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Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.

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COVID-19 vaccine hesitancy among chronic disease patients can severely impact individual health with the potential to impede mass vaccination essential for containing the pandemic. The present study was done to assess the COVID-19 vaccine antecedents and its predictors among chronic disease patients. This cross-sectional study was conducted among chronic disease patients availing care from a primary health facility in urban Jodhpur, Rajasthan. Factor and reliability analysis was done for the vaccine hesitancy scale to validate the 5 C scale. Predictors assessed for vaccine hesitancy were modelled with help of machine learning (ML). Out of 520 patients, the majority of participants were female (54.81%). Exploratory factor analysis revealed four psychological antecedents’ “calculation”; “confidence”; “constraint” and “collective responsibility” determining 72.9% of the cumulative variance of vaccine hesitancy scale. The trained ML algorithm yielded an R2 of 0.33. Higher scores for COVID-19 health literacy and preventive behaviour, along with family support, monthly income, past COVID-19 screening, adherence to medications and age were associated with lower vaccine hesitancy. Behaviour changes communication strategies targeting COVID-19 health literacy and preventive behaviour especially among population sub-groups with poor family support, low income, higher age groups and low adherence to medicines may prove instrumental in this regard.

Although intralesional triamcinolone acetonide (TA) is the most commonly prescribed treatment for localized alopecia areata (AA), the literature regarding the optimal concentration for attaining better efficacy with the most acceptable side effects is scarce. To compare hair regrowth and local side effects of various concentrations of intralesional TA in scalp AA using clinical and dermoscopic parameters. A double‐blind randomized control trial with four treatment groups (10, 5, 2.5 mg/ml TA and normal saline [NS]) was conducted between March 2018 and August 2019. After recruitment, each AA patch was divided into quadrants and randomized before first injection. Injections were given and outcome parameters were analyzed every 4‐weekly till 12‐weeks. Statistical analysis was done by the R software employing generalized estimation equation. P‐value <.05 was considered significant. Out of 105‐patients (168‐AA patches), 75‐patients (121‐patches) completed the study. Hair regrowth scale of all TA concentrations was better than NS group (P < .001). Other parameters such as quadrants with poor clinical response and dermoscopic disease activity signs were also favorable in TA groups in comparison to NS. However the evidence of atrophy and telangiectasia was maximum in 10 mg/mL group. 10 mg/mL TA showed a comparatively better response at the cost of increased adverse effects. Based on the clinical benefit and adverse risk assessment from our study, it may be better to start with 2.5 mg/mL intralesional TA in limited scalp AA patients. It can be implied that the concentration of TA can be increased as a step‐up regimen based on the serial clinical and dermoscopic response.

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