P B Shete1, P Haguma2, C R Miller2, E Ochom2, I Ayakaka2, J L Davis1, D W Dowdy3, P Hopewell1, A Katamba4, A Cattamanchi1. 1. Division of Pulmonary and Critical Care Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA. 2. Infectious Diseases Research Collaboration, Kampala, Uganda. 3. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA. 4. Infectious Diseases Research Collaboration, Kampala, Uganda; School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Abstract
SETTING: Six district-level government health centers in rural Uganda and the surrounding communities. OBJECTIVE: To determine pathways to care and associated costs for patients with chronic cough referred for tuberculosis (TB) evaluation in Uganda. DESIGN: We conducted a cross-sectional study, surveying 64 patients presenting with chronic cough and undergoing first-time sputum evaluation at government clinics. We also surveyed a random sample of 114 individuals with chronic cough in surrounding communities. We collected information on previous health visits for the cough as well as costs associated with the current visit. RESULTS: Eighty per cent of clinic patients had previously sought care for their cough, with a median of three previous visits (range 0-32, interquartile range [IQR] 2-5). Most (n = 203, 88%) visits were to a health facility that did not provide TB microscopy services, and the majority occurred in the private sector. The cost of seeking care for the current visit alone represented 28.8% (IQR 9.1-109.5) of the patients' median monthly household income. CONCLUSION: Most patients seek health care for chronic cough, but do so first in the private sector. Engagement of the private sector and streamlining TB diagnostic evaluation are critical for improving case detection and meeting global TB elimination targets.
SETTING: Six district-level government health centers in rural Uganda and the surrounding communities. OBJECTIVE: To determine pathways to care and associated costs for patients with chronic cough referred for tuberculosis (TB) evaluation in Uganda. DESIGN: We conducted a cross-sectional study, surveying 64 patients presenting with chronic cough and undergoing first-time sputum evaluation at government clinics. We also surveyed a random sample of 114 individuals with chronic cough in surrounding communities. We collected information on previous health visits for the cough as well as costs associated with the current visit. RESULTS: Eighty per cent of clinic patients had previously sought care for their cough, with a median of three previous visits (range 0-32, interquartile range [IQR] 2-5). Most (n = 203, 88%) visits were to a health facility that did not provide TB microscopy services, and the majority occurred in the private sector. The cost of seeking care for the current visit alone represented 28.8% (IQR 9.1-109.5) of the patients' median monthly household income. CONCLUSION: Most patients seek health care for chronic cough, but do so first in the private sector. Engagement of the private sector and streamlining TB diagnostic evaluation are critical for improving case detection and meeting global TB elimination targets.
Authors: Winceslaus Katagira; Nicholas D Walter; Saskia Den Boon; Nelson Kalema; Irene Ayakaka; Eric Vittinghoff; William Worodria; Adithya Cattamanchi; Laurence Huang; John Lucian Davis Journal: J Acquir Immune Defic Syndr Date: 2016-07-01 Impact factor: 3.731
Authors: Rebecca L Walcott; Justin B Ingels; Phaedra S Corso; Sarah Zalwango; Christopher C Whalen; Juliet N Sekandi Journal: Glob Public Health Date: 2020-02-06
Authors: Jillian L Kadota; Sarah Nabwire; Talemwa Nalugwa; Justin S White; Adithya Cattamanchi; Achilles Katamba; Priya B Shete Journal: Value Health Reg Issues Date: 2021-03-25
Authors: P B Shete; T Nalugwa; K Farr; C Ojok; M Nantale; P Howlett; P Haguma; E Ochom; F Mugabe; M Joloba; L H Chaisson; D W Dowdy; D Moore; J L Davis; A Katamba; A Cattamanchi Journal: Int J Tuberc Lung Dis Date: 2017-07-01 Impact factor: 2.373
Authors: Irene Ayakaka; Sara Ackerman; Joseph M Ggita; Phoebe Kajubi; David Dowdy; Jessica E Haberer; Elizabeth Fair; Philip Hopewell; Margaret A Handley; Adithya Cattamanchi; Achilles Katamba; J Lucian Davis Journal: Implement Sci Date: 2017-03-09 Impact factor: 7.327
Authors: Grace Mhalu; Jerry Hella; Francis Mhimbira; Khadija Said; Thomas Mosabi; Yeromin P Mlacha; Christian Schindler; Sébastien Gagneux; Klaus Reither; Kees de Hoogh; Mitchell G Weiss; Elisabeth Zemp; Lukas Fenner Journal: BMJ Open Date: 2019-04-20 Impact factor: 2.692