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Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study

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贫困所致传染病(英文) 2024年第2期13卷 1-12页

作者： Nguyen Hoa Binh Quang Vo Luan Nguyen forse rachel.jeanette Wiemers Anja Maria Christine Huynh Huy Ba Dong Thuy Thi Thu Phan Yen Thi Hoang Creswell Jacob Dang Thi Minh Ha Nguyen Lan Huu Shedrawy Jad L?nnroth Knut Nguyen Tuan Dinh Van Dinh Luong Annerstedt Kristi Sidney Codlin Andrew James National Lung Hospital Ha Noi Viet Nam Friends for International TB Relief Ha Noi Viet Nam Department of Global Public Health WHO Collaboration Centre On Tuberculosis and Social Medicine Karolinska Institute Stockholm Sweden Stop TB Partnership Geneva Switzerland Pham Ngoc Thach Hospital Ho Chi Minh City Viet Nam

Background In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private *** Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate *** The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578;P=0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313;P=0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164;P<0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%;P=0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio [(aOR=13.71; 95% confidence interval (CI): 1.36–138.14;P=0.026], unemployment during treatment (aOR=10.86; 95%CI: 2.64–44.60;P<0.001) and experiencing TB-related stigma (aOR=37.90; 95%CI: 1.72–831.73;P=0.021).Conclusions Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the

关键词： Tuberculosis Patient cost Catastrophic cost Private sector Comparative analysis Viet Nam

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Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City,Viet Nam

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Infectious Diseases of Poverty 2020年第6期9卷 16-28页

作者： Luan Nguyen Quang Vo Andrew James Codlin rachel.jeanette forse NgaThuy Nguyen Thanh Nguyen Vu Giang Truong Le Vinh Van Truong Giang Chau Do Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen Jens Levy Knut Lonnroth SBertel Squire Maxine Caws Friends for International TB Relief 68B Nguyen Van Troi8Phu NhuanHo Chi Minh CityViet Nam Interactive Research and Development Ho Chi Minh CityViet Nam Ho Chi Minh City Public Health Association Ho Chi Minh CityViet Nam Pham Ngoc Thach Hospital Ho Chi Minh CityViet Nam National Lung Hospital Ha NoiViet Nam KNCV Tuberculosefonds The HagueThe Netherlands Department of Global Public Health Karolinska InstitutetStockholmSweden Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK Birat Nepal Medical Trust LazimpatKathmanduNepal

Background: In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening ***,more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health *** 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 *** persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF *** individuals with normal or without radiography results were tested on smear *** described the TB care cascade and characteristics for each priority group,and calculated yield and number needed to ***,we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment ***: We verbally screened 321020 people including 24232 household contacts,3182 social and close contacts and 293606 residents of urban priority *** resulted in 1138 persons treated for TB,of whom 85 were household contacts,39 were close contacts and 1014 belonged to urban priority area *** 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 *** 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 ***: The study detected a large number of un

关键词： Case detection Tuberculosis Active case finding Urban Viet nam

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