KNCV Tuberculosis Foundation, Den Haag, The Netherlands.
BMC Public Health. 2011 Jan 18;11:43. doi: 10.1186/1471-2458-11-43.
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.
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.
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.
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.
贫困人口在获取结核病护理方面面临地理、社会文化和卫生系统障碍。这些障碍可能导致诊断和治疗不及时，从而使病情恶化，并继续传播结核病。通过解决障碍和延迟的原因，可以有效降低结核病患者的费用。已经开发出一种估算患者费用的工具。它可以帮助结核病控制规划评估这些障碍。本研究介绍了该工具及其在肯尼亚的试点结果。
该工具根据当地情况进行了调整，翻译成斯瓦希里语，并进行了预测试。在东部省的两个地区，有 9 家公共卫生机构被有目的地抽样。从年龄在 15 岁以上、至少接受了一个月治疗并签署了知情同意书的结核病患者那里收集了答复，并进行了双录入和分析。对地区和国家一级的主要信息来源进行了后续访谈，以评估试点的影响，并探讨潜在的干预措施。
2008 年 9 月共采访了 208 名患者。两个地区的结核病患者都因结核病而承受着直接（自付；55.8 美元）和间接（机会；294.2 美元）费用的巨大负担。无法工作是贫困加剧的主要原因。结果证实了这两个地区存在“医疗贫困陷阱”的情况：支出增加，而收入减少。随后，将结核病治疗服务下放给了另外 15 个设施，并向其他卫生方案寻求结核病患者的营养支持和痰样运输。在国家一级，成立了一个结核病和贫困问题小组委员会，以制定一项全面的扶贫办法。
患者费用估算工具被证明是一种评估结核病患者费用、社会经济状况、寻求医疗服务行为模式、艾滋病毒等并发疾病以及社会和性别相关影响的有用工具。该工具有助于发现和解决获得结核病护理方面的瓶颈问题，特别是对贫困人口。减少诊断延迟、服务下放、结核病/艾滋病毒全面综合护理以及扩大医疗保险覆盖范围，将减轻结核病给患者带来的经济压力。
