The Economic Burden and Non-Adherence Tuberculosis Treatment in Indonesia: Systematic Review

Diniawati, E; Wibowo, Adik

doi:10.18502/kls.v4i10.3703

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…In developing countries, patients with low socioeconomic status often face the challenge of balancing competing priorities. These competing priorities might require allocating limited resources to meet the needs of other family members, such as the children or parents catered for ( Killewo, 2002 ; World Health Organization, 2003 ; Diniawati and Wibowo, 2018 ; Mahara et al, 2018 ). Healthcare team-related factors (40 items) explored the effects of the patient-provider relationship, and more investigations are needed concerning the impact of the healthcare team and system-related factors on non-adherence.…”

Section: Resultsmentioning

confidence: 99%

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia

Rianto,

Agustina,

Alfian

et al. 2024

Front. Pharmacol.

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Background: Medication non-adherence is a significant concern in tuberculosis (TB) treatment, requiring a precise understanding of the associated risk factors. However, there is a lack of appropriate means to assess the risk factors among TB patients in Indonesia, leading to the development and validation of a structured questionnaire for this purpose.Method: This study unfolded in two distinct phases, namely, the first included questionnaire construction through framework development, item generation, item screening, and pretesting (in 50 patients). The second comprised questionnaire validation with 346 participants using confirmatory factor analysis (CFA) and structural equation modeling-partial least squares (SEM-PLS). Additionally, reliability testing was conducted using Cronbach’s alpha and composite reliability statistical techniques.Results: In the development phase, 168 items were defined, consisting of sociodemographic characteristics (8 items) and risk factors for medication non-adherence (160 items). Expert evaluation reduced the number of items to 60, which decreased to 22 after performing a pilot study. Subsequent SEM-PLS modeling resulted in the identification of 14 valid items, representing five major risk factors, namely, socioeconomics (4 items), healthcare team (4 items), condition (3 items), therapy (2 items), and patient (1 item). Only condition-related factors were found to influence non-adherence, and all constructs showed good reliability based on Cronbach’s alpha (>0.6) and composite reliability (0.7) values.Conclusion: The final 22 items that emerged from this rigorous process indicated a valid and robust questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia. The developed questionnaire was positioned to be a valuable tool for healthcare professionals, policymakers, and scientists in creating patient-centered strategies and interventions to address non-adherence.

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Section: Resultsmentioning

confidence: 99%

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia

Rianto,

Agustina,

Alfian

et al. 2024

Front. Pharmacol.

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“…Previous studies did not clearly indicate an association between adherence and economic outcomes (Diniawati and Wibowo, 2018;Chimeh et al, 2020). One study suggested that good adherence results in lower medical costs, with the medical cost for patients showing an outcome of treatment completion was estimated to be 17% higher than the cost estimate of the Frontiers in Pharmacology frontiersin.org national guideline-based treatment in South Africa.…”

Section: Discussionmentioning

confidence: 99%

Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data

et al. 2022

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Objectives: We analyzed tuberculosis (TB)-related costs according to treatment adherence, as well as the association between treatment adherence, treatment outcomes, and costs related to drug-susceptible TB in South Korea.Methods: Patients who had newly treated TB in South Korea between 2006 and 2015 were selected from nationwide sample claims data and categorized into adherent and non-adherent groups using the proportion of days TB drugs covered. Patients were followed-up from the initiation of TB treatment. The mean five-year cumulative costs per patient were estimated according to adherence. Moreover, we evaluated the relative ratios to identify cost drivers such as adherence, treatment outcomes, and baseline characteristics using generalized linear models. Four treatment outcomes were included: treatment completion, loss to follow-up, death, and the initiation of multidrug-resistant TB treatment.Results: Out of the 3,799 new patients with TB, 2,662 were adherent, and 1,137 were non-adherent. Five years after initiating TB treatment, the mean TB-related costs were USD 2,270 and USD 2,694 in the adherent and non-adherent groups, respectively. The TB-related monthly cost per patient was also lower in the adherent than in the non-adherent (relative ratio = 0.89, 95% CI 0.92–0.98), while patients who were lost to follow-up spent more on TB-related costs (2.52, 2.24–2.83) compared to those who completed the treatment.Conclusion: Non-adherent patients with TB spend more on treatment costs while they have poorer outcomes compared to adherent patients with TB. Improving patient adherence may lead to effective treatment outcomes and reduce the economic burden of TB. Policymakers and providers should consider commitment programs to improve patient’s adherence.

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“…Individuals and/or families are sometimes compelled to sell valuable personal or family assets, or to borrow money to meet the costs associated with TB infections, with catastrophic consequences for their ongoing lives (11,17).In the worst cases, individuals or families (in the lowest income quintile) nd themselves compelled to further reduce their spending on essentials such as food, school fees, and transportation (11,16,(18)(19)(20). TB care-seeking costs have been shown, in several countries, to have signi cant negative impacts on individuals (patients, survivors) and their families' wellbeing, and to present challenges for continued compliance with recommended care and treatment schedules (21). A recent national survey in Tanzania demonstrated that, of 777 TB-affected households, about 45 percent reported having faced catastrophic costs (18).…”

Section: Introductionmentioning

confidence: 99%

Knowing and working on care-seeking barriers are vital towards ending TB by 2035: Lessons from a qualitative study on stakeholders’ perceptions and experiences of the social and financial consequences of Tuberculosis Care-seeking in Mbeya and Songwe Regions, Tanzania

Kilima

Mubyazi

Moolla³

et al. 2022

Preprint

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Background: Tuberculosis (TB) remains among the top infectious and killer diseases both globally and in Tanzania. However, research on its social determinants and the consequences of the disease on patients, survivors and their families in Tanzania are limited. More studies are needed in order to narrow the evidence gap for policy and program benefits, both in Tanzania and beyond. Methods: A qualitative research study was undertaken in two regions of Tanzania: Mbeya and Songwe. In-depth interviews were undertaken with individual TB patients and survivors. An interview guide with open ended questions was used. The interviews were recorded and transcribed verbatim. Field notes were also taken, and thematic analysis were performed to identify key themes and sub-themes.Results: A total of 18 TB patients and 12 TB survivors took part in the interviews. Most participants reported financial and social strains; being mutually reinforcing, these strains influenced their treatment-seeking behaviours. Financial difficulties related to transportation or for actual medical services contributed to late treatment initiation or deferred TB clinic attendance. Money spent for care at the referred facility, and lost income and/or lost food generation activity while seeking care, were found to result in family food insecurity and shortage of cash for other essential needs, including (but not limited to) non-TB-related illnesses. Many community members associated TB with HIV. As a result, TB patients often experienced social stigma and discrimination, which resulted in additional financial and psychological strain. Some individuals chose traditional and spiritual medicines for TB care. This approach was found to cost the respective clients, both financially and psychologically.Conclusion: This study suggests that it is essential to understand and address the social and financial challenges experienced by TB patients and TB survivors during treatment. TB is a manageable condition. Improved medical treatment needs to be coupled with improved and sustained public education about the disease, its negative outcomes, and the need to take preventive and curative measures. This study also confirms the need to consider access to food; free treatment of other co-morbidities, such as diabetes; and reducing the duration of TB treatment if at all possible.

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The Economic Burden and Non-Adherence Tuberculosis Treatment in Indonesia: Systematic Review

Abstract: .

Cited by 4 publications

References 6 publications

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia

Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data

Knowing and working on care-seeking barriers are vital towards ending TB by 2035: Lessons from a qualitative study on stakeholders’ perceptions and experiences of the social and financial consequences of Tuberculosis Care-seeking in Mbeya and Songwe Regions, Tanzania

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