Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by 2020.The role of active case f...Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by 2020.The role of active case finding(ACF)in reducing patient costs has not been determined globally.This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.Methods:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August 2018.One hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs.Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household income.The intensity of catastrophic costs was calculated using the positive overshoot method.The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs.Meanwhile,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.Results:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,P<0.001).The cost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF patients.The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,although the difference was not statistically significant.Conclusions:ACF can reduce patient-incurred costs substantially,contributing to the End TB Strategy target.Other synergistic policies,such as social protection,will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.展开更多
Background: In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening initiatives.However,more evidence is needed for groups among whom systematic screening...Background: In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening initiatives.However,more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health Organization.This study evaluated concurrent screening in multiple target groups using community health workers(CHW).Methods:: In our two-year intervention study lasting from October 2017 to September 2019,CHWs in six districts of Ho Chi Minh City,Viet Nam verbally screened three urban priority groups:(1)household TB contacts;(2)close TB contacts;and(3)residents of urban priority areas without clear documented exposure to TB including hotspots,boarding homes and urban slums.Eligible persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF assay.Symptomatic individuals with normal or without radiography results were tested on smear microscopy.We described the TB care cascade and characteristics for each priority group,and calculated yield and number needed to screen.Subsequently,we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment initiation.Results: We verbally screened 321020 people including 24232 household contacts,3182 social and close contacts and 293606 residents of urban priority areas.This resulted in 1138 persons treated for TB,of whom 85 were household contacts,39 were close contacts and 1014 belonged to urban priority area residents.The yield of active TB in these groups was 351,1226 and 345 per 100000,respectively,corresponding to numbers needed to screen of 285,82 and 290.The fitted model showed that close contacts[adjusted odds ratio(aOR)=2.07;95%CI:1.38–3.11;P<0.001]and urban priority area residents(aOR=2.18;95%CI:1.69–2.79;P<0.001)had a greater risk of active TB than household contacts.Conclusions: The study detected a large number of unreached persons with TB,but most of them were not among persons in contact with an index patient.Therefore,while programs should continue to optimize screening in contacts,to close the detection gap in high TB burden settings such as Viet Nam,coverage must be expanded to persons without documented exposure such as residents in hotspots,boarding homes and urban slums.展开更多
文摘Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by 2020.The role of active case finding(ACF)in reducing patient costs has not been determined globally.This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal.Methods:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August 2018.One hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs.Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household income.The intensity of catastrophic costs was calculated using the positive overshoot method.The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs.Meanwhile,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis.Results:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,P<0.001).The cost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF patients.The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,although the difference was not statistically significant.Conclusions:ACF can reduce patient-incurred costs substantially,contributing to the End TB Strategy target.Other synergistic policies,such as social protection,will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
基金The IMPACT-TB study and LNQV,AJC,RJF,NTN,TNV,GTL,JL,SBS,KL and MC were supported by the European Commission’s Horizon 2020 programme under grant agreement number 733174.We received additional support from the Stop TB Partnership’s TB REACH initiative with funding from the Government of Canada.These funding bodies had no role in the design of the study,in collection,analysis,and interpretation of data,or in writing the manuscript.
文摘Background: In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening initiatives.However,more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health Organization.This study evaluated concurrent screening in multiple target groups using community health workers(CHW).Methods:: In our two-year intervention study lasting from October 2017 to September 2019,CHWs in six districts of Ho Chi Minh City,Viet Nam verbally screened three urban priority groups:(1)household TB contacts;(2)close TB contacts;and(3)residents of urban priority areas without clear documented exposure to TB including hotspots,boarding homes and urban slums.Eligible persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF assay.Symptomatic individuals with normal or without radiography results were tested on smear microscopy.We described the TB care cascade and characteristics for each priority group,and calculated yield and number needed to screen.Subsequently,we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment initiation.Results: We verbally screened 321020 people including 24232 household contacts,3182 social and close contacts and 293606 residents of urban priority areas.This resulted in 1138 persons treated for TB,of whom 85 were household contacts,39 were close contacts and 1014 belonged to urban priority area residents.The yield of active TB in these groups was 351,1226 and 345 per 100000,respectively,corresponding to numbers needed to screen of 285,82 and 290.The fitted model showed that close contacts[adjusted odds ratio(aOR)=2.07;95%CI:1.38–3.11;P<0.001]and urban priority area residents(aOR=2.18;95%CI:1.69–2.79;P<0.001)had a greater risk of active TB than household contacts.Conclusions: The study detected a large number of unreached persons with TB,but most of them were not among persons in contact with an index patient.Therefore,while programs should continue to optimize screening in contacts,to close the detection gap in high TB burden settings such as Viet Nam,coverage must be expanded to persons without documented exposure such as residents in hotspots,boarding homes and urban slums.
