ABSTRACT
Background: India reports the highest number of cases of tuberculosis (TB) in India. Patients with TB employ negative financial coping mechanisms (dissaving) to make up for the costs of care. Our objec-tives were to explore the dissaving employed and enablers perceived by patients with TB-HIV, patients with TB-diabetes, and program managers of TB. Methods: We conducted qualitative in-depth interviews among eight TB-HIV patients, eight TB-diabetes patients, and seventeen program managers of TB in the Bhavnagar region (western part of India). An in-terview guide focusing on the coping strategies and enablers was used. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis (codes and categories). Results: Borrowing money, taking a loan on interest, selling jewellery, taking up employment by the spouse, and mortgaging assets were the negative financial coping strategies employed by patients with TB-HIV co-infection/ TB-diabetes comorbidity. Free diagnosis, free treatment, accessible health facili-ties, support from health workers, bi-directional screening, and collaborative integration were some of the enablers perceived by patients and program managers. Conclusions: Even in settings with a decentralized “free” model of TB care, patients with co-prevalent TB-HIV/ TB-diabetes employ dissaving to offset the costs of care. The cash transfer scheme for patients with TB should be realigned to meet the financial protection targets of zero catastrophic costs by the year 2030.
ABSTRACT
Background: By the year 2030, no family with a patient of tuberculosis (TB) is supposed to incur cata-strophic costs. In India, a significant number of people suffer from TB, and many faces catastrophic costs. Our objective was to determine the predictors of catastrophic costs due to TB among co-prevalent TB-HIV and TB-diabetes patients. Methods: We conducted a cross-sectional study among 234 patients co-affected with TB-HIV and 304 patients with TB-diabetes co-prevalence in the Bhavnagar region (western part of India). TB costs was estimated using a validated questionnaire. Multivariable logistic regression was used to determine the significant predictors of catastrophic costs of TB. Results: Four percent of patients in each group incurred catastrophic costs due to TB. Female gender [aOR 6 (1.2-33)], being single [aOR 9 (1.5-52)], low socioeconomic status [aOR 7 (1.2-30)], private con-sultation for TB [aOR 9 (1.5-53)], and hospitalization in first HIV visit [aOR 19 (3-137)] were significant-ly predicted catastrophic costs of TB among patients co-affected with TB-HIV. Among patients with TB-diabetes co-prevalence, hospitalization in first TB visit [aOR 7 (2-29)], and private consultation for TB [aOR 7 (1.6-30)] were the significant predictors. Conclusions: Despite a lower percentage of TB-HIV/ TB-diabetes patients facing catastrophic costs, hospitalization and private care-seeking are the “modifiable” determinants of TB catastrophic costs in our study setting.