Economic support intervention improves tuberculosis treatment outcomes in rural Nigeria.

SETTING: A secondary care hospital in rural Nigeria. OBJECTIVE: To investigate the feasibility of providing financial incentives to tuberculosis (TB) patients under routine conditions, and to determine their impact on TB treatment outcomes in a low-resource setting. DESIGN: A prospective, non-randomised intervention study. RESULTS: A total of 294 TB patients (respectively 173 and 121 in the control and intervention periods of 3 months' duration each) were registered in the study. The patients did not differ in terms of their demographic or clinical characteristics (P not significant). The treatment success rate was 104/121 (86.0%) during the intervention, and 123/173 (71.1%) during the control period (P = 0.003). The proportion of patients who were lost to follow-up significantly decreased during the intervention period (20.2% vs. 5.0%, P <0.001). There were no differences in deaths (P = 0.8) or treatment failure rates (P = 0.5) in the intervention and control periods. There was also no difference in the rate of sputum smear conversion after the intensive phase of treatment (88.1% vs. 91.5%, P = 0.5). Independent determinants of treatment success were female sex (adjusted odds ratio [aOR] 1.9), human immunodeficiency virus negativity (aOR 2.5) and receiving financial incentives (aOR 2.3). CONCLUSIONS: Financial incentives proved to be effective in improving treatment success and reducing loss to follow-up among poor TB patients in Nigeria.

Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding.

BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4-22% of presumptive TB clients tested, and 4-24% of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Estimating the cost of TB and its social impact on TB patients and their households.

Illness often poses a significant financial burden on individuals and their households, and tuberculosis (TB) is no exception. Although TB treatment is free in Nigeria, patients are likely to incur costs due to multiple visits during treatment. The purpose of this study was 1) to examine the health-seeking behaviour of TB patients and the costs borne by TB patients in Nigeria, and 2) to assess the social impact of TB disease on TB patients and their families/households. Of 260 TB patients surveyed, the majority (74.7%) were aged between 20 and 49 years. TB patients expended an average of US$52.02 (N = 8323.58, at the rate of US$1 = N = 160) per person on all visits associated with diagnosis and receipt of diagnostic test results. Overall, households experienced a shortfall of about US$57.30 (N = 9174.72) or 24.9% of income loss due to TB illness. Further analysis revealed that 9.7% of TB patients relied on children of school age or below to finance the costs of TB illness.

La maladie constitue souvent un lourd fardeau financier pour les patients et leurs familles et il en va de même pour la tuberculose (TB). Même si le traitement de la TB est gratuit au Nigéria, les patients doivent supporter les coûts liés aux nombreuses consultations pendant le traitement. Le but de cette étude a été 1) d'examiner le comportement des patients TB en matière de recherche de soins et les coûts supportés par ces patients au Nigéria, et 2) d'évaluer l'impact social de la TB maladie sur les patients et leurs familles/foyers. Sur 260 patients TB de l'enquête, la majorité (74,7%) étaient âgés de 20 à 49 ans. Ils ont dépensé en moyenne US$52,02 (8323,58 nairas nigériens, au taux de change de $1 = N = 160) par personne pour les consultations liées au diagnostic et la réception des résultats de leurs examens. Au total, les foyers ont eu un déficit d'environ US$57,30 (N = 9174,72) ou 24,9% de perte de revenus due à la maladie. Une analyse plus approfondie a révélé que 9,7% des patients TB comptaient sur les enfants d'âge scolaire ou préscolaire pour financer les coûts de la TB.

Las enfermedades suelen imponer una considerable carga económica a los pacientes y sus hogares y la tuberculosis (TB) no constituye una excepción. Aunque el tratamiento antituberculoso sea gratuito en Nigeria, con frecuencia los pacientes deben asumir los gastos que generan las múltiples consultas durante el tratamiento. El presente estudio tuvo los siguientes objetivos: 1) examinar el comportamiento de búsqueda de atención sanitaria de los pacientes aquejados de TB y los costos que sufragan estos pacientes en Nigeria; y 2) evaluar la repercusión social de la enfermedad tuberculosa sobre los pacientes, sus familias y sus hogares. De los 260 pacientes con TB que participaron en el estudio, la mayoría tenía entre 20 y 49 años de edad (74,7%). En promedio, los gastos de cada paciente por todas las consultas asociadas con el diagnóstico y la recepción de los resultados de las pruebas fue 52,02 USD (u 8323,58 nairas; 1 USD = 160 NGD). En general, debido a la enfermedad tuberculosa el ingreso de los hogares sufrió una pérdida cercana a 57,30 USD (o 9174,72 NGD) o de una disminución del 24,9%. Un análisis más detallado reveló que un 9,7% de los pacientes con TB dependía de los hijos en edad escolar o menores para financiar los costos de la enfermedad.