S Erlinger1, N Stracker2, C Hanrahan2, S Nonyane3, L Mmolawa4, R Tampi2, A Tucker2, N West3, L Lebina4, N A Martinson5, D Dowdy6. 1. School of Medicine, Johns Hopkins University, Baltimore. 2. Department of Epidemiology. 3. Department of Epidemiology International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. Perinatal HIV Research Unit, Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa. 5. Perinatal HIV Research Unit, Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa, Johns Hopkins Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA. 6. Department of Epidemiology, Department of Epidemiology International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Johns Hopkins Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA.
Abstract
SETTING: Fifty-six public clinics in Limpopo Province, South Africa. OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index. DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, human immunodeficiency virus status and travel time. RESULTS: Among 323 participants, 108 (33%) were 'deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97-1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00-1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46-0.62). CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.
RCT Entities:
SETTING: Fifty-six public clinics in Limpopo Province, South Africa. OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index. DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, humanimmunodeficiency virus status and travel time. RESULTS: Among 323 participants, 108 (33%) were 'deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97-1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00-1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46-0.62). CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.
Authors: N Stracker; C Hanrahan; L Mmolawa; B Nonyane; R Tampi; A Tucker; N West; L Lebina; N Martinson; D Dowdy Journal: Int J Tuberc Lung Dis Date: 2019-06-01 Impact factor: 2.373
Authors: Bart Victor; Meridith Blevins; Ann F Green; Elisée Ndatimana; Lázaro González-Calvo; Edward F Fischer; Alfredo E Vergara; Sten H Vermund; Omo Olupona; Troy D Moon Journal: PLoS One Date: 2014-09-30 Impact factor: 3.240
Authors: Denise Evans; Craig van Rensburg; Caroline Govathson; Olena Ivanova; Friedrich Rieß; Andrew Siroka; Abdou K Sillah; Nyanda Elias Ntinginya; Ilesh Jani; Farzana Sathar; Sydney Rosen; Ian Sanne; Andrea Rachow; Knut Lönnroth Journal: Glob Health Action Date: 2021-01-01 Impact factor: 2.640
Authors: Yeonsoo Baik; Hannah M Rickman; Colleen F Hanrahan; Lesego Mmolawa; Peter J Kitonsa; Tsundzukana Sewelana; Annet Nalutaaya; Emily A Kendall; Limakatso Lebina; Neil Martinson; Achilles Katamba; David W Dowdy Journal: PLoS Med Date: 2020-11-10 Impact factor: 11.069