Modelling the preventive treatment under media impact on tuberculosis:A comparison in four regions of China

Preventive treatment for people with latent Tuberculosis infection(LTBI)has aroused our great interest.In this paper,we propose and analyze a novel mathematical model of TB considering preventive treatment with media impact.The basic reproduction number R_(0)is defined by the next generation matrix method.In the case without media impact,we prove that the disease-free equilibrium is globally asymptotically stable(unstable)if R_(0)<1(R_(0)>1).Furthermore,we obtain that a unique endemic equilibrium exists when R_(0)>1,which is globally asymptotically stable in the case of permanent immunity and no media impact.We fit the model to the newly reported TB cases data from 2009 to 2019 of four regions in China and estimate the parameters.And we estimatedR_(0)=0.5013<1 in Hubei indicating that TB in Hubei will be eliminated in the future.However,the estimatedR_(0)=1.015>1 in Henan,R_(0)=1.282>1 in Jiangxi andR_(0)=1.930>1 in Xinjiang imply that TB will continue to persist in these three regions without further prevention and control measures.Besides,sensitivity analysis is carried out to illustrate the role of model parameters for TB control.Our finding reveals that appropriately improving the rate of timely treatment for actively infected people and increasing the rate of individuals with LTBI seeking preventive treatment could achieve the goal of TB elimination.In addition,another interesting finding shows that media impact can only reduce the number of active infections to a limited extent,but cannot change the prevalence of TB.

Costs incurred by patients with drugsusceptible pulmonary tuberculosis in semiurban and rural settings of Western India

Background:India reports the highest number of tuberculosis(TB)cases worldwide.Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB.Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar(western India)using an adapted World Health Organization costing tool.Methods:We conducted a descriptive cross-sectional study of adults,notified in the public sector and being treated for drug-susceptible pulmonary TB during January-June 2019,in six urban and three rural blocks of Bhavnagar region,Gujarat state,India.The direct and indirect TB-related costs,as well as patients’coping strategies,were assessed for the overall care of TB till treatment completion.Catastrophic costs were defined as total costs>20%of annual household income(excluding any amount received from cash transfer programs or borrowed).Median and interquartile range(IQR)was used to summarize patient costs.The median costs between any two groups were compared using the median test.The association between any two categorical variables was tested by the Pearson chi-squared test.All costs were described in US dollars(USD).During the study period,on average,one USD equalled 70 Indian Rupees.Results:Of 458 patients included,70%were male,62%had no formal education,71%lived in urban areas,and 96%completed TB treatment.The median(IQR)total costs were USD 8(5-28),direct medical costs were USD 0(0-0),direct non-medical costs were USD 3(2-4)and indirect costs were USD 6(3-13).Among direct non-medical costs,travel cost(median=USD 3,IQR:2-4)to attend health facilities were the most prominent,whereas the indirect costs were mainly contributed by the patient’s loss of wages(median=USD 3,IQR:0-6).Four percent of patients faced catastrophic costs,11%borrowed money to cover costs and 7%lost their employment;the median working days lost to TB was 30(IQR:15-45).A majority(88%)of patients received a median USD 43(IQR:41-43)as part of a cash transfer program for TB patients.Conclusions:Treatment completion was high and the costs incurred by TB patients were low in this setting.However,negative financial consequences occur even in low-cost settings.The role of universal cash transfer programs in such settings requires further study.

Need for operational simplicity and timely disbursal of benefits—a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India

Background Ni-kshay Poshan Yojana(NPY)is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB(PwTB).Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states,reported a 70%coverage and high median delay in benefit credit.We undertook a qualitative study between January and July 2023,to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme.Methods We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources.We conducted 36 in-depth interviews of national,district and field-level staff of the National Tuberculosis Elimination Programme(NTEP)and NPY beneficiaries from 30 districts across nine states of India,selected using theoretical sampling.An analytical framework developed through inductive coding of a set of six interviews,guided the coding of the subsequent interviews.Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation.Results Stakeholders perceived NPY as a beneficial initiative.Strong political commitment from the state administration,mainstreaming of NTEP work with the district public healthcare delivery system,availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation.However,the complex,multi-level benefit approval process,difficulties in accessing banking services,perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization.Conclusion The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits.We recommend greater operational simplicity in NPY implementation,integrating NTEP activities with the public health system to reduce the burden on the program staff,and revising the benefit amount more equitably.