Rai Bhola, Dixit Kritika, Aryal Tara Prasad, Mishra Gokul, Siqueira-Filha Noemia Teixeira de, Paudel Puskar Raj, Levy Jens W, Rest Job van, Gurung Suman Chandra, Dhital Raghu, Lönnroth Knut, Squire S Bertel, Caws Maxine, Wingfield Tom
Birat Nepal Medical Trust, Kathmandu 44600, Nepal.
Social Medicine, Infectious Diseases, and Migration (SIM) Group, Department of Public Health Sciences, Karolinska Institutet, 10653 Stockholm, Sweden.
Trop Med Infect Dis. 2020 Jun 10;5(2):98. doi: 10.3390/tropicalmed5020098.
Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become "catastrophic", leading patients to abandon treatment, develop drug-resistance, and die. WHO's 2015 End TB Strategy recommends eliminating catastrophic costs and providing socioeconomic support for TB-affected people. However, there is negligible evidence to guide the design and implementation of such socioeconomic support, especially in low-income, TB-endemic countries. A national, multi-sectoral workshop was held in Kathmandu, Nepal, on the 11th and 12th September 2019, to develop a shortlist of feasible, locally appropriate socioeconomic support interventions for TB-affected households in Nepal, a low-income country with significant TB burden. The workshop brought together key stakeholders in Nepal including from the Ministry of Health and Population, Department of Health Services, Provincial Health Directorate, Health Offices, National TB Program (NTP); and TB/Leprosy Officers, healthcare workers, community health volunteers, TB-affected people, and external development partners (EDP). During the workshop, participants reviewed current Nepal NTP data and strategy, discussed the preliminary results of a mixed-methods study of the socioeconomic determinants and consequences of TB in Nepal, described existing and potential socioeconomic interventions for TB-affected households in Nepal, and selected the most promising interventions for future randomized controlled trial evaluations in Nepal. This report describes the activities, outcomes, and recommendations from the workshop.
结核病是全球主要的单一传染病杀手，其根源在于贫困。反之，患结核病会加剧贫困。在结核病患病期间，收入损失和自付费用可能会变得“灾难性”，导致患者放弃治疗、产生耐药性并死亡。世界卫生组织2015年《终止结核病战略》建议消除灾难性费用，并为结核病患者提供社会经济支持。然而，几乎没有证据可指导此类社会经济支持的设计和实施，尤其是在结核病流行的低收入国家。2019年9月11日至12日，在尼泊尔加德满都举办了一次全国性多部门研讨会，目的是为尼泊尔这个结核病负担沉重的低收入国家中受结核病影响的家庭，制定一份可行的、适合当地情况的社会经济支持干预措施清单。该研讨会汇聚了尼泊尔的主要利益相关者，包括卫生与人口部、卫生服务司、省级卫生局、卫生办公室、国家结核病规划（NTP）；以及结核病/麻风病防治官员、医护人员、社区卫生志愿者、结核病患者和外部发展伙伴（EDP）。在研讨会上，与会者审查了尼泊尔国家结核病规划的现有数据和战略，讨论了一项关于尼泊尔结核病社会经济决定因素及后果的混合方法研究的初步结果，描述了尼泊尔针对受结核病影响家庭的现有和潜在社会经济干预措施，并挑选出最具前景的干预措施，以便在尼泊尔进行未来的随机对照试验评估。本报告介绍了该研讨会的活动、成果和建议。
