Geliukh Evgenia, Nabirova Dilyara, Davtyan Karapet, Yesypenko Svetlana, Zachariah Rony
ICF "Alliance for Public Health", Kyiv, Ukraine.
US Centers for Disease Control and Prevention, Central Asia Regional Office, Almaty, Kazakhstan.
J Infect Dev Ctries. 2019 Jul 31;13(7.1):83S-88S. doi: 10.3855/jidc.11292.
We assessed the influence of a result-based financing (RBF) model, which included incentives for Primary Healthcare facilities on TB treatment outcomes.
We compared TB patients > 17 years and their treatment outcomes among those who did and did not benefit from RBF-model in 14 districts of Odeska oblast, Ukraine in 2017. Log-binomial regression was used to examine factors associated with being included in RBF-model.
Of 2,269 reported TB patients, 308 (14%) were included in RBF-model. Most patients in the RBF-model were from rural areas 229 (74%), unemployed 218 (71%), and HIV-infected 131 (43%). Individuals from urban areas (Adjusted risk ratio, ARR =0.9, 95% Confidence Interval, CI:0.89-0.94), having drug-resistant TB (ARR = 0.3, 95% CI: 0.18-0.45), and relapse TB (ARR = 0.6, 95% CI:0.40-0.83) were less likely to be included in RBF-model. Favorable outcomes in new/relapse cases with RBF-model was 89% compared with 41% (p < 0.001) without RBF. Similarly, for other retreatment this was 83% versus 40% (p < 0.001). Failures in the no-RBF group was 29% for new and relapse cases while for other retreatment cases, it was 26% (significantly higher than in the RBF-model).
RBF-model is effective in achieving high levels of favorable TB treatment outcomes. Almost three-in-ten TB patients in non-RBF category failed TB treatment despite having drug-susceptible TB. Efforts are now needed to include it within ongoing public health reforms and assess the feasibility of scaling-up this intervention through implementation research and dedicated funding.
我们评估了基于结果的融资（RBF）模式对结核病治疗结果的影响，该模式包括对初级卫生保健机构的激励措施。
2017年，我们在乌克兰敖德萨州的14个地区比较了17岁以上结核病患者及其在受益于RBF模式和未受益于该模式的患者中的治疗结果。采用对数二项回归分析与纳入RBF模式相关的因素。
在报告的2269例结核病患者中，308例（14%）纳入RBF模式。RBF模式下的大多数患者来自农村地区，有229例（74%），失业者218例（71%），艾滋病毒感染者131例（43%）。来自城市地区的个体（调整风险比，ARR = 0.9，95%置信区间，CI：0.89 - 0.94）、患有耐药结核病的个体（ARR = 0.3，95% CI：0.18 - 0.45）和复发性结核病患者（ARR = 0.6，95% CI：0.40 - 0.83）被纳入RBF模式的可能性较小。RBF模式下新发病例/复发病例的良好治疗结果为89%，而无RBF模式的为41%（p < 0.001）。同样，其他复治病例的这一比例分别为83%和40%（p < 0.001）。无RBF组新发病例和复发病例的治疗失败率为29%，而其他复治病例为26%（显著高于RBF模式）。
RBF模式在实现高水平的结核病良好治疗结果方面是有效的。在非RBF类别中，近十分之三的结核病患者尽管患有药敏结核病，但治疗仍告失败。现在需要努力将其纳入正在进行的公共卫生改革，并通过实施研究和专项资金评估扩大这一干预措施的可行性。
