Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

<p>Abstract</p> <p>Background</p> <p>The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.</p> <p>Methods</p> <p>The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.</p> <p>Results</p> <p>A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.</p> <p>Conclusions</p> <p>The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.</p

Epidemiological profile of tuberculosis infection and disease among cocaine users admitted to hospitals of the Greater São Paulo city

OBJECTIVE: To evaluate the prevalence and the risk factors for tuberculosis (TB) infection and disease among hospitalized cocaine users. METHOD: A cross-sectional study performed on a sample of 440 addicts over 18 years of age, admitted to hospitals of the metropolitan area of the Greater São Paulo city, whose clinical conditions allowed them to answer a standard questionnaire, and who agreed to participate in the study. The prevalence of TB infection was assessed through positive tuberculin testing (PPD), and of TB disease by the finding of M. tuberculosis in the sputum of patients with respiratory symptoms. RESULTS: Respiratory symptoms were present in 21% of the patients, the most frequent being weight loss and cough, which disappeared when cocaine use was discontinued. The general prevalence of TB infection was 28%. The prevalence of TB disease was 0.6%. The factors which were associated with positive PPD were: age, color/race, time spent in prison, and drug use in prison. CONCLUSION: No increased prevalence of TB infection and disease was found in these patients. Older addicts had a higher probability of having TB infection, and so had those who had been in prison