Abstract：
Although tuberculosis (TB) care is free in Tanzania, TB-associated costs may compromise access to services and treatment adherence resulting in poor outcomes and increased risk of transmission in the community. TB can impact economically patients and their households. We assessed the economic burden of TB on patients and their households in Tanzania and identified cost drivers to inform policies and programs for potential interventions to mitigate costs.
We conducted a nationally representative cross-sectional survey using a standard methodology recommended by World Health Organization. TB patients of all ages and with all types of TB from 30 clusters across Tanzania were interviewed during July - September 2019. We used the human capital approach to assess the indirect costs and a threshold of 20% of the household annual expenditure to determine the proportion of TB-affected households experiencing catastrophic cost. We descriptively analyzed the cost data and fitted multivariable logistic regression models to identify potential predictors of catastrophic costs.
Of the 777 TB-affected households, 44.9% faced catastrophic costs due to TB. This proportion was higher (80.0%) among households of patients with multi-drug resistant TB (MDR-TB). Overall, cost was driven by income loss while accessing TB services (33.7%), nutritional supplements (32.6%), and medical costs (15.1%). Most income loss was associated with hospitalization and time for picking up TB drugs. Most TB patients (85.9%) reported worsening financial situations due to TB, and over fifty percent (53.0%) borrowed money or sold assets to finance TB treatment. In multivariable analysis, the factors associated with catastrophic costs included hospitalization (adjusted odds ratio [aOR] = 34.9; 95% confidence interval (CI):12.5-146.17), living in semi-urban (aOR = 1.6; 95% CI:1.0-2.5) or rural areas (aOR = 2.6; 95% CI:1.8-3.7), having MDR-TB (aOR = 3.4; 95% CI:1.2-10.9), and facility-based directly-observed treatment (DOT) (aOR = 7.2; 95% CI:2.4-26.6).
We found that the cost of TB care is catastrophic for almost half of the TB-affected households in Tanzania; our findings support the results from other surveys recently conducted in sub-Saharan Africa. Collaborative efforts across health, employment and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence and outcomes.
We conducted a nationally representative cross-sectional survey using a standard methodology recommended by World Health Organization. TB patients of all ages and with all types of TB from 30 clusters across Tanzania were interviewed during July - September 2019. We used the human capital approach to assess the indirect costs and a threshold of 20% of the household annual expenditure to determine the proportion of TB-affected households experiencing catastrophic cost. We descriptively analyzed the cost data and fitted multivariable logistic regression models to identify potential predictors of catastrophic costs.
Of the 777 TB-affected households, 44.9% faced catastrophic costs due to TB. This proportion was higher (80.0%) among households of patients with multi-drug resistant TB (MDR-TB). Overall, cost was driven by income loss while accessing TB services (33.7%), nutritional supplements (32.6%), and medical costs (15.1%). Most income loss was associated with hospitalization and time for picking up TB drugs. Most TB patients (85.9%) reported worsening financial situations due to TB, and over fifty percent (53.0%) borrowed money or sold assets to finance TB treatment. In multivariable analysis, the factors associated with catastrophic costs included hospitalization (adjusted odds ratio [aOR] = 34.9; 95% confidence interval (CI):12.5-146.17), living in semi-urban (aOR = 1.6; 95% CI:1.0-2.5) or rural areas (aOR = 2.6; 95% CI:1.8-3.7), having MDR-TB (aOR = 3.4; 95% CI:1.2-10.9), and facility-based directly-observed treatment (DOT) (aOR = 7.2; 95% CI:2.4-26.6).
We found that the cost of TB care is catastrophic for almost half of the TB-affected households in Tanzania; our findings support the results from other surveys recently conducted in sub-Saharan Africa. Collaborative efforts across health, employment and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence and outcomes.
摘要：
虽然结核病（TB）护理在坦桑尼亚是免费的，与结核病相关的费用可能会影响获得服务的机会和治疗的依从性，从而导致效果不佳，并增加社区传播的风险。结核病可以影响经济患者及其家庭。我们评估了结核病对坦桑尼亚患者及其家庭的经济负担，并确定了成本驱动因素，为潜在干预措施的政策和计划提供信息，以减轻成本。
我们使用世界卫生组织推荐的标准方法进行了具有全国代表性的横断面调查。在2019年7月至9月期间，采访了来自坦桑尼亚30个集群的所有年龄和所有类型结核病的结核病患者。我们使用人力资本方法来评估间接成本和家庭年度支出的20％的阈值，以确定受结核病影响的家庭遭受灾难性成本的比例。我们对成本数据进行了描述性分析，并拟合了多变量逻辑回归模型，以确定灾难性成本的潜在预测因素。
在777个受TB影响的家庭中，44.9%的人因结核病面临灾难性成本。在耐多药结核病（MDR-TB）患者的家庭中，这一比例更高（80.0％）。总的来说,成本是由获得结核病服务时的收入损失(33.7%)驱动的，营养补充剂(32.6%)，和医疗费用(15.1%)。大多数收入损失与住院和服用结核病药物的时间有关。大多数结核病患者（85.9％）报告说，由于结核病，财务状况恶化，超过50%(53.0%)的人借钱或出售资产来资助结核病治疗。在多变量分析中，与灾难性费用相关的因素包括住院(调整后比值比[aOR]=34.9;95%置信区间(CI):12.5-146.17)，生活在半城市（aOR=1.6；95%CI：1.0-2.5）或农村地区（aOR=2.6；95%CI：1.8-3.7），患有耐多药结核病（aOR=3.4；95%CI：1.2-10.9），和基于设施的直接观察治疗（DOT）（aOR=7.2；95%CI：2.4-26.6）。
我们发现，对于坦桑尼亚近一半受结核病影响的家庭来说，结核病护理的成本是灾难性的；我们的发现支持了最近在撒哈拉以南非洲进行的其他调查的结果。跨健康领域的合作努力，就业和社会福利部门必须最大限度地降低因结核病导致的家庭成本，并改善获得护理的机会，患者依从性和结果。
我们使用世界卫生组织推荐的标准方法进行了具有全国代表性的横断面调查。在2019年7月至9月期间，采访了来自坦桑尼亚30个集群的所有年龄和所有类型结核病的结核病患者。我们使用人力资本方法来评估间接成本和家庭年度支出的20％的阈值，以确定受结核病影响的家庭遭受灾难性成本的比例。我们对成本数据进行了描述性分析，并拟合了多变量逻辑回归模型，以确定灾难性成本的潜在预测因素。
在777个受TB影响的家庭中，44.9%的人因结核病面临灾难性成本。在耐多药结核病（MDR-TB）患者的家庭中，这一比例更高（80.0％）。总的来说,成本是由获得结核病服务时的收入损失(33.7%)驱动的，营养补充剂(32.6%)，和医疗费用(15.1%)。大多数收入损失与住院和服用结核病药物的时间有关。大多数结核病患者（85.9％）报告说，由于结核病，财务状况恶化，超过50%(53.0%)的人借钱或出售资产来资助结核病治疗。在多变量分析中，与灾难性费用相关的因素包括住院(调整后比值比[aOR]=34.9;95%置信区间(CI):12.5-146.17)，生活在半城市（aOR=1.6；95%CI：1.0-2.5）或农村地区（aOR=2.6；95%CI：1.8-3.7），患有耐多药结核病（aOR=3.4；95%CI：1.2-10.9），和基于设施的直接观察治疗（DOT）（aOR=7.2；95%CI：2.4-26.6）。
我们发现，对于坦桑尼亚近一半受结核病影响的家庭来说，结核病护理的成本是灾难性的；我们的发现支持了最近在撒哈拉以南非洲进行的其他调查的结果。跨健康领域的合作努力，就业和社会福利部门必须最大限度地降低因结核病导致的家庭成本，并改善获得护理的机会，患者依从性和结果。
