Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal

Abstract

Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become “catastrophic”, leading patients to abandon treatment, develop drug-resistance, and die. WHO’s 2015 End TB Strategy recommends eliminating catastrophic costs and providing socioeconomic support for TB-affected people. However, there is negligible evidence to guide the design and implementation of such socioeconomic support, especially in low-income, TB-endemic countries. A national, multi-sectoral workshop was held in Kathmandu, Nepal, on the 11th and 12th September 2019, to develop a shortlist of feasible, locally appropriate socioeconomic support interventions for TB-affected households in Nepal, a low-income country with significant TB burden. The workshop brought together key stakeholders in Nepal including from the Ministry of Health and Population, Department of Health Services, Provincial Health Directorate, Health Offices, National TB Program (NTP); and TB/Leprosy Officers, healthcare workers, community health volunteers, TB-affected people, and external development partners (EDP). During the workshop, participants reviewed current Nepal NTP data and strategy, discussed the preliminary results of a mixed-methods study of the socioeconomic determinants and consequences of TB in Nepal, described existing and potential socioeconomic interventions for TB-affected households in Nepal, and selected the most promising interventions for future randomized controlled trial evaluations in Nepal. This report describes the activities, outcomes, and recommendations from the workshop.

Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention

“…We did not conduct any follow-up discussions with participants but some of the participants attended a workshop to discuss the FGD findings, the outputs of which are published elsewhere. 12 We performed real-time member checking in each FGD by noting key points of the discussion, summarising them on a wall chart and clarifying their accuracy with the group. No formal field notes were taken.…”

“…There is currently no cash incentive scheme for people with drug-sensitive TB (DS-TB) in Nepal. 12 In other settings, socioeconomic support for TB-affected households, including mutual support groups and cash transfers, has been shown to help overcome barriers to accessing TB services, defraying catastrophic costs and improving treatment success rates. 3 13–16 However, there is limited context-specific understanding of the barriers and facilitators to TB diagnosis and care in LMICs with which to inform the development of tailored socioeconomic support interventions for people with TB and their households.…”

The potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria control in Africa: a systematic review of modelling studies and population surveys

“…The current crisis because of COVID-19 creates all the conditions that have been indicated in previous studies as being associated with HIV and TB treatment non-adherence and lost to follow across the continent. 25,49,[58][59][60][61][62][63][64][65][66][67] The cost-effectiveness of various innovative solutions for service delivery is well documented across the continent, 54,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] warranting their utility to mitigate the risks posed by COVID-19 (Table 3); however, some constraints have been reported. In relation to mobile clinics, these include logistical challenges as well as spatial and structural constraints.…”

Biosocial Strategies to Address the Socioeconomic Determinants and Consequences of the TB and COVID-19 Pandemics

“…19 These surveys and related mixed-methods research also show that significant drivers of catastrophic costs are: lost income and time, reduced productivity, and significant non-medical expenses such as travel to access healthcare services and nutritional expenditure meet even basic food requirements. [20][21][22] In certain regions, these costs may be exacerbated by an unregulated and convoluted public-private sector mix 23 and avoidable expenditure on unproven, costly "therapies" including nutritional supplements. Furthermore, mask-wearing and respiratory symptoms of COVID-19 and TB may be associated with diagnostic uncertainty, stigma, discrimination, and isolation, which further compound challenges to accessing care and appropriate treatment.…”