Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India

Background Tuberculosis(TB)poses a significant social and economic burden to households of persons with TB(PwTB).Despite free diagnosis and care under the National TB Elimination Programme(NTEP),individuals often expe-rience significant out-of-pocket expenditure and lost productivity,causing financial catastrophe.We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs.Methods In our cross-sectional study,we used multi-stage sampling to select PwTB notified under the NTEP,whose treatment outcome was declared between May 2022 and February 2023.Total patient costs were meas-ured through direct medical,non-medical and indirect costs.Catastrophic costs were defined as expenditure on TB care>20%of the annual household income.We determined the factors influencing the total cost of TB care using median regression.We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles.We used a cluster-adjusted,generalized model to determine the factors associated with cata-strophic costs.Results The mean(SD)age of the 1407 PwTB interviewed was 40.8(16.8)years.Among them,865(61.5%)were male,and 786(55.9%)were economically active.Thirty-four(2.4%)had Drug Resistant TB(DRTB),and 258(18.3%)had been hospitalized for TB.The median(Interquartile range[IQR]and 95%confidence interval[CI])of total costs of TB care was US$386.1(130.8,876.9).Direct costs accounted for 34%of the total costs,with a median of US$78.4(43.3,153.6),while indirect costs had a median of US$279.8(18.9,699.4).PwTB<60 years of age(US$446.1;370.4,521.8),without health insurance(US$464.2;386.7,541.6),and those hospitalized(US$900.4;700.2,1100.6)for TB experienced higher median costs.Catastrophic costs,experienced by 45%of PwTB,followed a pro-poor distribution.Hospitalized PwTB(adjusted prevalence ratio[aPR]=1.9;1.6,2.2)and those notified from the private sector(aPR=1.4;1.1,1.8)were more likely to incur catastrophic costs.Conclusions PwTB in India incur high costs mainly due to lost productivity and hospitalization.Nearly half of them experience catastrophic costs,especially those from poorer economic quintiles.Enabling early notification of TB,expanding the coverage of health insurance schemes to include PwTB,and implementing TB sensitive strategies to address social determinants of TB may significantly reduce catastrophic costs incurred by PwTB.

应用痰抗酸杆菌涂片批量抽样对镜检中心进行评价

地点:进行痰抗酸菌镜检的指定镜检中心(DMC)和其他镜检中心(AMC),地区结核病中心(DTC)和参比实验室(RL)。目的:使用盲法 AFB 痰涂片对不知晓 AFB 镜检质控的结核病实验室高级督导员(STLS)和经过培训知晓质控的参比实验室(RL)的技术员进行结果评估,确定批量抽样痰涂片的可行性。方法:镜检中心(MC)的痰涂片送至地区结核病中心(DTC)和参比实验室;经过系统选择每个镜检中心每月送 20 个涂片;DMC 的 1547 张涂片和 AMC 的 726张涂片分别由DTC的STLS和RL的技术员进行检查,由第三者负责分析差别。结果:和 RL 的 1%相比,MC 实验室技术员和 DTC 的STLSs 之间的不符合率为 4.7%。STLSs 与 RL 实验室技术员各有 70 次和 2 次错误。结论:AFB 涂片的批量抽样在现场情况下是可行的。受过 AFB 涂片镜检质控培训的 RL 技术员对 MC 的评价比没有受过此训练的 STLSs 更有效。