Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Am J Trop Med Hyg. 2011 Sep;85(3):528-34. doi: 10.4269/ajtmh.2011.10-0683.
Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis. Bangladesh national treatment guidelines during the study period called for 120 intramuscular injections of sodium antimony gluconate (SAG). We assessed care-seeking behavior, diagnosis and treatment costs, and coping strategies among 134 PKDL patients; 56 (42%) patients had been treated with SAG, and 78 (58%) remained untreated. The median direct cost per patient treated was US$367 (interquartile range [IQR] = 90-284), more than two times the estimated per capita annual income for the study population. The most common coping strategy was to take a loan; the median amount borrowed was US$98 (IQR = 71-150), with a median interest of US$32 (IQR = 16-95). Households lost a median of 123 work-days per patient treated. The current regimen for PKDL imposes a significant financial burden, reinforcing the link between poverty and visceral leishmaniasis. More practical shorter-course regimens for PKDL are urgently needed to achieve national and regional visceral leishmaniasis elimination goals.
内脏利什曼病（VL）治愈后出现的皮肤利什曼病（PKDL）是一种并发症。在研究期间，孟加拉国国家治疗指南要求对患者进行 120 次肌肉内注射葡萄糖酸锑钠（SAG）。我们评估了 134 名 PKDL 患者的就医行为、诊断和治疗费用以及应对策略；56 名（42%）患者接受了 SAG 治疗，78 名（58%）患者未接受治疗。每位接受治疗的患者的直接医疗费用中位数为 367 美元（四分位距 [IQR] = 90-284），是研究人群估计人均年收入的两倍多。最常见的应对策略是借款；借款中位数为 98 美元（IQR = 71-150），中位数利息为 32 美元（IQR = 16-95）。每个接受治疗的患者平均损失 123 个工作日。目前用于治疗 PKDL 的方案给患者带来了巨大的经济负担，这进一步证实了贫困与内脏利什曼病之间的关联。迫切需要更实用、疗程更短的 PKDL 治疗方案，以实现国家和区域消除内脏利什曼病的目标。
