Expanded blood borne virus testing in a tuberculosis clinic. A cost and yield analysis

Sewell, Janey; Capocci, Santino; Johnson, Johnny; Hopkins, Susan; Cropley, I; Webster, Daniel P.; Lipman, Marc

doi:10.1016/j.jinf.2014.10.014

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…These fees are known to have a negative impact on general health service utilisation and this is likely to be more prominent in TB patients with limited financial resilience [ 18 ]. Clinic costs for attending TB clinics in the study comprised consultation fees, smear microscopy, X-rays and blood tests to screen for other diseases [ 19 ]. Furthermore, although not captured in the study, bacteriologically negative cases may undergo further consultation and testing, pay for further visits and have higher expenditure than smear-positive cases.…”

Section: Resultsmentioning

confidence: 99%

“…The costs described here represent only a proportion of the economic barriers faced by individuals with symptoms of TB, as the cost of previous healthcare, visits to the private sector and indirect costs - such as loss of employment and work time – which may constitute a major part of patients’ outgoings, were not documented [ 19 , 20 , 23 – 26 ]. Opportunity costs tend to be higher for people living in poverty, who for the most part work in the informal sector and are vulnerable to loss of income or dismissal from work [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

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Patients direct costs to undergo TB diagnosis

et al. 2016

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BackgroundA major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.MethodsWe aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75th quartile were considered to have high expenditure (cases) and compared with patients with costs <75th quartile to identify factors associated with high expenditure.ResultsThe most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy.ConclusionsThe costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0117-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Patients direct costs to undergo TB diagnosis

et al. 2016

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“…The prevalence of HBV coinfection ranged from 0.6% to 1.2% in patients with LTBI and ranged from 0.8% to 3.7% in patients with active TB. When performing a meta-analysis, we utilized the HBV prevalence in active TB patients for the Nooredinvand et al 27 study and the HBV prevalence in LTBI patients for the Sewell et al 28 study given that the diagnostic criteria for active TB and LTBI in those studies, respectively, were more accurately described. Taken together, the pooled HBV coinfection prevalence among TB patients in these 2 studies was 2.24% (95% CI: 0.00-4.69), with significant heterogeneity observed (I 2 = 74%) (Fig.…”

Section: European Regionmentioning

confidence: 99%

Estimating Prevalence of Hepatitis B Virus Coinfection Among Adults With Tuberculosis

Wong

Hubbard

Bagley

et al. 2021

Journal of Clinical Gastroenterology

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Background: While patients with hepatitis B virus (HBV) infection and tuberculosis (TB) have similar risk factors, little is known regarding the prevalence of HBV and TB coinfection. We aim to evaluate the prevalence of HBV among patients with TB across world regions. Methods:We systematically reviewed the literature using PubMed from inception through September 1, 2019, to identify studies that provided data to calculate HBV coinfection prevalence among adults with TB infection. Prevalence estimates of HBV coinfection among TB patients were stratified by world regions and calculated using meta-analyses with random-effects models.Results: A total of 36 studies met inclusion criteria (4 from the Africa region, 6 from the Americas region, 5 from the Eastern Mediterranean region, 2 from European region, 6 from Southeast Asia region, and 13 from the Western Pacific region). On metaanalysis, overall pooled HBV coinfection prevalence among TB patients was 7.1%, but varied by world region. Region-specific pooled HBV prevalence among TB patients was highest in Africa region [11.4%, 95% confidence interval (CI): 3.45-19.31] and Western Pacific region (10.8%, 95% CI: 8.68-12.84), and was lowest in the Americas (2.2%, 95% CI: 0.78-3.53). Sensitivity analyses yielded similar HBV prevalence estimates across world regions. Conclusions:In this meta-analysis, we observed HBV coinfection prevalence among TB patients to be 38% to 450% higher than published estimates from the Polaris group of region-specific overall HBV prevalence. Timely identification of HBV infection among TB patients will improve patient outcomes by allowing for closer clinical monitoring and management, which may reduce the risk of liver dysfunction and liver failure related to TB treatment.

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“…Studies evaluating the yield of LTBI screening when implemented among risk groups in parallel to active TB case finding, along with acceptance and completion of LTBI treatment, and impact on incident TB risk are needed. Furthermore, risk groups for TB overlap with those for other diseases -including HIV, hepatitis B and hepatitis C70 . Combining active case finding and linkage to care for these services for individuals in hard-to-reach groups may therefore be cost-effective by capitalising upon a shared resource infrastructure, though data to support this are currently lacking.There have been few studies evaluating the role of interventions in improving adherence and active TB treatment completion among individuals from risk groups [Table 3].…”

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confidence: 99%

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era

Lipman

Story³

et al. 2018

int j tuberc lung dis

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Vulnerable populations, including homeless persons, high-risk drug and alcohol users, prison inmates and other marginalised populations, contribute a disproportionate burden of tuberculosis (TB) cases in low-incidence settings. Drivers of this disease burden include an increased risk of both TB transmission in congregate settings, and progression from infection to active disease. Late diagnosis and poor treatment completion further propagate the epidemic and fuel the acquisition of drug resistance. These groups are therefore a major priority for TB control programmes in low-incidence settings. Targeted strategies include active case finding (ACF) initiatives and interventions to improve treatment completion, both of which should be tailored to local populations. ACF usually deploys mobile X-ray unit screening, which allows sensitive, high-throughput screening with immediate availability of results. Such initiatives have been found to be effective and cost-effective, and associated with reductions in proxy measures of transmission in hard-to-reach groups. The addition of point-of-care molecular diagnostics and automated X-ray readers may further streamline the screening pathway. There is little evidence to support interventions to improve adherence among these risk groups. Such approaches include enhanced case management and directly observed treatment, while video-observed therapy (currently under evaluation) appears to be a promising tool for the future. Integrating outreach services to include both case detection and case-management interventions that share a resource infrastructure may allow cost-effectiveness to be maximised. Integrating screening and treatment for other diseases that are prevalent among targeted risk groups into TB outreach interventions may further improve cost-effectiveness. This article reviews the existing literature, and highlights priorities for further research.

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Expanded blood borne virus testing in a tuberculosis clinic. A cost and yield analysis

Cited by 4 publications

References 18 publications

Patients direct costs to undergo TB diagnosis

Patients direct costs to undergo TB diagnosis

Estimating Prevalence of Hepatitis B Virus Coinfection Among Adults With Tuberculosis

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era

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