Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Abstract

Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.

What Proportion of New Tuberculosis Patients Has a History of Household Tuberculosis Exposure? A Cross-Sectional Study from Udupi District, South India

“…In this context, the community-level transmission might have declined and the proportion of incident TB attributable to household TB exposure might have increased. This is in line with results of a more recent study (2016-2017) conducted in India, which shows that 25% of new sputum-positive TB patients had a history of household contact with tuberculosis [6].…”

“…We found that one in four patients had household TB exposure. This is thrice higher than that reported from a 1968 cohort (8.5%) and similar to the 2016-17 cohort (25%) reported from India [5,6]. Nearly half of the TB patients reported exposure within the past five years with parents being the most common source of exposure.…”

Active versus passive case finding for tuberculosis in marginalised and vulnerable populations in India: comparison of treatment outcomes

“…The 'Axshya SAMVAD study' was primarily designed to study the differences in total pre-treatment delay among ACF and PCF-diagnosed people with TB, with a sample size of 325 in each group [20][21][22]. Assessment of the relative difference in TB treatment outcomes was the secondary objective.…”

“…The ACF focussed on increasing the detection of people with new smear-positive pulmonary TB. It resulted in detection of a large number of persons with presumptive pulmonary TB and smearpositive pulmonary TB, reduced diagnosis delay, reduced costs due to TB diagnosis and prevalence of catastrophic costs due to TB diagnosis [19][20][21][22]. However, we do not know whether this translated into improved TB treatment outcomes.…”

GeneXpert and Community Health Workers Supported Patient Tracing for Tuberculosis Diagnosis in Conflict-Affected Border Areas in India

“…Investments for the continuous operation of GeneXpert must be considered by TB programs. The availability and accessibility of diagnostic tools like GeneXpert [17] and the implementation by a trained team [18] help in early and appropriate TB diagnoses in these hard-to-reach areas.…”