An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia

Summaryobjectives To understand determinants of care-seeking patterns and diagnostic delay amongst tuberculosis (TB) patients diagnosed at direct observed treatment short course (DOTS) facilities in Jogjakarta, Indonesia.methods Cross-sectional survey amongst newly diagnosed TB patients in 89 DOTS facilities whose history of care-seeking was reconstructed through retrospective interviews gathering data on sociodemographic determinants, onset of TB symptoms, type of health facilities visited, duration of each careseeking action were recorded.results Two hundred and fifty-three TB patients were included in the study whose median duration of patients' delay was 1 week and whose total duration of diagnostic delay was 5.4 weeks. The median number of visits was 4. Many of the patients' socio-demographic determinants were not associated with the care-seeking patterns, and no socio-demographic determinants were associated with the duration of diagnostic delay. More than 60% of TB patients started their care-seeking processes outside DOTS facilities, but the number of visits in DOTS facilities was greater during the overall care-seeking process. Surprisingly, patient's immediate visits to a DOTS facility did not correspond to shorter diagnostic delay.conclusion Diagnostic delay in Jogjakarta province was not associated with patients' socio demographic factors, but rather with the health system providing DOTS services. This suggests that strengthening the health system and improving diagnostic quality within DOTS services is now a more rational strategy than expanding the TB programme to engage more providers.

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“…The NTP had piloted several TB intervention strategies in this province (Irawati et al. 2007; Johns et al. 2009).…”

Section: Discussionmentioning

confidence: 99%

“…The total duration of diagnostic delay was the sum of patient delay and provider delay. Socio‐economic status of individuals was measured by the status of their households (Vyas & Kumaranayake 2006; Johns et al. 2009; Pantoja et al.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities

Ahmad

Mahendradhata

Vlas

2010

Tropical Med Int Health

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“…Johns y col. (13) desarrollaron una investigación en Indonesia, donde se comparó el costo del tratamiento DOTS frente a otras estrategias en pacientes diagnosticados con tuberculosis, y reportó un costo bajo respecto a otras estrategias diferentes, incluyendo los gastos directos de los pacientes, que oscilaban entre 511 615 COP y 1 716 484 COP, frente a 460 151 COP y 2 972 818 COP de otras terapias. Las cifras del presente estudio son mucho menores en las tres ciudades, lo que ratifica la importancia de la terapia DOTS frente a las demás prácticas para la erradicación de la TB.…”

Section: Discussionunclassified

Costos de bolsillo de pacientes con diagnóstico de Tuberculosis en Colombia

et al. 2017

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Resumen Introducción. La tuberculosis (TB) es una enfermedad infecto-contagiosa producida por micobacterias; según datos de la Organización Mundial de la Salud, un tercio de la población mundial está infectada. Para combatirla se ha empleado la estrategia DOTS (Directly Observed Therapy Short Course), efectiva para el diagnóstico, tratamiento y monitoreo de la tuberculosis. Objetivo. Estimar costos de bolsillo que asumen los pacientes con tuberculosis, que reciben tratamiento bajo la estrategia DOTS. Diseño. Estudio observacional descriptivo, prospectivo. Lugar. Tres ciudades de Colombia (Medellín, Montería y Quibdó). Participantes. Pacientes con diagnóstico de TB. Intervenciones. Se utilizó un instrumento de recolección que incluía variables relacionadas con los costos de bolsillo directos e indirectos. El análisis se hizo en el programa SPSS versión 17,0 y STATA 11; a las variables cuantitativas se les estimó media y desviación estándar, mientras que a las cualitativas proporciones. Resultados. Participaron 91 pacientes que se encontraban en tratamiento bajo la estrategia DOTS. El promedio de edad fue 39,3±20 años; la mayoría vivía con sus familiares. Los ingresos mensuales de los pacientes tuvieron una media de 422 863 COP (1€ = 3 149 COP) y los gastos directos más altos generados por el tratamiento fueron los destinados al desplazamiento y ayudas diagnósticas, con una media de 8 181 y 7 630 COP, respectivamente. Conclusiones. Los costos asumidos por los pacientes bajo la estrategia DOTS fueron altos, incluso cuando el tratamiento se entrega gratuitamente. La modificación de la estrategia para evitar costos en los pacientes podría impactar disminuyendo el abandono del tratamiento por los mismos. Palabras clave. Tuberculosis; Costos y Análisis de Costo; Promoción de la Salud; Terapia por Observación Directa. Abstract Introduction: Tuberculosis (TB) is a contagious disease caused by mycobacteria. According to the World Health Organization, one third of the world's population is infected. The directly observed therapy short course (DOTS) strategy has been used effective for the diagnosis, treatment and monitoring of tuberculosis. Objective: To estimate the out-of-pocket costs of TB patients who receive treatment under the DOTS strategy. Design: Descriptive prospective and observational study. Setting: Three cities in Colombia (Medellin, Monteria and Quibdo). Participants: Patients diagnosed with TB. Interventions: An instrument was used that included variables related to direct and indirect out-of-pocket costs. The analysis was done using the SPSS version 17.0 and STATA 11; mean and standard deviation were estimated for quantitative variables, and proportions for qualitative variables. Results: The DOTS strategy was applied in 91 patients. The average age was 39.3 ± 20 years; most patients lived with their families. The monthly income of the patients was 422 863 COP (1€ = 3 149 COP) in average and the higher direct costs generated by the treatment were those for traveling and diagnostic aids, with an average cos...

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“…Their satisfaction with the domains of the Family CIS was better than the family members of tuberculosis (TB) patients in the same hospital (data not shown). TB is also a chronic infectious disease, curable, less stigmatized, common in Indonesia, with treatment programme known in the general community for a longer time (Johns, Probandari, Mahendradhata, & Ahmad, 2009;WHO-SEARO, 2013). Family members of HIV patient with a history of IDU perceived more problems compared to the family of HIV patients without a history of IDU, especially for their sick relatives' bad behaviour such as sexual and injecting-risk behaviour.…”

Section: Discussionmentioning

confidence: 99%

Experience in care, burden, and hope of the family members of HIV patients with and without a history of injecting drug use in Indonesia: An exploratory case

Iskandar

Trianda

Fitriana

et al. 2014

Mental Health and Substance Use

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An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia

Cited by 13 publications

References 16 publications

Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities

Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities

Costos de bolsillo de pacientes con diagnóstico de Tuberculosis en Colombia

Experience in care, burden, and hope of the family members of HIV patients with and without a history of injecting drug use in Indonesia: An exploratory case

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