背景:印度正在努力应对令人震惊的结核病(TB)负担,2023年报告了260万例事故病例,需要加大努力消除结核病。灾难性成本的普遍存在,定义为支出超过家庭年收入的20%,差异很大。我们的目标是确定TB-HIV和TB-糖尿病护理的灾难性成本与不良TB治疗结果之间的关联。
方法:我们在Bhavnagar进行了一项队列研究,印度,从2019年7月到2021年1月,涉及234名TB-HIV患者和304名TB-糖尿病患者。使用世界卫生组织的工具评估灾难性成本。不利的结核病治疗结果包括痰涂片的阳性结果,核酸扩增,或治疗完成时的培养测试,治疗期间死亡,或停止治疗一个月(对于药物敏感性结核病)或两个月(对于耐药结核病)。Firth回归用于解决准分离问题并确定预测因子。
结果:在TB-HIV患者中,12%的人面临灾难性的成本,20%的患者出现不良的结核病结局。在这个群体中,重要的预测因素包括体重(OR:0.93,95%CI:0.89-0.98),家族类型(OR:2.5,95%CI:1.2-5.5),和初次住院(OR:2.6,95%CI:1.1-6.3)。对于结核病糖尿病患者,5%面临灾难性成本,14%的人有不利的结果,显著预测因子低于贫困线(BPL)(OR:2.9,95%CI:1.5-5.9)和初始住院(OR:3.4,95%CI:1.1-11.1).结核病-艾滋病毒的灾难性成本发生率更高(12%与4%仅用于TB)和TB-糖尿病(5%与仅TB患者中为4%)。然而,两组的灾难性成本均未显示与不良结局有直接关联.
结论:我们的研究发现,在TB-HIV/TB-糖尿病患者中,灾难性成本与不良TB结局之间没有直接关联。相反,体重等因素,家庭类型,BPL状态,和初次住院是重要的预测因素。这些发现强调了社会经济条件和初次住院的重要性,倡导加强支持机制,包括营养和财政援助,特别是BPL家庭。
BACKGROUND: India grapples with an alarming burden of tuberculosis (TB), reporting 2.6 million incident cases in 2023, necessitating intensified efforts toward TB elimination. The prevalence of catastrophic costs, defined as expenses exceeding 20% of annual household income, varies widely. Our objective was to determine the association between catastrophic costs from TB-HIV and TB-diabetes care and unfavorable TB treatment outcomes.
METHODS: We conducted a cohort study in Bhavnagar, India, from July 2019 to January 2021, involving 234 TB-HIV and 304 TB-diabetes patients. Catastrophic costs were assessed using the World Health Organization\'s tool. Unfavorable TB treatment outcomes included positive results from sputum smear, nucleic acid amplification, or culture tests at treatment completion, death during treatment, or treatment cessation for a month (for drug-sensitive TB) or two months (for drug-resistant TB). Firth regression was employed to address quasi-separation issues and identify predictors.
RESULTS: Among TB-HIV patients, 12% faced catastrophic costs, with 20% experiencing unfavorable TB outcomes. In this group, significant predictors included weight (OR: 0.93, 95% CI: 0.89-0.98), family type (OR: 2.5, 95% CI: 1.2-5.5), and initial hospitalization (OR: 2.6, 95% CI: 1.1-6.3). For TB-diabetes patients, 5% faced catastrophic costs, and 14% had unfavorable outcomes, with significant predictors being below the poverty line (BPL) (OR: 2.9, 95% CI: 1.5-5.9) and initial hospitalization (OR: 3.4, 95% CI: 1.1-11.1). Catastrophic cost incidence was higher in TB-HIV (12% vs. 4% in TB only) and TB-diabetes (5% vs. 4% in TB only) patients. However, catastrophic costs did not show a direct association with unfavorable outcomes in either group.
CONCLUSIONS: Our study found no direct association between catastrophic costs and unfavorable TB outcomes among TB-HIV/TB-diabetes patients. Instead, factors such as weight, family type, BPL status, and initial hospitalization were significant predictors. These findings underscore the importance of socio-economic conditions and initial hospitalization, advocate for enhanced support mechanisms including nutritional and financial aid, especially for BPL families.