We observed similar patterns and challenges of TB-related costs for patients across the three countries. We advocate for global, united action for TB patients to be included under social protection schemes and for national TB programmes to improve equitable access to care.

BackgroundThe poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.MethodsThe Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.ResultsA total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.ConclusionsThe Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.

No abstract

@ERSpublications New literature review of patient costs in tuberculosis reveals the financial burden of the disease http://ow.ly/vBGej Recently, numerous countries have suffered the impact of the worldwide financial crisis [1]. Major economic problems have been faced by low and middle income countries; however, even some European Union nations (such as Greece, Spain and Italy) are experiencing the effects of the global crisis [2].Several experts have noted the limited economic resources focused by governments, and international governmental and non-governmental organisations on health systems: dramatic funding reductions for numerous acute and chronic diseases, inability to improve healthcare organisations, incapability to replace personnel leaving their jobs (e.g. migration to a richer country or retirement), and inability to transfer new diagnostic, therapeutic and preventive approaches to daily routine clinical and public health activities. The most relevant outcome of this scenario is the increased burden of some diseases (inaccurate diagnosis and/ or therapy and/or prevention) [3][4][5]. The highest risk of a difficult-to-recover picture is associated with increased probability of transmission of infectious diseases.At this point in time it is crucial to develop a strategy of health priorities based on accurately evaluated epidemiological and financial burdens of the most important diseases.Tuberculosis (TB), one of the main global health priorities with about 9 million estimated new cases and 2 million deaths, together with HIV/AIDS and malaria, creates major economic problems in high burden countries and among affected communities [6]. Several studies, as well as systematic reviews and metaanalyses, have been carried out on the healthcare burden of TB, including more severe forms of TB such as multidrug-resistant TB (MDR-TB) [7][8][9][10][11][12].The World Health Organization (WHO) and its partners are finalising the latest version of the new post-2015 TB control and elimination strategy, which will be discussed at the World Health Assembly in May 2014 [13,14]. With the vision of leaving a TB-free world to future generations (zero deaths, diseases and TB-related suffering) and the goal of putting an end to the global TB epidemic, the new WHO strategy has ambitious targets for 2035 ( fig. 1): 1) a 95% reduction in TB deaths (compared with 2015); 2) a 90%

Free TB diagnosis and treatment are not enough to alleviate the financial constraints experienced by vulnerable groups as a result of the illness. Health insurance covering TB in- and outpatient costs is critical to prevent TB-related financial hardship.