Measuring catastrophic costs due to tuberculosis in Viet Nam

Nhung, Nguyen Viet; Hoa, Nguyen Binh; Anh, Nguyen Thu; Anh, Le Thi Ngoc; Siroka, Andrew; Lönnroth, Knut; Baena, Ines Garcia

doi:10.5588/ijtld.17.0859

Cited by 62 publications

(127 citation statements)

References 1 publication

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“…Previous surveys done in Africa and Asia have shown that TB patients incur huge catastrophic costs despite free TB treatment. (8,9,11,12) Our study provided additional evidence to this nding. However, catastrophic costs were not homogeneous among the different groups as the poorest households were disproportionally affected and risk of catastrophic costs increased as wealth quintile decreased (5,8,11,12) This makes intuitive sense, and may be attributed to reduced resilience to external shocks such as TB.…”

Section: Discussionsupporting

confidence: 73%

“…Also, in our context even DS-TB patients experienced higher catastrophic costs than overall costs reported from other low-and middle income countries. (8,9,12,13) High catastrophic costs may negatively impact on both access and adherence to TB treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Despite interventions aimed at cushioning TB patients against direct medical costs, surveys in Africa and Asia have shown high prevalence of catastrophic costs especially among i) drug resistant TB (DR-TB) patients, ii) poorest households, iii) cases where the patients were breadwinners and iv) those co-infected with HIV. (8,9,(11)(12)(13) In 2016, Zimbabwe embraced the End TB targets of eliminating catastrophic costs by 2020. The national TB control programme (NTP) has decentralised TB services, provided cash transfers to DR-TB patients and adopted active case nding to detect TB cases early.…”

Section: Introductionmentioning

confidence: 99%

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Catastrophic costs among tuberculosis patients in Zimbabwe: a national health facility-based survey

Timire¹,

Ngwenya²,

Chirenda³

et al. 2020

Preprint

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Background: Tuberculosis (TB) has biological and socio-economic dimensions. The socio-economic impact of TB may plunge households into financial catastrophes. The End TB strategy seeks to mitigate socio-economic factors which may act as barriers to accessing TB services. Countries have been encouraged to provide baseline estimates of catastrophic costs by 2020. We sought to determine the prevalence, risk factors and major drivers of catastrophic costs among TB patients in Zimbabwe. Methods: We conducted a nationally representative, health facility-based survey with random cluster sampling among TB patients. We enrolled patients with drug susceptible (DS-TB) and drug resistant TB (DR-TB) consecutively. We administered a standardised questionnaire to capture the costs incurred as well as lost income due to TB illness. Catastrophic costs were measured at a threshold of 20%. We did a sensitivity analysis of indirect costs using the time lost by patients in each phase of treatment. We used multivariable logistic regression to determine the risk factors for experiencing catastrophic costs. Results: A total of 841 patients were enrolled in the survey, weighted to 900 during data analysis. There were 500 (56%) males and 46 (6%) DR-TB patients. Thirty-five (72%) DR-TB patients were HIV co-infected. Overall, 80% (95% CI:77-82%) of TB patients and their households experienced catastrophic costs. The major cost drivers pre-TB diagnosis were direct medical costs. Nutritional supplements were the major cost driver post-TB diagnosis, (median cost US$360 (IQR: 240-600). Post-TB diagnosis costs were three-times higher among DR-TB [US$1,659 (653-2,787)] versus drug susceptible TB (DS-TB) affected households [US$537 (204-1,134)]. Income loss was five-times higher among DR-TB versus DS-TB patients. In multivariable analysis, household wealth was the only covariate that remained significantly associated with catastrophic costs: the poorest households had sixteen times the odds of incurring catastrophic costs compared to wealthiest households [adjusted odds ratio (aOR:15.7 95% CI:7.5-33.1)]. Conclusion: The majority of TB patients enrolled in care experienced catastrophic costs, with the highest burden on DR-TB patients. Since the major cost drivers fall outside the healthcare system, a multi-sectoral approach to TB control and linking TB patients to social protection schemes holds promise for reducing catastrophic costs in Zimbabwe.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Catastrophic costs among tuberculosis patients in Zimbabwe: a national health facility-based survey

Timire¹,

Ngwenya²,

Chirenda³

et al. 2020

Preprint

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“…This is witnessed by the low TB burden in countries with high social protection and vice-versa [3]. Evidence from several countries including India shows that TB causes catastrophic economic effects on the patients and their households [4][5][6][7][8][9][10]. Ensuring that no TBaffected families face catastrophic expenditure by 2020 is one of the goals of the END TB strategy of the World Health Organization (WHO) [11].…”

mentioning

confidence: 99%

‘I am on treatment since 5 months but I have not received any money’: coverage, delays and implementation challenges of ‘Direct Benefit Transfer’ for tuberculosis patients – a mixed-methods study from South India

Nirgude

Kumar

Timire

et al. 2019

Global Health Action

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Background : In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India’s national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives : To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods : This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results : Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion : DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action.

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“…[7][8][9] Another major reason is that adherence to TB treatment protocols represents a heavy economic burden for TB patients in Viet Nam and many other settings due to lost income, travel and opportunity costs. 10,11 A key barrier to effective TB care and prevention is loss to follow-up (LTFU), which is a key contributor to drug resistance, continued transmission and death. 12,13 Nevertheless, 77%-92% of susceptible cases were successfully treated in 2017.…”

Section: Introductionmentioning

confidence: 99%

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

Codlin

Forse

et al. 2020

Preprint

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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.

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Measuring catastrophic costs due to tuberculosis in Viet Nam

Cited by 62 publications

References 1 publication

Catastrophic costs among tuberculosis patients in Zimbabwe: a national health facility-based survey

Catastrophic costs among tuberculosis patients in Zimbabwe: a national health facility-based survey

‘I am on treatment since 5 months but I have not received any money’: coverage, delays and implementation challenges of ‘Direct Benefit Transfer’ for tuberculosis patients – a mixed-methods study from South India

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

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