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Teibo TKA, Andrade RLDP, Rosa RJ, de Abreu PD, Olayemi OA, Alves YM, Vaz Tavares RB, da Costa FBP, Dias Moura HS, Ferezin L, Tártaro AF, de Campos MT, Ribeiro NM, Berra TZ, Arcêncio RA. Barriers That Interfere with Access to Tuberculosis Diagnosis and Treatment across Countries Globally: A Systematic Review. ACS Infect Dis 2024; 10:2600-2614. [PMID: 39023509 PMCID: PMC11320565 DOI: 10.1021/acsinfecdis.4c00466] [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: 06/08/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
This study evaluated the barriers that interfere with access to diagnosis and treatment of tuberculosis (TB) from the perspective of the patient and health professionals globally. Using the PICo acronym, the question we asked was "What are the barriers that interfere with access to tuberculosis diagnosis and treatment (I) from the perspective of patients and/or health professionals (P) across countries globally (Co)?". We searched the following databases: EMBASE, Scopus, MEDLINE, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. On Rayyan, duplicates were removed and extraction was done afterward by two authors independently, followed by a tiebreaker. Using a Critical Appraisal Tool proposed by the Joanna Briggs Institute, the methodological quality of the article was assessed. From 36 published articles, the barriers to tuberculosis diagnosis as obtained from our study include information scarcity/low TB knowledge, exorbitant cost of transport, sample collection challenges, long distance to health facility, gender limitations, lack of decentralized diagnostic services, payment for diagnosis and testing, medication side effects, multiple visits during therapy, delayed diagnosis, poor human resources, low knowledge of medical practitioners, concerns regarding the efficacy of treatment, poor facility coordination, poor socioeconomic factors, fear and stigmatization of TB, and wrong initial diagnosis. The review of studies on TB diagnosis and treatment barriers evidences the diverse barriers to the eradication of tuberculosis. Eliminating these barriers is an onus that lies on policy makers, citizens, and health workers alike, with the joint aim of reducing the global TB burden.
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Affiliation(s)
- Titilade Kehinde Ayandeyi Teibo
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Rubia Laine de Paula Andrade
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Rander Junior Rosa
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
- Department
of Physiology, Obafemi Awolowo University, Ile-Ife, Osun State 220282, Nigeria
| | - Paula Daniella de Abreu
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | | | - Yan Mathias Alves
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Reginaldo Bazon Vaz Tavares
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
- Department
of Physiology, Obafemi Awolowo University, Ile-Ife, Osun State 220282, Nigeria
| | - Heriederson Sávio Dias Moura
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Letícia
Perticarrara Ferezin
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
- Department
of Physiology, Obafemi Awolowo University, Ile-Ife, Osun State 220282, Nigeria
| | - Ariela Fehr Tártaro
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Mônica
Chiodi Toscano de Campos
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Natacha Martins Ribeiro
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Thaís Zamboni Berra
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
| | - Ricardo Alexandre Arcêncio
- Department
of Maternal-Infant and Public Health Nursing, Ribeirão Preto
College of Nursing, University of São
Paulo, Ribeirão
Preto, São Paulo 14040-092, Brazil
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Sinha P, Dauphinais M, Carwile ME, Horsburgh CR, Menzies NA. In-kind nutritional supplementation for household contacts of persons with tuberculosis would be cost-effective for reducing tuberculosis incidence and mortality in India: a modeling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.12.30.23300673. [PMID: 38260435 PMCID: PMC10802630 DOI: 10.1101/2023.12.30.23300673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Undernutrition is the leading cause of tuberculosis (TB) globally, but nutritional interventions are often considered cost prohibitive. The RATIONS study demonstrated that nutritional support provided to household contacts of persons with TB can reduce TB incidence. However, the long-term cost-effectiveness of this intervention is unclear. Methods We assessed the cost-effectiveness of a RATIONS-style intervention (daily 750 kcal dietary supplementation and multi-micronutrient tablet). Using a Markov state transition model we simulated TB incidence, treatment, and TB-attributable mortality among household contacts receiving the RATIONS intervention, as compared to no nutritional support. We calculated health outcomes (TB cases, TB deaths, and disability-adjusted life years [DALYs]) over the lifetime of intervention recipients and assessed costs from government and societal perspectives. We tested the robustness of results to parameter changes via deterministic and probabilistic sensitivity analysis. Findings Over two years, household contacts receiving the RATIONS intervention would experience 39% (95% uncertainty interval (UI): 23-52) fewer TB cases and 59% (95% UI: 44-69) fewer TB deaths. The intervention was estimated to avert 13,775 (95% UI: 9036-20,199) TB DALYs over the lifetime of the study cohort comprising 100,000 household contacts and was cost-effective from both government (incremental cost-effectiveness ratio: $229 per DALY averted [95% UI: 133-387]) and societal perspectives ($184 per DALY averted [95% UI: 83-344]). The results were most sensitive to the cost of the nutritional supplement. Interpretation Prompt nutritional support for household contacts of persons with TB disease would be cost-effective in reducing TB incidence and mortality in India. Summary Undernutrition is the leading cause of tuberculosis in India. Using a Markov state-transition model, we found that food baskets for household contacts of persons with tuberculosis would be cost-effective in reducing tuberculosis incidence and mortality in India. Research in context Evidence before this study: Undernutrition is the leading risk factor for TB worldwide. Recently, the RATIONS study demonstrated a roughly 40% reduction in incident TB among household contacts who received in-kind macronutrient and micronutrient supplementation. Added value of this study: Although the RATIONS study demonstrated a dramatic reduction in incident TB, it is unclear if nutritional interventions to prevent TB are cost-effective. Previously, only one cost-effectiveness analysis of nutritional interventions for household contacts has been published. Due to lack of published data, that study had to make assumptions regarding the impact of nutritional interventions on TB incidence and mortality. In this study, we conducted an economic evaluation of a RATIONS-style intervention to reduce incident TB and mortality in India using observed data. Implications of all the available evidence: In-kind nutritional supplementation for household contacts of individuals with TB disease would be cost-effective in reducing incident TB and TB mortality, particularly if TB programs leverage economies of scale to bring down the cost of the nutritional intervention.
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Brooks MB, Pingali V, Nicholson T, Keshavjee S. Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context. BMJ Open 2023; 13:e070717. [PMID: 38128936 DOI: 10.1136/bmjopen-2022-070717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease. DESIGN Estimating the economic cost of not finding and treating a patient suffering from tuberculosis. SETTING Estimation methodology is developed in the Indian context, as informed by local costs and reported tuberculosis epidemiology. PARTICIPANTS No individual participants were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure is the total cost of patients with drug-susceptible and drug-resistant tuberculosis who are and are not found and treated by tuberculosis programmes, including costs for medications, lost productivity, healthcare services and furthered transmission. We calculate the economic burdens by varying the number of individuals a person sick with tuberculosis infects (10 or 15 people) and the risk of progression to tuberculosis disease if infected (5 or 8%). The secondary outcome measure is the amount saved by finding a patient early or who would not have otherwise been found. All costs are presented in US dollars (exchange rate: 72 Indian rupees/1 US$). RESULTS By finding and treating a patient early before furthered transmission occurs-or stopping progression of tuberculosis infection to tuberculosis disease with preventive therapy-the Indian health system can save US$5502 to US$15 825 and US$5846 to US$25 575, for each individual with drug-susceptible and drug-resistant tuberculosis, respectively, across scenarios. CONCLUSIONS These estimates provide crude, lower bounds for the potential costs of not appropriately diagnosing and treating a single patient with active tuberculosis in a timely manner, or preventing a patient with tuberculosis infection from progressing to active disease. The actual financial burden on society is far higher than estimated using this simple, short-term cost-effective analyses. Our results highlight the limitations of tuberculosis costing models to date, and demonstrate the importance of accounting for airborne transmission of tuberculosis.
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Affiliation(s)
- Meredith B Brooks
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tom Nicholson
- Center for International Development, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
- Advance Access & Delivery, Durham, North Carolina, USA
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Clark RA, Weerasuriya CK, Portnoy A, Mukandavire C, Quaife M, Bakker R, Scarponi D, Harris RC, Rade K, Mattoo SK, Tumu D, Menzies NA, White RG. New tuberculosis vaccines in India: modelling the potential health and economic impacts of adolescent/adult vaccination with M72/AS01 E and BCG-revaccination. BMC Med 2023; 21:288. [PMID: 37542319 PMCID: PMC10403932 DOI: 10.1186/s12916-023-02992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/20/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND India had an estimated 2.9 million tuberculosis cases and 506 thousand deaths in 2021. Novel vaccines effective in adolescents and adults could reduce this burden. M72/AS01E and BCG-revaccination have recently completed phase IIb trials and estimates of their population-level impact are needed. We estimated the potential health and economic impact of M72/AS01E and BCG-revaccination in India and investigated the impact of variation in vaccine characteristics and delivery strategies. METHODS We developed an age-stratified compartmental tuberculosis transmission model for India calibrated to country-specific epidemiology. We projected baseline epidemiology to 2050 assuming no-new-vaccine introduction, and M72/AS01E and BCG-revaccination scenarios over 2025-2050 exploring uncertainty in product characteristics (vaccine efficacy, mechanism of effect, infection status required for vaccine efficacy, duration of protection) and implementation (achieved vaccine coverage and ages targeted). We estimated reductions in tuberculosis cases and deaths by each scenario compared to the no-new-vaccine baseline, as well as costs and cost-effectiveness from health-system and societal perspectives. RESULTS M72/AS01E scenarios were predicted to avert 40% more tuberculosis cases and deaths by 2050 compared to BCG-revaccination scenarios. Cost-effectiveness ratios for M72/AS01E vaccines were around seven times higher than BCG-revaccination, but nearly all scenarios were cost-effective. The estimated average incremental cost was US$190 million for M72/AS01E and US$23 million for BCG-revaccination per year. Sources of uncertainty included whether M72/AS01E was efficacious in uninfected individuals at vaccination, and if BCG-revaccination could prevent disease. CONCLUSIONS M72/AS01E and BCG-revaccination could be impactful and cost-effective in India. However, there is great uncertainty in impact, especially given the unknowns surrounding the mechanism of effect and infection status required for vaccine efficacy. Greater investment in vaccine development and delivery is needed to resolve these unknowns in vaccine product characteristics.
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Affiliation(s)
- Rebecca A Clark
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Chathika K Weerasuriya
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Christinah Mukandavire
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Quaife
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Roel Bakker
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Danny Scarponi
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca C Harris
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Sanofi Pasteur, Singapore, Singapore
| | | | | | - Dheeraj Tumu
- World Health Organization, New Delhi, India
- Central TB Division, NTEP, MoHFW Govt of India, New Delhi, India
| | - Nicolas A Menzies
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Richard G White
- TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
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Buonomo G, Acuña-Villaorduna C, Poongothai V, Dharmalingam M, Cintron C, Dauphinais M, Babu SP, Locks LM, Sarkar S, Salgame P, Hochberg NS, Lakshminaryanan S, Narasimhan PB, Sinha P. A micro-costing analysis of nutritional support for persons with TB and their families in India. Public Health Action 2023; 13:34-36. [PMID: 37359061 PMCID: PMC10290260 DOI: 10.5588/pha.22.0058] [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: 10/24/2022] [Accepted: 04/21/2023] [Indexed: 06/28/2023] Open
Abstract
Undernutrition is the leading risk factor for TB infection and death in India. We undertook a micro-costing analysis of a nutritional intervention for household contacts of people living with TB in Puducherry, India. We found that the total 6-month food cost for a family of four was USD4/day. We also identified several alternative regimens and cost-lowering strategies to encourage wider adoption of nutritional supplementation as a public health tool.
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Affiliation(s)
- G Buonomo
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - C Acuña-Villaorduna
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - V Poongothai
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - M Dharmalingam
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - C Cintron
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - M Dauphinais
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - S P Babu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - L M Locks
- Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - S Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P Salgame
- Center for Emerging Pathogens, Department of Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - N S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - S Lakshminaryanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P B Narasimhan
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
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Kanmani S, Logaraj M, John R, Arumai MM. Is economic burden still a problem among the patients with tuberculosis - A cost analysis: A descriptive cross-sectional study in Tamil Nadu. Indian J Tuberc 2022; 69:602-607. [PMID: 36460396 DOI: 10.1016/j.ijtb.2021.09.006] [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: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND There were more than 10 million people infected with TB across the globe. India has the world's largest tuberculosis load, with 2.4 million recorded cases in 2019. Poverty has an inseparable relationship with Tuberculosis. It is an inevitable risk factor, often resulting in delays in seeking treatment, imposing a financial burden on families, and poor compliance with treatment, etc., thereby leading to a very low rate of success in TB treatment. In this context, a study was undertaken among TB patients in Kanchipuram district with the objective of assessing the different costs associated with treatment and other associated issues they face from society as a consequence of the disease. MATERIALS METHODS A descriptive cross sectional descriptive study design was espoused to study among the 312 TB patients registered in the government's RNTCP program. A multi-stage random sampling technique was adopted to recruit and obtain data from them. A Univariate and bivariate analysis were employed to get the mean costs incurred during the pre & post diagnosis TB treatment. A linear regression test was performed to identify the relationship between the variables that influence the economic burden during the treatment process. CONCLUSION The study demonstrates that the total costs sustained by patients during the post-diagnosis phase are astronomical in contrast to the costs spent during the pre-diagnosis phase. The indirect cost in terms of time lost due to hospital visits and medication pickup, as well as inability to work, imposes a significant economic burden on patients and their families.
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Affiliation(s)
- Sellamuthu Kanmani
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology Campus, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India
| | - Muthunarayanan Logaraj
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology Campus, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India.
| | - Russelselvan John
- Department of Community Medicine, Apollo Institute of Medical Science & Research, Murakambattu, Chittoor, Andhra Pradesh, India
| | - Mariaselvam Mathew Arumai
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology Campus, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India
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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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