Where will it end? Pathways to care and catastrophic costs following negative TB evaluation in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Catastrophic costs incurred by tuberculosis (TB) patients have received considerable attention,
however little is known about costs and pathways to care after a negative TB
evaluation.
Materials and methods
We conducted a cross-sectional study of 70 patients with a negative TB evaluation at four
community health centres in rural and peri-urban Uganda. Patients were traced 9 months
post-evaluation using contact information from TB registers. We collected information on
healthcare visits and implemented locally-validated costing questionnaires to assess the
financial impact of their symptoms post-evaluation.
Results
Of 70 participants, 57 (81%) were traced and 53 completed the survey. 31/53 (58%) surveyed
participants returned to healthcare facilities post-evaluation, making a median of 2
visits each (interquartile range [IQR] 1–3). 11.3% (95%CI 4.3–23.0%) of surveyed patients
and 16.1% (95%CI 5.5–33.7%) of those returning to healthcare facilities incurred catastrophic
costs (i.e., spent >20% annual household income). Indirect costs related to lost
work represented 80% (IQR 32–100%) of total participant costs.
Conclusions
Patients with TB symptoms who experience financial catastrophe after negative TB evaluation
may represent a larger absolute number of patients than those suffering from costs due to TB. They may not be captured by existing definitions of non-TB catastrophic health
expenditure.
Description
Keywords
Pathways, Care, Catastrophic costs, Negative TB
Citation
Samuels THA, Shete PB, Ojok C, Nalugwa T, Farr K, Turyahabwe S, et al. (2021) Where will it end? Pathways to care and catastrophic costs following negative TB evaluation in Uganda. PLoS ONE 16(7): e0253927. https://doi.org/10.1371/ journal.pone.0253927