Is It The Right Time for India to Move From Targeted Cash Transfers to Universal Cash Transfers for Patients with Tuberculosis?

Rupani, Mihir P.

doi:10.55489/njcm.130720222225

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…They also suggested providing a nutritious food kit that would help them to tolerate the adverse drug reactions and help in completing their treatment 28 . A universal cash transfer scheme would help alleviate poverty, secure access to food, and increase the corpus available to patients for spending on healthcare [29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India

Rupani

Vyas

2023

Sci Rep

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Diabetes is one of the commonest morbidity among patients with tuberculosis (TB). We conducted this study to estimate the costs incurred by patients with TB comorbid with diabetes and to explore the perspectives of program managers as well as patients on the reasons and solutions for the costs incurred due to TB-diabetes. We conducted a descriptive cross-sectional study to estimate costs among 304 patients with TB-diabetes comorbidity registered in the public health system during 2017–2020 in the Bhavnagar region of western India, which was followed by in-depth interviews among program functionaries and patients to explore solutions for reducing the costs. Costs, when exceeded 20% of annual household income, were defined as catastrophic as this cut-off was most significantly related to adverse TB outcomes. Among the 304 patients with TB-diabetes comorbidity, 72% were male and the median (interquartile IQR) monthly family income was Indian rupees (INR) 9000 (8000–11,000) [~ US$ 132 (118–162)]. The median (IQR) total costs due to combined TB-diabetes were INR 1314 (788–3170) [~ US$ 19 (12–47)], while that due to TB were INR 618 (378–1933) [~ US$ 9 (6–28)]. Catastrophic costs due to TB were 4%, which increased to 5% on adding the costs due to diabetes. Health system strengthening, an increase in cash assistance, and other benefits such as a nutritious food kit were suggested for reducing the costs incurred. We conclude that, in addition to a marginal increase in the percentage of catastrophic costs, co-existent diabetes nearly doubled the median total costs incurred among patients with TB. Strengthening the TB-diabetes bi-directional activities, tailoring the cash transfer scheme for comorbid patients, and making the common two-drug combination diabetes tablets available at government drug stores would help TB-diabetes comorbid patients cope with the costs of care.

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Section: Discussionmentioning

confidence: 99%

A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India

Rupani

Vyas

2023

Sci Rep

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“…The program functionaries also suggested strengthening the bi-directional TB-HIV collaborative activities, proven to be a cost-effective intervention in regions with a high prevalence of co-infection [30]. Although a few cash assistance schemes have been in place for TB and HIV in India, it has to be seen whether universal cash transfers would prevent patients from being pushed below the poverty line [31,32]. This is the first study estimating costs among patients with TB-HIV co-infection in India.…”

Section: Discussionmentioning

confidence: 99%

Costs incurred by patients with tuberculosis co-infected with human immunodeficiency virus in Bhavnagar, western India: a sequential explanatory mixed-methods research

Rupani

Vyas

2022

BMC Health Serv Res

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Background India reports the highest number of tuberculosis (TB) and second-highest number of the human immunodeficiency virus (HIV) globally. We hypothesize that HIV might increase the existing financial burden of care among patients with TB. We conducted this study to estimate the costs incurred by patients with TB co-infected with HIV and to explore the perspectives of patients as well as program functionaries for reducing the costs. Methods We conducted a descriptive cross-sectional study among 234 co-infected TB-HIV patients notified in the Bhavnagar region of western India from 2017 to 2020 to estimate the costs incurred, followed by in-depth interviews among program functionaries and patients to explore the solutions for reducing the costs. Costs were estimated in Indian rupees (INR) and expressed as median (interquartile range IQR). The World Health Organization defines catastrophic costs as when the total costs incurred by patients exceed 20% of annual household income. The in-depth interviews were audio-recorded, transcribed, and analyzed as codes grouped into categories. Results Among the 234 TB-HIV co-infected patients, 78% were male, 18% were sole earners in the family, and their median (IQR) monthly family income was INR 9000 (7500–11,000) [~US$ 132 (110–162)]. The total median (IQR) costs incurred for TB were INR 4613 (2541–7429) [~US$ 69 (37–109)], which increased to INR 7355 (4337–11,657) [~US$ 108 (64–171)] on adding the costs due to HIV. The catastrophic costs at a 20% cut-off of annual household income for TB were 4% (95% CI 2–8%), which increased to 12% (95% CI 8–16%) on adding the costs due to HIV. Strengthening health systems, cash benefits, reducing costs through timely referral, awareness generation, and improvements in caregiving were some of the solutions provided by program functionaries and the patients. Conclusion We conclude that catastrophic costs due to TB-HIV co-infection were higher than that due to TB alone in our study setting. Bringing care closer to the patients would reduce their costs. Strengthening town-level healthcare facilities for diagnostics as well as treatment might shift the healthcare-seeking of patients from the private sector towards the government and thereby reduce the costs incurred.

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Treatment seeking dilemma for tuberculosis as timed strategic prisoner’s dilemma game

Yadav,

Goel

2023

Physica A: Statistical Mechanics and its Applications

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Is It The Right Time for India to Move From Targeted Cash Transfers to Universal Cash Transfers for Patients with Tuberculosis?

Cited by 4 publications

References 12 publications

A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India

A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India

Costs incurred by patients with tuberculosis co-infected with human immunodeficiency virus in Bhavnagar, western India: a sequential explanatory mixed-methods research

Treatment seeking dilemma for tuberculosis as timed strategic prisoner’s dilemma game

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