NT. Socio-protective effects of active case finding on catastrophic costs from tuberculosis in Ho Chi Minh City, Viet Nam: a longitudinal patient cost survey. BMC Health Serv Res 2021; 21:1051. [PMID: 34610841 PMCID: PMC8493691 DOI: 10.1186/s12913-021-06984-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many tuberculosis (TB) patients incur catastrophic costs. Active case finding (ACF) may have socio-protective properties that could contribute to the WHO End TB Strategy target of zero TB-affected families suffering catastrophic costs, but available evidence remains limited. This study measured catastrophic cost incurrence and socioeconomic impact of an episode of TB and compared those socioeconomic burdens in patients detected by ACF versus passive case finding (PCF). METHODS This cross-sectional study fielded a longitudinal adaptation of the WHO TB patient cost survey alongside an ACF intervention from March 2018 to March 2019. The study was conducted in six intervention (ACF) districts and six comparison (PCF) districts of Ho Chi Minh City, Viet Nam. Fifty-two TB patients detected through ACF and 46 TB patients in the PCF cohort were surveyed within two weeks of treatment initiation, at the end of the intensive phase of treatment, and after treatment concluded. The survey measured income, direct and indirect costs, and socioeconomic impact based on which we calculated catastrophic cost as the primary outcome. Local currency was converted into US$ using the average exchange rates reported by OANDA for the study period (VNĐ1 = US$0.0000436, 2018-2019). We fitted logistic regressions for comparisons between the ACF and PCF cohorts as the primary exposures and used generalized estimating equations to adjust for autocorrelation. RESULTS ACF patients were poorer than PCF patients (multidimensional poverty ratio: 16 % vs. 7 %; p = 0.033), but incurred lower median pre-treatment costs (US$18 vs. US$80; p < 0.001) and lower median total costs (US$279 vs. US$894; p < 0.001). Fewer ACF patients incurred catastrophic costs (15 % vs. 30 %) and had lower odds of catastrophic cost (aOR = 0.17; 95 % CI: [0.05, 0.67]; p = 0.011), especially during the intensive phase (OR = 0.32; 95 % CI: [0.12, 0.90]; p = 0.030). ACF patient experienced less social exclusion (OR = 0.41; 95 % CI: [0.18, 0.91]; p = 0.030), but more often resorted to financial coping mechanisms (OR = 5.12; 95 % CI: [1.73, 15.14]; p = 0.003). CONCLUSIONS ACF can be effective in reaching vulnerable populations and mitigating the socioeconomic burden of TB, and can contribute to achieving the WHO End TB Strategy goals. Nevertheless, as TB remains a catastrophic life event, social protection efforts must extend beyond ACF.
Collapse
Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Vietnam. .,IRD VN, Ho Chi Minh City, Vietnam.
| | - Rachel Jeanette Forse
- Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Vietnam.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Andrew James Codlin
- Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Vietnam
| | - Ha Minh Dang
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Knut Lonnroth
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - S Bertel Squire
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | - Maxine Caws
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK.,Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| | - Eve Worrall
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | |
Collapse
|
13
|
Dixit K, Biermann O, Rai B, Aryal TP, Mishra G, Teixeira de Siqueira-Filha N, Paudel PR, Pandit RN, Sah MK, Majhi G, Levy J, Rest JV, Gurung SC, Dhital R, Lönnroth K, Squire SB, Caws M, Sidney K, Wingfield T. Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention. BMJ Open 2021; 11:e049900. [PMID: 34598986 PMCID: PMC8488704 DOI: 10.1136/bmjopen-2021-049900] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/10/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. DESIGN From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. SETTING The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. PARTICIPANTS Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. RESULTS The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. CONCLUSION These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.
Collapse
Affiliation(s)
- Kritika Dixit
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Olivia Biermann
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Bhola Rai
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Tara Prasad Aryal
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Gokul Mishra
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Noemia Teixeira de Siqueira-Filha
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Health Sciences, University of York, York, UK
| | - Puskar Raj Paudel
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Ram Narayan Pandit
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Manoj Kumar Sah
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Govinda Majhi
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Jens Levy
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Job van Rest
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Suman Chandra Gurung
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Raghu Dhital
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
| | - Knut Lönnroth
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - S Bertel Squire
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Maxine Caws
- Department of Research, Birat Nepal Medical Trust (BNMT), Kathmandu, Nepal
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kristi Sidney
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tom Wingfield
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
14
|
Ellaban MM, Basyoni NI, Boulos DNK, Rady M, Gadallah M. Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study. Tuberc Respir Dis (Seoul) 2021; 85:165-174. [PMID: 34814238 PMCID: PMC8987667 DOI: 10.4046/trd.2021.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background One goal of the End tuberculosis (TB) Strategy is to see no TB-affected households experiencing catastrophic costs. Therefore, it is crucial for TB-elimination programs to identify catastrophic costs and their main drivers in order to establish appropriate health and social measures. This study aimed to measure the percent of catastrophic costs experienced by Egyptian TB patients and to identify its determinants. Methods We conducted a prospective cohort study with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governate from May 2019 to May 2020. We used a validated World Health Organization TB patient-cost tool to collect data on patients’ demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household’s annual income. Results Of the patients, 33% experienced catastrophic costs. The highest proportion of the total came in the pretreatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early coronavirus disease 2019 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted. Conclusion Despite the availability of free TB care under the Egyptian National TB Program, nearly a third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs. Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.
Collapse
Affiliation(s)
- Manar M Ellaban
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nashwa I Basyoni
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina N K Boulos
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mervat Rady
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohsen Gadallah
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
15
|
Estill J, Islam T, Houben RMGJ, Rudman J, Ragonnet R, McBryde ES, Trauer JM, Orel E, Nguyen AT, Rahevar K, Morishita F, Oh KH, Raviglione MC, Keiser O. Tuberculosis in the Western Pacific Region: Estimating the burden of disease and return on investment 2020-2030 in four countries. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 11:100147. [PMID: 34327358 PMCID: PMC8315379 DOI: 10.1016/j.lanwpc.2021.100147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
Abstract
Background We aimed to estimate the disease burden of Tuberculosis (TB) and return on investment of TB care in selected high-burden countries of the Western Pacific Region (WPR) until 2030. Methods We projected the TB epidemic in Viet Nam and Lao People's Democratic Republic (PDR) 2020–2030 using a mathematical model under various scenarios: counterfactual (no TB care); baseline (TB care continues at current levels); and 12 different diagnosis and treatment interventions. We retrieved previous modeling results for China and the Philippines. We pooled the new and existing information on incidence and deaths in the four countries, covering >80% of the TB burden in WPR. We estimated the return on investment of TB care and interventions in Viet Nam and Lao PDR using a Solow model. Findings In the baseline scenario, TB incidence in the four countries decreased from 97•0/100,000/year (2019) to 90•1/100,000/year (2030), and TB deaths from 83,300/year (2019) to 71,100/year (2030). Active case finding (ACF) strategies (screening people not seeking care for respiratory symptoms) were the most effective single interventions. Return on investment (2020–2030) for TB care in Viet Nam and Lao PDR ranged US$4-US$49/dollar spent; additional interventions brought up to US$2•7/dollar spent. Interpretation In the modeled countries, TB incidence will only modestly decrease without additional interventions. Interventions that include ACF can reduce TB burden but achieving the End TB incidence and mortality targets will be difficult without new transformational tools (e.g. vaccine, new diagnostic tools, shorter treatment). However, TB care, even at its current level, can bring a multiple-fold return on investment. Funding World Health Organization Western Pacific Regional Office; Swiss National Science Foundation Grant 163878.
Collapse
Affiliation(s)
- Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Tauhid Islam
- End TB and Leprosy Unit, Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Rein M G J Houben
- TB Modeling Group, Department of Infectious Disease Epidemiology, London School of Hygiene ad Tropical Medicine, London, United Kingdom
| | - Jamie Rudman
- TB Modeling Group, Department of Infectious Disease Epidemiology, London School of Hygiene ad Tropical Medicine, London, United Kingdom
| | - Romain Ragonnet
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - James M Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Erol Orel
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Anh Tuan Nguyen
- Department of TB and Lung Diseases, Hanoi Medical University, Hanoi, Viet Nam
| | - Kalpeshsinh Rahevar
- End TB and Leprosy Unit, Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Fukushi Morishita
- End TB and Leprosy Unit, Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- End TB and Leprosy Unit, Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| |
Collapse
|
16
|
Long Q, Jiang WX, Zhang H, Cheng J, Tang SL, Wang WB. Multi-source financing for tuberculosis treatment in China: key issues and challenges. Infect Dis Poverty 2021; 10:17. [PMID: 33750460 PMCID: PMC7943260 DOI: 10.1186/s40249-021-00809-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background The End Tuberculosis (TB) Strategy of the World Health Organization highlights the need for patient-centered care and social protection measures that alleviate the financial hardships faced by many TB patients. In China, TB treatments are paid for by earmarked government funds, social health insurance, medical assistance for the poor, and out-of-pocket payments from patients. As part of Phase III of the China-Gates TB project, this paper introduces multi-source financing of TB treatment in the three provinces of China and analyzes the challenges of moving towards universal coverage and its implications of multi-sectoral engagement for TB care. Main text The new financing policies for TB treatment in the three provinces include increased reimbursement for TB outpatient care, linkage of TB treatment with local poverty alleviation programs, and use of local government funds to cover some costs to reduce out-of-pocket expenses. However, there are several challenges in reducing the financial burdens faced by TB patients. First, medical costs must be contained by reducing the profit-maximizing behaviors of hospitals. Second, treatment for TB and multi-drug resistant TB (MDR-TB) is only available at county hospitals and city or provincial hospitals, respectively, and these hospitals have low reimbursement rates and high co-payments. Third, many patients with TB and MDR-TB are at the edge of poverty, and therefore ineligible for medical assistance, which targets extremely poor individuals. In addition, the local governments of less developed provinces often face fiscal difficulties, making it challenging to use of local government funds to provide financial support for TB patients. We suggest that stakeholders at multiple sectors should engage in transparent and responsive communications, coordinate policy developments, and integrate resources to improve the integration of social protection schemes. Conclusions The Chinese government is examining the establishment of multi-source financing for TB treatment by mobilization of funds from the government and social protection schemes. These efforts require strengthening the cooperation of multiple sectors and improving the accountability of different government agencies. All key stakeholders must take concrete actions in the near future to assure significant progress toward the goal of alleviating the financial burden faced by TB and MDR-TB patients. Graphic abstract ![]()
Collapse
Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
| | - Wei-Xi Jiang
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Jun Cheng
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Sheng-Lan Tang
- Global Health Research Center, Duke Kunshan University, Jiangsu, China.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Wei-Bing Wang
- Department of Epidemiology, School of Public Health & Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China.
| |
Collapse
|
17
|
Chittamany P, Yamanaka T, Suthepmany S, Sorsavanh T, Siphanthong P, Sebert J, Viney K, Vixaysouk T, Nagai M, Seevisay V, Izumi K, Morishita F, Nishikiori N. First national tuberculosis patient cost survey in Lao People's Democratic Republic: Assessment of the financial burden faced by TB-affected households and the comparisons by drug-resistance and HIV status. PLoS One 2020; 15:e0241862. [PMID: 33180777 PMCID: PMC7660466 DOI: 10.1371/journal.pone.0241862] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients incur large costs for care seeking, diagnosis, and treatment. To understand the magnitude of this financial burden and its main cost drivers, the Lao People's Democratic Republic (PDR) National TB Programme carried out the first national TB patient cost survey in 2018-2019. METHOD A facility-based cross-sectional survey was conducted based on a nationally representative sample of TB patients from public health facilities across 12 provinces. A total of 848 TB patients including 30 drug resistant (DR)-TB and 123 TB-HIV coinfected patients were interviewed using a standardised questionnaire developed by the World Health Organization. Information on direct medical, direct non-medical and indirect costs, as well as coping mechanisms was collected. We estimated the percentage of TB-affected households facing catastrophic costs, which was defined as total TB-related costs accounting for more than 20% of annual household income. RESULT The median total cost of TB care was US$ 755 (Interquartile range 351-1,454). The costs were driven by direct non-medical costs (46.6%) and income loss (37.6%). Nutritional supplements accounted for 74.7% of direct non-medical costs. Half of the patients used savings, borrowed money or sold household assets to cope with TB. The proportion of unemployment more than doubled from 16.8% to 35.4% during the TB episode, especially among those working in the informal sector. Of all participants, 62.6% of TB-affected households faced catastrophic costs. This proportion was higher among households with DR-TB (86.7%) and TB-HIV coinfected patients (81.1%). CONCLUSION In Lao PDR, TB patients and their households faced a substantial financial burden due to TB, despite the availability of free TB services in public health facilities. As direct non-medical and indirect costs were major cost drivers, providing free TB services is not enough to ease this financial burden. Expansion of existing social protection schemes to accommodate the needs of TB patients is necessary.
Collapse
Affiliation(s)
| | - Takuya Yamanaka
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | | | - Jacques Sebert
- National TB Programme, Ministry of Health, Vientiane, Lao PDR
| | - Kerri Viney
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
- Research School of Population Health, Australian National University, Canberra, Australia
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Moeko Nagai
- World Health Organization, Country Office, Vientiane, Lao PDR
| | - Vilath Seevisay
- World Health Organization, Country Office, Vientiane, Lao PDR
| | - Kiyohiko Izumi
- World Health Organization, Country Office, Vientiane, Lao PDR
| | - Fukushi Morishita
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Nobuyuki Nishikiori
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| |
Collapse
|
18
|
Rupani MP, Cattamanchi A, Shete PB, Vollmer WM, Basu S, Dave JD. Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India. Infect Dis Poverty 2020; 9:144. [PMID: 33076969 PMCID: PMC7574230 DOI: 10.1186/s40249-020-00760-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background India reports the highest number of tuberculosis (TB) cases worldwide. Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB. Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar (western India) using an adapted World Health Organization costing tool. Methods We conducted a descriptive cross-sectional study of adults, notified in the public sector and being treated for drug-susceptible pulmonary TB during January–June 2019, in six urban and three rural blocks of Bhavnagar region, Gujarat state, India. The direct and indirect TB-related costs, as well as patients’ coping strategies, were assessed for the overall care of TB till treatment completion. Catastrophic costs were defined as total costs > 20% of annual household income (excluding any amount received from cash transfer programs or borrowed). Median and interquartile range (IQR) was used to summarize patient costs. The median costs between any two groups were compared using the median test. The association between any two categorical variables was tested by the Pearson chi-squared test. All costs were described in US dollars (USD). During the study period, on average, one USD equalled 70 Indian Rupees. Results Of 458 patients included, 70% were male, 62% had no formal education, 71% lived in urban areas, and 96% completed TB treatment. The median (IQR) total costs were USD 8 (5–28), direct medical costs were USD 0 (0–0), direct non-medical costs were USD 3 (2–4) and indirect costs were USD 6 (3–13). Among direct non-medical costs, travel cost (median = USD 3, IQR: 2–4) to attend health facilities were the most prominent, whereas the indirect costs were mainly contributed by the patient’s loss of wages (median = USD 3, IQR: 0–6). Four percent of patients faced catastrophic costs, 11% borrowed money to cover costs and 7% lost their employment; the median working days lost to TB was 30 (IQR: 15–45). A majority (88%) of patients received a median USD 43 (IQR: 41–43) as part of a cash transfer program for TB patients. Conclusions Treatment completion was high and the costs incurred by TB patients were low in this setting. However, negative financial consequences occur even in low-cost settings. The role of universal cash transfer programs in such settings requires further study.
Collapse
Affiliation(s)
- Mihir P Rupani
- Department of Community Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Near ST Bus Stand, Jail Road, Bhavnagar, Gujarat 364001, India.
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco (UCSF), California, USA
| | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco (UCSF), California, USA
| | - William M Vollmer
- Division of Biostatistics, Kaiser Permanente Center for Health Research, Portland, USA
| | - Sanjib Basu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Jigna D Dave
- Department of Respiratory Medicine, Government Medical College Bhavnagar (Maharaja Krishnakumarsinhji Bhavnagar University), Bhavnagar, Gujarat, India
| |
Collapse
|
19
|
Morishita F, Viney K, Lowbridge C, Elsayed H, Oh KH, Rahevar K, Marais BJ, Islam T. Epidemiology of tuberculosis in the Western Pacific Region: Progress towards the 2020 milestones of the End TB Strategy. Western Pac Surveill Response J 2020; 11:10-23. [PMID: 34046237 PMCID: PMC8152824 DOI: 10.5365/wpsar.2020.11.3.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Since 2015, the End TB Strategy and the Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016-2020 have guided national tuberculosis (TB) responses in countries and areas of the Region. This paper provides an overview of the TB epidemiological situation in the Western Pacific Region and of progress towards the 2020 milestones of the Strategy. A descriptive analysis was conducted of TB surveillance and programme data reported to WHO and estimates of the TB burden generated by WHO for the period 2000-2018. An estimated 1.8 million people developed TB and 90 000 people died from it in the Region in 2018. Since 2015, the estimated TB incidence rate and the estimated number of TB deaths in the Region decreased by 3% and 10%, with annual reduction rates of 1.0% and 3.4%, respectively. With current efforts, the Region is unlikely to achieve the 2020 milestones and other targets of the Strategy. Major challenges include: (1) wide variation in the geographical distribution and rate of TB incidence among countries; (2) a substantial proportion (23%) of TB cases that remain unreached, undiagnosed or unreported; (3) insufficient coverage of drug susceptibility testing (51%) for bacteriologically confirmed cases and limited use of WHO-recommended rapid diagnostics (11 countries reported < 60% coverage); (4) suboptimal treatment outcomes of TB (60% of countries reported < 85% success), of TB/HIV co-infection (79%) and of multidrug- or rifampicin-resistant TB (59%); (5) limited coverage of TB preventive treatment among people living with HIV (39%) and child contacts (12%); and (6) substantial proportions (35-70%) of TB-affected families facing catastrophic costs. For the Region to stay on track to achieve the End TB Strategy targets, an accelerated multisectoral response to TB is required in every country.
Collapse
Affiliation(s)
- Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- Prevention, Diagnosis, Treatment, Care and Innovation Unit, Global TB Programme, World Health Organization, Geneva, Switzerland
- Centre for Research Excellence in Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Chris Lowbridge
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Hend Elsayed
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Kalpeshsinh Rahevar
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J Marais
- Centre for Research Excellence in Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Tauhid Islam
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Assebe LF, Negussie EK, Jbaily A, Tolla MTT, Johansson KA. Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey. BMJ Open 2020; 10:e036892. [PMID: 32487582 PMCID: PMC7265036 DOI: 10.1136/bmjopen-2020-036892] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES HIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia. DESIGN A cross-sectional survey. SETTING 27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV. PARTICIPANTS A total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively. OUTCOME MEASURES The economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold. RESULTS The mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%). CONCLUSIONS HIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.
Collapse
Affiliation(s)
- Lelisa Fekadu Assebe
- Department Of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Disease Prevention and Control, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Abdulrahman Jbaily
- Department Of Global Health and Population, Harvard T.H.Chan School of Public Health,Harvard University, Boston, Massachusetts, USA
| | - Mieraf Taddesse Taddesse Tolla
- Department Of Global Health and Population, Harvard T.H.Chan School of Public Health,Harvard University, Boston, Massachusetts, USA
| | - Kjell Arne Johansson
- Department Of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
22
|
Vo LNQ, Codlin AJ, Forse RJ, Nguyen HT, Vu TN, Van Truong V, Do GC, Nguyen LH, Le GT, Caws M. Tuberculosis among economic migrants: a cross-sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam. BMC Infect Dis 2020; 20:134. [PMID: 32050913 PMCID: PMC7017549 DOI: 10.1186/s12879-020-4865-7] [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: 07/06/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. METHODS This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient's government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7). RESULTS Short-term, inter-province migrants experienced lower treatment success (aRR = 0.95 [95% CI: 0.92-0.99], p = 0.010) and higher loss to follow-up (aOR = 1.98 [95% CI: 1.44-2.72], p < 0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR = 1.86 [95% CI: 1.03-3.36], p = 0.041). There was evidence that patients > 55 years of age (aRR = 0.93 [95% CI: 0.89-0.96], p < 0.001), relapse patients (aRR = 0.89 [95% CI: 0.84-0.94], p < 0.001), and retreatment patients (aRR = 0.62 [95% CI: 0.52-0.75], p < 0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR = 0.77 [95% CI: 0.73-0.82], p < 0.001) and higher loss to follow-up (aOR = 2.18 [95% CI: 1.55-3.06], p < 0.001). The provision of treatment adherence support increased treatment success (IRR(β6) = 1.07 [95% CI: 1.00, 1.15], p = 0.041) and reduced loss to follow-up (IRR(β6) = 0.17 [95% CI: 0.04, 0.69], p = 0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7) = 0.90 [95% CI: 0.83, 0.98], p = 0.019). CONCLUSIONS Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.
Collapse
Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam. .,Interactive Research and Development, Ho Chi Minh City, Viet Nam.
| | - Andrew James Codlin
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | - Rachel Jeanette Forse
- Friends for International TB Relief, 68B Nguyen Van Troi, 8, Phu Nhuan, Ho Chi Minh City, Viet Nam
| | | | - Thanh Nguyen Vu
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | | | - Giang Chau Do
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | | | - Giang Truong Le
- Ho Chi Minh City Public Health Association, Ho Chi Minh City, Viet Nam
| | - Maxine Caws
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK.,Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| |
Collapse
|