Patient's site of first access to health system influences length of delay for tuberculosis treatment in Tajikistan

BACKGROUND: Tajikistan has the highest incidence rate of tuberculosis (TB) in Central Asia. Its health system still bears many features from Soviet times and is under-funded. Affordability is a major barrier to health care. Little is known about health care seeking of TB patients in post-Soviet countries and their delay until the start of TB therapy. The low estimated case detection rate in Tajikistan suggests major problems with access to care and consequently long delays are likely. METHODS: The study investigated extent and determinants of patient and health system delays for TB. A questionnaire was administered to a cohort of TB patients in twelve study districts representing a wide range of conditions found in Tajikistan. Common patterns of health care seeking were analysed. Cox proportional hazards models using eight predictor variables, including characteristics of health services delivery, were built to identify determinants of patient and health system delays. RESULTS: Two-hundred-and-four TB patients were interviewed. A common pattern in treatment-seeking was visiting a specialised TB facility at some stage. Typical delays until start of TB therapy were moderate and did not confirm the expectation of long delays. Median patient, health system and total delays to TB treatment were 21.5, 16 and 52 days, respectively. None of the investigated predictors was significantly associated with patient delay. The type of facility, where patients made their first contact with the health system, was the main determinant of health system delay (p > 0.00005). We show for the first time that patients who had fallen ill and first presented to health care in Russia had the longest delays. Those who first presented to peripheral primary care facilities also had relatively long delays. CONCLUSIONS: While overall delays were moderate, further improvement is needed for different subgroups. An international referral system between Russia and Tajikistan to reduce delays of Tajik migrants who develop active TB in Russia is urgently needed and would benefit both countries. Within Tajikistan, diagnostic pathways for patients in the periphery should be shortened. To achieve this, strengthening of sputum smear examination possibly including collection of sputa at peripheral primary care facilities may be needed

Factors determining household expenditure for tuberculosis and coping strategies in Tajikistan

Objective: To investigate factors influencing expenditure levels and the use of potentially detrimental coping strategies among tuberculosis (TB) patients. For the purpose of the present study, potentially detrimental coping strategies included borrowing money and selling assets. Method: Questionnaire survey with an initial and a follow-up interview of each adult new pulmonary TB case registered over a period of 4 months, conducted in 12 districts with DOTS in Tajikistan, one of the poorest countries in the world. Results: Patients and their households faced mean expenditures of US$396 related to a TB episode. In multivariate mixed-effect regression models, the main determinants of out-of-pocket payments-either over the whole course of the disease or after enrolment in DOTS treatment-were 'complimentary treatment' besides the anti-TB drugs, duration of hospitalization and treatment delay. Complimentary treatment mainly consisted of vitamins and rehydrating infusions. Sex showed no association with expenditure. To cope with the costs of illness, two-thirds of patients employed a potentially detrimental coping strategy. TB patients raised on average US$ 23 through loans with interest, US$57 through loans without interest and US$ 102 through selling assets. Conclusion: The catastrophic out-of-pocket payments faced by TB patients are correlated with receiving complimentary treatment, delay to treatment and duration of hospitalisation. The widespread use of potentially detrimental coping strategies illustrates that TB constitutes a substantial risk of impoverishment. More parsimonious use of complimentary treatment and hospitalisation could reduce illness-related costs for patients and should be carefully considere

Lessons Learned from Fighting Coronavirus Disease in the Republic of Uzbekistan

The paper contains the data on epidemiological situation on COVID-19 in the Republic of Uzbekistan. As of June 29, 2020, 8031 laboratory confirmed cases of COVID-19 were registered across the country; 22 cases with lethal outcome. The paper describes the national policy in the prevention of importation of this infection into the territory of Uzbekistan and halting further spread among the population. Complex measures in response to the transmission of COVID-10 are specified. The paper defines support activities provided for the partner countries by the Republic of Uzbekistan to control COVID-19 pandemic

Illness costs to households are a key barrier to access diagnostic and treatment services for tuberculosis in Tajikistan

ABSTRACT: BACKGROUND: Tuberculosis (TB) control is based on early detection and complete treatment of infectious cases. Consequently, it is important that TB suspects and patients can readily access medical care. This qualitative study investigated determinants of access to DOTS services as identified by patients, health providers and community members in four districts in Tajikistan. FINDINGS: Focus group discussions were conducted in order to investigate access to TB services. A conceptual framework for access to care guided the analysis. Thirteen focus group discussions involving a total of 97 informants were conducted. Content analysis of discussions and a rating to quantify the relative importance of discussed factors were carried out. The conceptual framework identifies five main components of access to which factors can be assigned: availability, adequacy, acceptability, accessibility and affordability.Financial factors were considered the most important determinants of access to diagnosis and treatment of tuberculosis. Expenditure for drugs and consultations, for transport, and for special foods as well as lost income were identified as major barriers to treatment. Stigma, doubts about curability and low perceived quality of care were not seen to be significant determinants of access to care for tuberculosis. Community members were well aware of symptoms of tuberculosis and of medical services. These findings were consistent between different respondent groups (community members, patients and providers). They were also highly consistent between the open discussion and the confidential rating. CONCLUSIONS: Illness-costs to households were identified as the main barrier to tuberculosis diagnosis and treatment. To improve access and ultimately adherence to tuberculosis treatment, effective mitigation strategies, e.g. changes in case management, food contributions or financial stimuli, need to be explored and implemented