<p>Challenges Faced by Multidrug-Resistant Tuberculosis Patients in Three Financially Affluent Chinese Cities</p>

Abstract

Purpose The aim of this study was to analyze socioeconomic burdens and other difficulties that multidrug-resistant tuberculosis (MDR-TB) patients in cities are facing, to identify major obstacles and which groups of patients are most affected. Methods Face-to-face and phone-call interviews were conducted in early 2018 to follow-up with patients newly diagnosed with MDR-TB in 2017 in three tuberculosis hospitals in three financially affluent Chinese cities. Demographic data and information on their medical care, insurance coverage, and medical expenses were collected and analyzed. Results A total of 144 newly diagnosed MDR-TB cases were reviewed during the study period, excluding 38 who were lost to follow-up and 29 patients who refused to participate, 77 patients were enrolled in this study. A total of 61 (79%) of these patients were hospitalized after MDR-TB diagnosis with an average hospital stay of 14 days, of them 57 (74%) were sputum positive on diagnosis. The proportion of patients who failed community care were 48% married, 56% in white collar employment and 43% in temp jobs/unemployed. In terms of insurance coverage, the proportion of patients who failed community care were 23% with no insurance and/or New Rural Co-operative Medical Care Scheme (NRCMS) and 45% with Urban Employee Basic Medical Insurance (UEBMI)/Urban Residents Basic Medical Insurance (URBMI) and commercial insurance. Difficulties patients encountered were, financial pressure (33%), psychological stress (26%), adverse drug reactions (23%), repulsive reaction to injections (17%). Fourty-eight percent of the patients spent over ¥2000 (USD300) per month on TB treatment. Conclusion Despite insurance coverage, financial hardship remains the number one difficulty MDR-TB patients encountered in relatively financially affluent cities. Among them, the married working class were found to be the most financially sensitive group and have the highest tendency to fail community care. It is of utmost urgency to enhance the current medical policy to improve treatment adherence.

Factors Associated with Medical Follow-Up Adherence for Patients on All-Oral Regimen for Multidrug-Resistant Tuberculosis in Shenzhen, China

“…17,18 Previous study from our team showed that average out-of-pocket expense for an MDR-TB patient was about US$300 per month in Shenzhen city. 19 This amounts to nearly half of average monthly income based on a reported GDP per capita of…”

“… 17 , 18 Previous study from our team showed that average out-of-pocket expense for an MDR-TB patient was about US$300 per month in Shenzhen city. 19 This amounts to nearly half of average monthly income based on a reported GDP per capita of USD7808 in 2018. 20 Our study established a direct relationship between treatment adherence and household income.…”

The trial of sending short message service multidrug-resistant tuberculosis patients in Indonesia

“…In general, MDR TB patients have gone through the long-term medication method with quite a long period of time taking medicines ( Table I ). Because they require medication consistency, both TB patients and MDR TB patients together with their family can experience exhaustion and not small mental pressure ( 21 , 22 ) as well as stressful events ( 23 ). TB patients have the risk to fall into medication failure, and so do the MDR TB patients because the essence of medication lies in the compliance ( 24 , 25 ).…”

Predictors and Trends of MDR/RR-TB in Shenzhen China: A Retrospective 2012–2020 Period Analysis

“…The financial costs of TB can force patients (particularly internal migrants) to remain undiagnosed and untreated, leading to prolonged transmission of MDR-TB. [19][20][21][22] Changes in coverage and reimbursement policies have helped alleviate these financial difficulties, which may partially explain the increase in the proportion of patients enrolled on treatments (from 49.4% in 2012 to 70% in 2017). This financing policy may further improve MDR-TB treatment compliance and outcomes, leading to lower ongoing MDR-TB transmissions in Shenzhen.…”