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Risk factors for catastrophic costs associated with tuberculosis in rural South Africa

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SETTING

Fifty-five public clinics in northern South Africa.
OBJECTIVE

To estimate patient costs and identify the factors associated with catastrophic costs among individuals treated for tuberculosis (TB).
DESIGN

We performed cross-sectional interviews of consecutive patients at public clinics from October 2017 to January 2018. ‘Catastrophic costs' were defined as costs totalling ≥20% of annual household income. For participants with no reported income, we considered scenarios where costs were considered non-catastrophic if 1) costs totalled RESULTS

Among 327 participants, the estimated mean TB episode costs were US$365 (95%CI 233–498): out-of-pocket costs comprised 58% of costs, wages lost due to health care-seeking represented 26%, and income reduction accounted for 16% of costs. Ninety (28%) participants experienced catastrophic costs, which were associated with clinic travel times of 60–90 min (adjusted prevalence ratio [aPR] 1.7, 95%CI 0.9–3.1), unemployment (aPR 2.0, 95%CI 1.0–4.0) and having fewer household members (aPR 0.6, 95%CI 0.3–1.0).
CONCLUSIONS

In rural South Africa, catastrophic costs from TB are common and associated with distance to clinics, unemployment, and household size. These findings can help tailor social protection programs and enhance service delivery to patients at greatest risk of experiencing financial hardship.
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Keywords: care-seeking; epidemiology; income; patient cost; socio-economic

Document Type: Research Article

Affiliations: 1: Departments of Epidemiology and 2: Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa 3: International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 4: Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA 5: Departments of Epidemiology and, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA

Publication date: June 1, 2019

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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