Friends for International TB Relief, 1/21 Le Van Luong, Nhan Chinh, Thanh Xuan, Ha Noi, Vietnam.
IRD VN, Ho Chi Minh City, Vietnam.
BMC Health Serv Res. 2021 Oct 5;21(1):1051. doi: 10.1186/s12913-021-06984-2.
Many tuberculosis (TB) patients incur catastrophic costs. Active case finding (ACF) may have socio-protective properties that could contribute to the WHO End TB Strategy target of zero TB-affected families suffering catastrophic costs, but available evidence remains limited. This study measured catastrophic cost incurrence and socioeconomic impact of an episode of TB and compared those socioeconomic burdens in patients detected by ACF versus passive case finding (PCF).
This cross-sectional study fielded a longitudinal adaptation of the WHO TB patient cost survey alongside an ACF intervention from March 2018 to March 2019. The study was conducted in six intervention (ACF) districts and six comparison (PCF) districts of Ho Chi Minh City, Viet Nam. Fifty-two TB patients detected through ACF and 46 TB patients in the PCF cohort were surveyed within two weeks of treatment initiation, at the end of the intensive phase of treatment, and after treatment concluded. The survey measured income, direct and indirect costs, and socioeconomic impact based on which we calculated catastrophic cost as the primary outcome. Local currency was converted into US$ using the average exchange rates reported by OANDA for the study period (VNĐ1 = US$0.0000436, 2018-2019). We fitted logistic regressions for comparisons between the ACF and PCF cohorts as the primary exposures and used generalized estimating equations to adjust for autocorrelation.
ACF patients were poorer than PCF patients (multidimensional poverty ratio: 16 % vs. 7 %; p = 0.033), but incurred lower median pre-treatment costs (US$18 vs. US$80; p < 0.001) and lower median total costs (US$279 vs. US$894; p < 0.001). Fewer ACF patients incurred catastrophic costs (15 % vs. 30 %) and had lower odds of catastrophic cost (aOR = 0.17; 95 % CI: [0.05, 0.67]; p = 0.011), especially during the intensive phase (OR = 0.32; 95 % CI: [0.12, 0.90]; p = 0.030). ACF patient experienced less social exclusion (OR = 0.41; 95 % CI: [0.18, 0.91]; p = 0.030), but more often resorted to financial coping mechanisms (OR = 5.12; 95 % CI: [1.73, 15.14]; p = 0.003).
ACF can be effective in reaching vulnerable populations and mitigating the socioeconomic burden of TB, and can contribute to achieving the WHO End TB Strategy goals. Nevertheless, as TB remains a catastrophic life event, social protection efforts must extend beyond ACF.
许多结核病（TB）患者会产生灾难性的费用。主动病例发现（ACF）可能具有社会保护性质，可以帮助世卫组织终结结核病战略实现“零结核病影响家庭陷入灾难性支出”的目标，但现有证据仍然有限。本研究旨在衡量结核病发作期间的灾难性费用发生情况和社会经济影响，并比较通过 ACF 和被动病例发现（PCF）发现的患者的这些社会经济负担。
本横断面研究采用世卫组织结核病患者费用调查的纵向改编版，同时在 2018 年 3 月至 2019 年 3 月期间开展了 ACF 干预措施。该研究在越南胡志明市的六个干预（ACF）区和六个对照（PCF）区进行。在治疗开始后两周内、治疗强化期结束时和治疗结束后，对通过 ACF 发现的 52 名结核病患者和 PCF 队列中的 46 名结核病患者进行调查。该调查根据收入、直接和间接费用以及社会经济影响来衡量，我们据此计算了灾难性费用作为主要结果。当地货币使用 OANDA 在研究期间报告的平均汇率（VNĐ1=US$0.0000436，2018-2019 年）转换为美元。我们将 ACF 和 PCF 队列作为主要暴露因素进行逻辑回归比较，并使用广义估计方程来调整自相关。
ACF 患者比 PCF 患者更贫困（多维贫困率：16%比 7%；p=0.033），但治疗前费用中位数较低（18 美元比 80 美元；p<0.001），总费用中位数也较低（279 美元比 894 美元；p<0.001）。较少的 ACF 患者产生灾难性费用（15%比 30%），发生灾难性费用的可能性也较低（比值比=0.17；95%置信区间：[0.05, 0.67]；p=0.011），尤其是在强化治疗期间（比值比=0.32；95%置信区间：[0.12, 0.90]；p=0.030）。ACF 患者经历的社会排斥较少（比值比=0.41；95%置信区间：[0.18, 0.91]；p=0.030），但更频繁地采用财务应对机制（比值比=5.12；95%置信区间：[1.73, 15.14]；p=0.003）。
ACF 可以有效地接触弱势群体并减轻结核病的社会经济负担，并有助于实现世卫组织终结结核病战略的目标。然而，由于结核病仍然是灾难性的生活事件，社会保护工作必须超越 ACF。
