Programme National de Lutte contre la Tuberculose, Ministére de la Santé Publique, Kinshasa, DR Congo, Service de Microbiologie, Département de Biologie médicale, Université de Kinshasa, Kinshasa, DR Congo.
World Health Organization, DR Congo Office, Kinshasa, DR Congo.
Int J Tuberc Lung Dis. 2021 Nov 1;25(11):923-932. doi: 10.5588/ijtld.21.0182.
The Democratic Republic of Congo´s free TB care policy and recent progress with universal health coverage are insufficient to remove barriers to TB care access and adherence. As there were no nationally representative data on the economic burden borne by TB patients, the TB programme conducted a national survey to assess the proportion of TB patients facing catastrophic costs, which could also serve as a baseline for monitoring progress. A national survey with retrospective data collection and projection, following WHO methods, was administered to 1,118 patients in 43 treatment zones. Each patient was interviewed once on costs, time loss, coping measures, income, household expenditure and asset ownership. Total costs were expressed as a percentage of annual household expenditure. In 2019, 56.5% of households affected by TB experienced costs above 20% of their annual household expenditure. Mean costs amounted to respectively US$400 (range: 328-471) and US$1,224 (range: 762-1,686) per episode of first-line and drug-resistant TB. The risk of catastrophic costs increased with hospitalisation, drug resistance status and lower economic status. Half of households resorted to coping strategies and experienced food insecurity. Only 7.5% received social support. TB-affected households incur on average a cost of US$549, despite free TB care policy. Mitigating this burden with medical cost reductions, social and labour market measures will be key.
刚果民主共和国的免费结核病护理政策和最近在全民健康覆盖方面取得的进展，不足以消除结核病护理获得和坚持的障碍。由于没有全国代表性的数据来衡量结核病患者的经济负担，结核病规划署开展了一项全国性调查，以评估面临灾难性费用的结核病患者比例，这也可以作为监测进展的基线。这项全国性调查采用了回顾性数据收集和预测方法，遵循世界卫生组织的方法，对 43 个治疗区的 1118 名患者进行了调查。每位患者接受了一次关于费用、时间损失、应对措施、收入、家庭支出和资产所有权的采访。总费用表示为年度家庭支出的百分比。2019 年，56.5%的结核病患者家庭的支出超过了其年度家庭支出的 20%。一线和耐药结核病每例的平均费用分别为 400 美元（范围：328-471）和 1224 美元（范围：762-1686）。住院治疗、耐药状况和较低的经济状况会增加灾难性费用的风险。一半的家庭采取了应对策略，面临粮食不安全。只有 7.5%的家庭获得了社会支持。尽管有免费的结核病护理政策，但受结核病影响的家庭平均每年要承担 549 美元的费用。通过降低医疗费用、采取社会和劳动力市场措施来减轻这一负担将是关键。
