Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Thorax. 2021 Apr;76(4):387-395. doi: 10.1136/thoraxjnl-2020-215338. Epub 2020 Dec 18.
Mitigating the socioeconomic impact of tuberculosis (TB) is key to the WHO End TB Strategy. However, little known about socioeconomic well-being beyond TB-treatment completion. In this mixed-methods study, we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery.
Adults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed up for 12 months. Socioeconomic, income, occupation, health seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants.
405 participants were recruited from February 2016 to April 2017. Median age was 35 years (IQR: 28-41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% (232/368) vs 72.4% (293/405), p=0.006), median incomes were lower (US$44.13 (IQR: US$0-US$106.15) vs US$72.20 (IQR: US$26.71-US$173.29), p<0.001), and more patients were living in poverty (earning <US$1.90/day: 57.7% (211/366) vs 41.6% (166/399), p<0.001) 1 year after TB-treatment completion compared with before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity and stigma.
TB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment, persistent financial strain requiring dissaving, and ongoing school interruptions. Measures of the economic impact of TB disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.
减轻结核病（TB）的社会经济影响是世界卫生组织终结结核病战略的关键。然而，人们对 TB 治疗完成后社会经济福利知之甚少。在这项混合方法研究中，我们描述了马拉维布兰太尔城市中 TB 疾病后的社会经济结果，并探讨了财务恢复的途径和障碍。
在国家结核病控制规划下成功完成首次肺 TB 治疗的 15 岁及以上成年人被前瞻性随访 12 个月。收集社会经济、收入、职业、卫生服务利用和费用数据。通过对有目的地选择的参与者进行疾病叙述访谈，探讨持续经济困难的决定因素和影响。
2016 年 2 月至 2017 年 4 月期间共招募了 405 名参与者。中位年龄为 35 岁（IQR：28-41），67.9%（275/405）为男性，60.6%（244/405）为 HIV 阳性。在 TB 治疗完成时，就业和收入最低，在接下来的一年中恢复有限：从事有薪工作的人数减少（63.0%（232/368）与 72.4%（293/405）相比，p=0.006），中位收入较低（US$44.13（IQR：US$0-US$106.15）与 US$72.20（IQR：US$26.71-US$173.29）相比，p<0.001），更多的患者生活在贫困中（每天收入<US$1.90：57.7%（211/366）与 41.6%（166/399）相比，p<0.001），与 TB 发病前相比，在 TB 治疗完成后 1 年。一半的参与者（50.5%，184/368）报告持续减债（使用储蓄、出售资产、借款），9.5%（35/368）报告在 TB 治疗完成后一年中断学业。21 名参与者完成了深入访谈。报告的经济复苏障碍包括经济不安全、重建商业关系的挑战、残留的身体残疾和耻辱感。
即使在 TB 治疗完成后，受 TB 影响的家庭仍然面临经济脆弱性，收入和就业恢复有限，持续的财务压力需要减债，且持续中断学业。TB 疾病的经济影响评估应包括 TB 后时期。必须探索保护 TB 幸存者的长期健康和生计的干预措施。
