K Viney1, S Amaral2, E Baptista Marques2, A Siroka3, C Lopes4, S Vaz Nery5. 1. Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia, Centre of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 2. Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia. 3. Centre of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Tuberculosis Monitoring and Evaluation Unit, Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland. 4. Communicable Disease Control, Ministry of Health, Dili, Timor-Leste. 5. Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia, Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Abstract
SETTING: Seventeen health care facilities that report to the national tuberculosis (TB) programme in Timor-Leste. Participants were TB patients. OBJECTIVE: To determine the proportion of TB patients who experienced catastrophic costs due to their TB diagnosis and care, and the magnitude and composition of these costs. DESIGN: This was a cross-sectional health facility-based survey, conducted in 17 DOTS centres between October 2016 and March 2017. TB patients were interviewed by trained nurses using a standardised questionnaire. RESULTS: Among the 457 TB patients who participated (response rate 96.6%), the median age was 32 years; 39.2% were from the capital, Dili. The patient was the main income earner in 26.3% of households. Annual individual and household incomes before and after TB diagnosis decreased by respectively 30.4% and 31.1%. Using a cut-off of 20% of annual household income, 83.0% of patients experienced catastrophic costs related to their TB diagnosis and care. Income loss and nutritional supplementation accounted for respectively 40.7% and 37.9% of these costs. CONCLUSION: Four of five TB patients in Timor-Leste experienced catastrophic costs related to TB diagnosis and care. Financial and social protection to mitigate against these costs are urgently needed, in addition to universal health coverage.
SETTING: Seventeen health care facilities that report to the national tuberculosis (TB) programme in Timor-Leste. Participants were TBpatients. OBJECTIVE: To determine the proportion of TBpatients who experienced catastrophic costs due to their TB diagnosis and care, and the magnitude and composition of these costs. DESIGN: This was a cross-sectional health facility-based survey, conducted in 17 DOTS centres between October 2016 and March 2017. TBpatients were interviewed by trained nurses using a standardised questionnaire. RESULTS: Among the 457 TBpatients who participated (response rate 96.6%), the median age was 32 years; 39.2% were from the capital, Dili. The patient was the main income earner in 26.3% of households. Annual individual and household incomes before and after TB diagnosis decreased by respectively 30.4% and 31.1%. Using a cut-off of 20% of annual household income, 83.0% of patients experienced catastrophic costs related to their TB diagnosis and care. Income loss and nutritional supplementation accounted for respectively 40.7% and 37.9% of these costs. CONCLUSION: Four of five TBpatients in Timor-Leste experienced catastrophic costs related to TB diagnosis and care. Financial and social protection to mitigate against these costs are urgently needed, in addition to universal health coverage.