Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia

PLOS ONE, Dec 2019

Background Despite free TB services available in public health facilities, TB patients often face severe financial burden due to TB. WHO set a new global target that no TB-affected families experience catastrophic costs due to TB. To monitor the progress and strategize the optimal approach to achieve the target, there is a great need to assess baseline cost data, explore potential proxy indicators for catastrophic costs, and understand what intervention mitigates financial burden. In Cambodia, nationwide active case finding (ACF) targeting household and neighbourhood contacts was implemented alongside routine passive case finding (PCF). We analyzed household cost data from ACF and PCF to determine the financial benefit of ACF, update the baseline cost data, and explore whether any dissaving patterns can be a proxy for catastrophic costs in Cambodia. Methods In this cross-sectional comparative study, structured interviews were carried out with 108 ACF patients and 100 PCF patients. Direct and indirect costs, costs before and during treatment, costs as percentage of annual household income and dissaving patterns were compared between the two groups. Results The median total costs were lower by 17% in ACF than in PCF ($240.7 [IQR 65.5–594.6] vs $290.5 [IQR 113.6–813.4], p = 0.104). The median costs before treatment were significantly lower in ACF than in PCF ($5.1 [IQR 1.5–25.8] vs $22.4 [IQR 4.4–70.8], p<0.001). Indirect costs constituted the largest portion of total costs (72.3% in ACF and 61.5% in PCF). Total costs were equivalent to 11.3% and 18.6% of annual household income in ACF and PCF, respectively. ACF patients were less likely to dissave to afford TB-related expenses. Costs as percentage of annual household income were significantly associated with an occurrence of selling property (p = 0.02 for ACF, p = 0.005 for PCF). Conclusions TB-affected households face severe financial hardship in Cambodia. ACF has the great potential to mitigate the costs incurred particularly before treatment. Social protection schemes that can replace lost income are critically needed to compensate for the most devastating costs in TB. An occurrence of selling household property can be a useful proxy for catastrophic cost in Cambodia.

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Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia

September Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia Editor: Yoel Lubell Mahidol-Oxford Tropical Medicine Research Unit THAILAND Fukushi Morishita 0 Rajendra-Prasad Yadav Mao Tan Eang Saly Saint Nobuyuki Nishikiori 0 0 World Health Organization Regional Office for the Western Pacific, Manila, Philippines, 2 World Health Organization Representative Office in the Philippines , Manila , Philippines , 3 National Center for Tuberculosis and Leprosy Control, Ministry of Health , Phnom Penh , Cambodia Despite free TB services available in public health facilities, TB patients often face severe financial burden due to TB. WHO set a new global target that no TB-affected families experience catastrophic costs due to TB. To monitor the progress and strategize the optimal approach to achieve the target, there is a great need to assess baseline cost data, explore potential proxy indicators for catastrophic costs, and understand what intervention mitigates financial burden. In Cambodia, nationwide active case finding (ACF) targeting household and neighbourhood contacts was implemented alongside routine passive case finding (PCF). We analyzed household cost data from ACF and PCF to determine the financial benefit of ACF, update the baseline cost data, and explore whether any dissaving patterns can be a proxy for catastrophic costs in Cambodia. - Data Availability Statement: Our data sets contain privacy-sensitive information including participant’s individual and household income that formed a core part of the analysis. Even though we remove patient’s identifiable variables and make it minimal data set, there is still a possibility that those who are familiar with the project sites and beneficiaries may be able to identify participants. The informed consent signed by all participants explicitly mentioned that only the research team have access to the data set. Due to such ethical and confidentiality restrictions, data sets will be made available only upon request and with Background Methods Results In this cross-sectional comparative study, structured interviews were carried out with 108 ACF patients and 100 PCF patients. Direct and indirect costs, costs before and during treatment, costs as percentage of annual household income and dissaving patterns were compared between the two groups. The median total costs were lower by 17% in ACF than in PCF ($240.7 [IQR 65.5–594.6] vs $290.5 [IQR 113.6–813.4], p = 0.104). The median costs before treatment were significantly lower in ACF than in PCF ($5.1 [IQR 1.5–25.8] vs $22.4 [IQR 4.4–70.8], p<0.001). Indirect costs constituted the largest portion of total costs (72.3% in ACF and 61.5% in PCF). Total costs were equivalent to 11.3% and 18.6% of annual household income in ACF and PCF, permission from World Health Organization and the National Center for Tuberculosis and Leprosy Control, Ministry of Health, Cambodia. All interested researchers will contact Fukushi Morishita (morishita. ) to request the data. Funding: The study was conducted by World Health Organization with the financial support from the Government of Japan through Ministry of Health, Labour and Welfare and from the Government of the Republic of Korea through Korean Centers for Disease Control & Prevention. The main intervention (active case finding) was a part of project activities funded by the Stop TB Partnership's TB REACH Initiative. TB REACH is primarily supported by the Government of Canada, with additional funding from the Bill and Melinda Gates Foundation. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the WHO. Competing Interests: The authors have declared that no competing interests exist. respectively. ACF patients were less likely to dissave to afford TB-related expenses. Costs as percentage of annual household income were significantly associated with an occurrence of selling property (p = 0.02 for ACF, p = 0.005 for PCF). Conclusions TB-affected households face severe financial hardship in Cambodia. ACF has the great potential to mitigate the costs incurred particularly before treatment. Social protection schemes that can replace lost income are critically needed to compensate for the most devastating costs in TB. An occurrence of selling household property can be a useful proxy for catastrophic cost in Cambodia. Introduction Tuberculosis (TB) is predominantly a disease of the poor [ 1 ]. For the past decades, the global TB community has strived to address the needs of poor and marginalized population through promoting pro-poor strategies in TB control programmes [ 1 ]. The international standard has been established that basic TB diagnostic and treatment services are provided free of charge [ 2, 3 ]. Nevertheless, TB patients often face severe financial burden by spending considerable amount (...truncated)


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Fukushi Morishita, Rajendra-Prasad Yadav, Mao Tan Eang, Saly Saint, Nobuyuki Nishikiori. Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia, PLOS ONE, 2016, Volume 11, Issue 9, DOI: 10.1371/journal.pone.0162796