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BackgroundRoutine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. MethodsWe adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. ResultsEven temporary disruptions can cause long-term increases in TB incidence and mortality. We estimated that a 3-month lockdown, followed by 10 months to restore normal TB services, would cause, over the next 5 years, an additional 1.65 million TB cases (Crl 1.49- 1.85) and 438,000 TB deaths (CrI 403 - 483 thousand) in India, 41,400 (28,900-62,200) TB cases and 14,800 deaths (10.5 - 19.2 thousand) in Kenya, and 7,960 (6,250 - 9,880) cases and 2,050 deaths (1,610 - 2,360) in Ukraine. However, any such negative impacts could be averted through supplementary "catch-up" TB case detection and treatment, once restrictions are eased. InterpretationLockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with targeted interventions implemented rapidly once lockdowns are lifted.
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Background: Patients with multidrug-resistant tuberculosis (MDR-TB) incur hugeexpenditures for diagnosis and treatment; these costs can be reduced through awell-designed and implemented social health insurance mechanism. The State ofChhattisgarh in India successfully established a partnership between the RevisedNational TB Control Programme (RNTCP) and the Health Insurance Programme,to form a universal health insurance scheme for all, by establishing RashtriyaSwasthya Bima Yojna (RSBY) and Mukhyamantri Swasthya Bima Yojana(MSBY) MDR-TB packages. The objective of this partnership was to absorbthe catastrophic expenses incurred by patients with MDR-TB, from diagnosis totreatment completion, in the public and private sector. This paper documents theinitial experience of a tailor-made health insurance programme, linked to coveringcatastrophic health expenditure for patients with MDR-TB.Methods: In this descriptive study, data on uptake of insurance claims throughinnovative MDR-TB packages from January 2013 to April 2014 were collected.A simple survey of costs for clinical investigation and inpatient care was conductedacross two major urban districts in Chhattisgarh. In these selected districts, threehealth facilities from the private sector and one medical college from the publicsector with a functional drug-resistant tuberculosis (DR-TB) centre were chosenby the RSBY and MSBY State Nodal Agency to complete a simple, structuredquestionnaire on existing market rates. The mean costs for clinical investigationsand hospital stay were calculated for an individual patient with MDR-TB who wouldseek services from the private or public sector.Results: A total of 207 insurance claims for RSBY and MSBY MDR-TB packageswere processed, of which 20 were from private and 187 from public healthestablishments, covered under the health insurance programme, free of charge.An estimated catastrophic expenditure, of approximately US$ 20 000, was savedthrough the RSBY and MSBY health insurance mechanism during the study period.Conclusion: The innovative RSBY and MSBY MDR-TB insurance package is astep towards reducing catastrophic expenses associated with treatment for MDRTB.