TY - JOUR
T1 - Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment - Tamil Nadu, India
AU - Veesa, Karun Sandeep
AU - John, Kamalabhai Russell
AU - Moonan, Patrick K.
AU - Kaliappan, Saravanakumar Puthupalayam
AU - Manjunath, Krishna
AU - Sagili, Karuna D.
AU - Ravichandra, Chinnappareddy
AU - Menon, Pradeep Aravindan
AU - Dolla, Chandrakumar
AU - Luke, Nancy
AU - Munshi, Kaivan
AU - George, Kuryan
AU - Minz, Shantidani
N1 - Funding Information:
The project was supported by agrant (R01 HD058831-01) from the Eunice K ennedy Shriver NationalInstituteofChildHealthandHumanDevelopment(NICHD).Supportwasalsopro-videdbythePopulationResearchInstituteatPennStateUniversity,whichissupportedbyan infrastructuregrantfromNICHD(P2CHD041025);theNewtonTrustattheUniversityof Cambridge;andthePopulationStudiesandTrainingCenteratBrownUniversity.
Funding Information:
The data used in this paper are from a project directed by Kaivan Munshi, University of Cambridge, Nancy Luke, Pennsylvania State University, Soumya Swaminathan, Indian Council of Medical Research, and Shantidani Minz, Christian Medical College, Vellore. The project was supported by a grant (R01 HD058831-01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Support was also provided by the Population Research Institute at Penn State University, which is supported by an infrastructure grant from NICHD (P2CHD041025); the Newton Trust at the University of Cambridge; and the Population Studies and Training Center at Brown University. The study was conducted as a part of the ‘TB Operations Research Training Project’ aimed to build operational research capacity within the Government of India’s RNTCP. This training project was conceived and implemented jointly by Central TB Division (Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India), the National TB Institute (Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Bangalore, India), The International Union Against Tuberculosis and Lung Diseases (The Union, South-East Asia Regional Office, New Delhi, India) and U.S. Centers for Disease Control and Prevention (Division of TB Elimination, Atlanta, USA).
Publisher Copyright:
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2018/2
Y1 - 2018/2
N2 - Background Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India. Methods This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures. Results Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69% incurred some pre-treatment costs at an average of $39.74. Overall, patients experienced a median of 6 days (3-11 IQR) of time to treatment initiation and 21 days (10-30 IQR) of health systems delay. Age 40 years (aOR: 1.73; CI: 1.22-2.44), diabetes (aOR: 1.63; CI: 1.08-2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1-26.4) were associated with higher direct OOP medical costs, while age 40 years (aOR: 0.64; CI: 0.48-0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34-2.39) were associated with health systems delay. Conclusion The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently.
AB - Background Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India. Methods This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures. Results Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69% incurred some pre-treatment costs at an average of $39.74. Overall, patients experienced a median of 6 days (3-11 IQR) of time to treatment initiation and 21 days (10-30 IQR) of health systems delay. Age 40 years (aOR: 1.73; CI: 1.22-2.44), diabetes (aOR: 1.63; CI: 1.08-2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1-26.4) were associated with higher direct OOP medical costs, while age 40 years (aOR: 0.64; CI: 0.48-0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34-2.39) were associated with health systems delay. Conclusion The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently.
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U2 - 10.1371/journal.pone.0191591
DO - 10.1371/journal.pone.0191591
M3 - Article
C2 - 29414980
AN - SCOPUS:85041544978
VL - 13
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 2
M1 - e0191591
ER -