Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda

Shete, Priya B.; Haguma, Priscilla; Miller, Cecily; Ochom, Emmanuel; Ayakaka, Irene; Davis, J. Lucian; Dowdy, David W.; Hopewell, Philip C.; Katamba, Achilles; Cattamanchi, Adithya

doi:10.5588/ijtld.14.0166

Cited by 43 publications

(69 citation statements)

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“…Deficiências de micronutrientes, em especial, vitaminas e minerais são importantes no metabolismo, na função celular e defesa contra tuberculose (BHARGAVA et al, 2014;HAYASHI et al, 2014;KANT;GUPTA;AHLUWALIA, 2015;TANG;YAM;CHEN, 2016;WHO, 2013). O conhecimento dos efeitos de micronutrientes e suas interações com tuberculose/HIV é de grande importância nas estratégias abrangentes de planejamento para promover a saúde através da nutrição e para aumentar a eficácia da terapia específica (AMARE et al, 2015).…”

Section: Resultsunclassified

“…A desnutrição, a falta de acesso e recursos fornecidos aos serviços públicos de saúde contribui para a vulnerabilidade da população e para a prevalência de doenças infectocontagiosas. Em âmbito global, a infecção pelo HIV tem modificado a tendência epidemiológica da tuberculose, principalmente em países onde há índices elevados da doença (KWAN; ERNST, 2011;TANG;YAM;CHEN, 2016). Apesar do Brasil ter apresentado uma diminuição no coeficiente de incidência de TB, existem desafios para a redução do número de casos da doença, visto que o país ainda registra cerca de 73 mil casos novos por ano.…”

Section: Resultsunclassified

“…Má alimentação, falta de higiene, tabagismo, alcoolismo ou qualquer outro fator que gere baixa resistência orgânica, também favorece o estabelecimento da TB (SHETE et al, 2015).…”

Section: Introductionunclassified

“…Tosse seca e contínua, posteriormente com secreção e com duração de mais de quatro semanas, sudorese noturna, cansaço excessivo, palidez, falta de apetite e rouquidão são os sintomas da doença. Dificuldade na respiração, eliminação de sangue e acúmulo de pus na pleura pulmonar são característicos em casos mais graves (BRASIL, 2015;SHETE et al, 2015).…”

Section: Introductionunclassified

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Perfil clínico de pacientes com diagnóstico de tuberculose atendidos no Hospital Universitário de Londrina, Paraná

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Silva

Sanfelice

et al. 2017

Semin. Cienc. Biol. Saude

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O objetivo deste estudo consistiu em analisar o perfil clínico de pacientes positivos para tuberculose através de um estudo epidemiológico, descritivo e retrospectivo, com base em dados secundários contidos em prontuários dos pacientes atendidos no Hospital Universitário de Londrina compreendendo de janeiro de 2010 a dezembro de 2014. Dos prontuários disponíveis para a análise no momento de estudo 86 casos eram positivos para tuberculose, sendo a maioria do sexo masculino (65/76%) com faixa etária compreendida entre 2 e 91 anos. Os principais sinais clínicos apresentados foram tosse (50/58%), febre (45/52%) e perda de peso (34/40%). Em relação à forma clínica, 58/67% dos pacientes apresentaram a forma pulmonar, e 28/33% a forma não pulmonar. Casos positivos para tuberculose em associação com HIV/AIDS corresponderam a 32/37%. Também foram relatados hábitos prejudiciais dos pacientes nos quais 30/34% eram tabagistas, 20/23% usuários de drogas e 14/16% etilistas. Diante da escassez de dados publicados referentes à tuberculose na nossa região e sua relevância para a saúde pública, nosso estudo contribui com os aspectos epidemiológicos principalmente em relação ao elevado número de casos de coinfecção com Vírus da Imunodeficiência Humana e pacientes com evolução a óbito, auxiliando assim, o desenvolvimento e implementação de campanhas ou projetos que visem o diagnóstico e tratamento precoce.

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Section: Resultsunclassified

“…Má alimentação, falta de higiene, tabagismo, alcoolismo ou qualquer outro fator que gere baixa resistência orgânica, também favorece o estabelecimento da TB (SHETE et al, 2015).…”

Section: Introductionunclassified

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Perfil clínico de pacientes com diagnóstico de tuberculose atendidos no Hospital Universitário de Londrina, Paraná

Bosqui

Silva

Sanfelice

et al. 2017

Semin. Cienc. Biol. Saude

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“…Por el contrario, en un trabajo realizado por Shete y col. (10) , la media de edad fue 45 años, pero el número de convivientes fue 5.…”

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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Patient Preferences for Strategies to Improve Tuberculosis Diagnostic Services in Zambia

et al. 2022

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IMPORTANCE Delayed engagement in tuberculosis (TB) services is associated with ongoing transmission and poor clinical outcomes. OBJECTIVE To assess whether patients with TB have differential preferences for strategies to improve the public health reach of TB diagnostic services. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was undertaken in which a discrete choice experiment (DCE) was administered between September 18, 2019, and January 17, 2020, to 401 adults (>18 years of age) with microbiologically confirmed TB in Lusaka, Zambia. The DCE had 7 attributes with 2 to 3 levels per attribute related to TB service enhancements. Latent class analysis was used to identify segments of participants with unique preferences. Multiscenario simulations were used to estimate shares of preferences for different TB service improvement strategies. MAIN OUTCOMES AND MEASURESThe main outcomes were patient preference archetypes and estimated shares of preferences for different strategies to improve TB diagnostic services. Collected data were analyzed between January 3, 2022, to July 2, 2022. RESULTS Among 326 adults with TB (median [IQR] age, 34 [27-42] years; 217 [66.8%] male; 158 [48.8%] HIV positive), 3 groups with distinct preferences for TB service improvements were identified. Group 1 (192 participants [58.9%]) preferred a facility that offered same-day TB test results, shorter wait times, and financial incentives for testing. Group 2 (83 participants [25.4%])preferred a facility that provided same-day TB results, had greater privacy, and was closer to home. Group 3 (51 participants [15.6%]) had no strong preferences for service improvements and had negative preferences for receiving telephone-based TB test results. Groups 1 and 2 were more likely to report at least a 4-week delay in seeking health care for their current TB episode compared with group 3 (29 [51.3%] in group 1, 95 [35.8%] in group 2, and 10 [19.6%] in group 3; P < .001). Strategies to improve TB diagnostic services most preferred by all participants were same-day TB test results alone (shares of preference, 69.9%) and combined with a small financial testing incentive (shares of preference, 79.3%), shortened wait times (shares of preference, 76.1%), or greater privacy (shares of preference, 75.0%). However, the most preferred service improvement strategies differed substantially by group. CONCLUSIONS AND RELEVANCEIn this study, patients with TB had heterogenous preferences for TB diagnostic service improvements associated with differential health care-seeking behavior.Tailored strategies that incorporate features most valued by persons with undiagnosed TB, including same-day results, financial incentives, and greater privacy, may optimize reach by overcoming key barriers to timely TB care engagement.

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Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda

Abstract: Primary care physicians initiated a substantial number of LTBI treatments, but less than half of patients completed treatment regardless of the physician specialty. Primary care physicians should be supported to enhance treatment completion.

Cited by 43 publications

References 13 publications

Perfil clínico de pacientes com diagnóstico de tuberculose atendidos no Hospital Universitário de Londrina, Paraná

Perfil clínico de pacientes com diagnóstico de tuberculose atendidos no Hospital Universitário de Londrina, Paraná

Costos de bolsillo de pacientes con diagnóstico de Tuberculosis en Colombia

Patient Preferences for Strategies to Improve Tuberculosis Diagnostic Services in Zambia

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