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Patients direct costs to undergo TB diagnosis

Infectious Diseases of Poverty 2016年第1期5卷 221-229页

作者： Rachel M.Anderson de Cuevas Lovett Lawson Najla Al-Sonboli Nasher Al-Aghbari isabel arbide Jeevan B.Sherchand Emenyonu E.Nnamdi Abraham Aseffa Mohammed A.Yassin Saddiq T.Abdurrahman Joshua Obasanya Oladimeji Olanrewaju Daniel Datiko Sally J.Theobald Andrew Ramsay S.Bertel Squire Luis E.Cuevas Liverpool School of Tropical Medicine Pembroke PlaceLiverpool L35QAUK Zankli Medical Center AbujaNigeria Bingham University Nassarawa StateAbujaNigeria Medical Faculty Sana’a UniversitySana’aYemen National Tuberculosis Institute Sana’aYemen Bushullo Major Health Centre AwassaEthiopia Tribhuvan University Institute of Medicine KathmanduNepal Armauer Hansen Research Institute Addis AbabaEthiopia The Global Fund to Fight AIDS Tuberculosis and MalariaGenevaSwitzerland Federal Capital Territory Tuberculosis and Leprosy Control Programme AbujaNigeria Nigeria Tuberculosis and Leprosy Control Programme AbujaNigeria REACH Ethiopia HawassaEthiopia UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases World Health OrganizationGenevaSwitzerland

Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.Methods:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis.Surveys of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and Yemen.Adults>18 years with cough>2 weeks were enrolled prospectively.Direct costs were quantified using structured questionnaires.Patients with costs>75^(th) quartile were considered to have high expenditure(cases)and compared with patients with costs<75^(th) quartile to identify factors associated with high expenditure.Results:The most significant expenses were due to clinic fees and transport.Most participants attended the centres with companions.High expenditure was associated with attending with company,residing in rural areas/other towns and illiteracy.Conclusions:The costs incurred by patients are substantial and share common patterns across countries.Removing user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs.In locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.

关键词： Tuberculosis Costs Access to healthcare Ethiopia Nepal Nigeria Yemen

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