Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

被引：38

作者：

Shewade, Hemant Deepak ^{[1
,2
]}

Gupta, Vivek ^{[3
]}

Satyanarayana, Srinath ^{[2
]}

Kharate, Atul ^{[4
]}

Sahai, K. N. ^{[5
]}

Murali, Lakshmi ^{[6
]}

Kamble, Sanjeev ^{[7
]}

Deshpande, Madhav ^{[8
]}

Kumar, Naresh ^{[9
]}

Kumar, Sunil ^{[10
]}

Pandey, Prabhat ^{[11
]}

Bajpai, U. N. ^{[12
]}

Tripathy, Jaya Prasad ^{[1
,2
]}

Kathirvel, Soundappan ^{[1
,13
]}

Pandurangan, Sripriya ^{[11
]}

Mohanty, Subrat ^{[11
]}

Ghule, Vaibhav Haribhau ^{[11
]}

Sagili, Karuna D. ^{[11
]}

Prasad, Banuru Muralidhara ^{[11
]}

Nath, Sudhi ^{[11
]}

Singh, Priyanka ^{[14
]}

Singh, Kamlesh ^{[15
]}

Singh, Ramesh ^{[12
]}

Jayaraman, Gurukartick ^{[16
]}

Rajeswaran, P. ^{[16
]}

Srivastava, Binod Kumar ^{[17
]}

Biswas, Moumita ^{[11
]}

Mallick, Gayadhar ^{[11
]}

Bera, Om Prakash ^{[11
]}

Jaisingh, A. James Jeyakumar ^{[16
]}

Naqvi, Ali Jafar ^{[14
]}

Verma, Prafulla ^{[14
]}

Ansari, Mohammed Salauddin ^{[17
]}

Mishra, Prafulla C. ^{[18
]}

Sumesh, G. ^{[16
]}

Barik, Sanjeeb ^{[19
]}

Mathew, Vijesh ^{[15
]}

Lohar, Manas Ranjan Singh ^{[19
]}

Gaurkhede, Chandrashekhar S. ^{[15
]}

Parate, Ganesh ^{[14
]}

Bale, Sharifa Yasin ^{[15
]}

Koli, Ishwar ^{[15
]}

Bharadwaj, Ashwin Kumar ^{[15
]}

Venkatraman, G. ^{[16
]}

Sathiyanarayanan, K. ^{[16
]}

Lal, Jinesh ^{[15
]}

Sharma, Ashwini Kumar ^{[17
]}

Rao, Raghuram ^{[20
]}

Kumar, Ajay M. V. ^{[1
,2
]}

Chadha, Sarabjit Singh ^{[11
]}

机构：

[1] Int Union TB & Lung Dis Union, Dept Operat Res, South East Asia Off, New Delhi, India

[2] Int Union TB & Lung Dis Union, Ctr Operat Res, Paris, France

[3] All India Inst Med Sci, Dr Rajendra Prasad Ctr Ophthalm Sci, New Delhi, India

[4] Govt Madhya Pradesh, Dept Hlth & Family Welf, State TB Cell, Bhopal, India

[5] Govt Bihar, Dept Hlth & Family Welf, State TB Cell, Patna, Bihar, India

[6] Govt Tamil Nadu, Dept Hlth & Family Welf, State TB Cell, Madras, Tamil Nadu, India

[7] Govt Maharashtra, Hlth Dept, State TB Cell, Pune, Maharashtra, India

[8] Govt Chattisgarh, Dept Hlth & Family Welf, State TB Cell, Raipur, Madhya Pradesh, India

[9] Govt Punjab, Dept Hlth & Family Welf, State TB Cell, Chandigarh, India

[10] Govt Kerala, Dept Hlth & Family Welf, State TB Cell, Thiruvananthapuram, Kerala, India

[11] Int Union TB & Lung Dis Union, Dept TB & Communicable Dis, New Delhi, India

[12] Voluntary Hlth Assoc India, New Delhi, India

[13] PGIMER, Dept Community Med, Chandigarh, India

[14] MAMTA Hlth Inst Mother & Child, New Delhi, India

[15] Catholic Hlth Assoc India, Hyderabad, Telangana, India

[16] Resource Grp Educ & Advocacy Community Hlth REACH, Madras, Tamil Nadu, India

[17] Populat Serv Int, New Delhi, India

[18] CBCI CARD, New Delhi, India

[19] EHA, New Delhi, India

[20] Govt India, Cent TB Div, Revised Natl TB Control Programme, Minist Hlth & Family Welf, New Delhi, India

来源：

GLOBAL HEALTH ACTION | 2018年 / 11卷 / 01期

关键词：

tuberculosis/prevention and control; systematic screening; vulnerable populations; health care costs; health equity; ECONOMIC BURDEN; CARE; EXPENDITURE; HOUSEHOLDS; AFRICA; ACCESS;

D O I：

10.1080/16549716.2018.1494897

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF (-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-058 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.

引用

页数：14

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