The affordability for patients of a new universal MDR-TB coverage model in China

Yz, Ruan; Rz, Li; Xx, Wang; Lx, Wang; Sun, Qing‐Yuan; Chen, C; Xu, Cheng; Su, Wei; Zhao, Jian; Cheng, Jun; Wang, Q; Yt, Fu; St, Huan; Mt, Chen; Scano, Fabio; Floyd, Katherine; Dp, Chin; Fitzpatrick, Christopher

doi:10.5588/ijtld.15.0413

Cited by 18 publications

(31 citation statements)

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“…Thus, our findings are consistent with previous work suggesting that vulnerable populations, such as rural residents have benefitted least from China’s economic development and health system reforms over the last 30 years and that current measures are insufficient to provide financial protection from the potentially catastrophic costs of TB/MDR care, especially for low income groups [ 56 , 57 ]. A recent attempt to make MDR-TB more affordable for patients in China by limiting patients out-of-pocket spending to 10% was still found to be insufficient [ 58 ]. Together with this study and others [ 21 , 27 , 32 , 59 ], we suggest a need for greater attention to the total direct and indirect costs to individuals and society.…”

Section: Discussionmentioning

confidence: 99%

Financial barriers and coping strategies: a qualitative study of accessing multidrug-resistant tuberculosis and tuberculosis care in Yunnan, China

et al. 2017

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BackgroundTuberculosis (TB) and multidrug-resistance tuberculosis (MDR-TB) pose serious challenges to global health, particularly in China, which has the second highest case burden in the world. Disparities in access to care for the poorest, rural TB patients may be exacerbated for MDR-TB patients, although this has not been investigated widely. We examine whether certain patient groups experience different barriers to accessing TB services, whether there are added challenges for patients with MDR-TB, and how patients and health providers cope in Yunnan, a mountainous province in China with a largely rural population and high TB burden.MethodsUsing a qualitative study design, we conducted five focus group discussions and 47 in-depth interviews with purposively sampled TB and MDR-TB patients and healthcare providers in Mandarin, between August 2014 and May 2015. Field-notes and interview transcripts were analysed via a combination of open and thematic coding.ResultsPatients and healthcare providers consistently cited financial constraints as the most common barriers to accessing care. Rural residents, farmers and ethnic minorities were the most vulnerable to these barriers, and patients with MDR-TB reported a higher financial burden owing to the centralisation and longer duration of treatment. Support in the form of free or subsidised treatment and medical insurance, was deemed essential but inadequate for alleviating financial barriers to patients. Most patients coped by selling their assets or borrowing money from family members, which often strained relationships. Notably, some healthcare providers themselves reported making financial and other contributions to assist patients, but recognised these practices as unsustainable.ConclusionsFinancial constraints were identified by TB and MDR-TB patients and health care professionals as the most pervasive barrier to care. Barriers appeared to be magnified for ethnic minorities and patients coming from rural areas, especially those with MDR-TB. To reduce financial barriers and improve treatment outcomes, there is a need for further research into the total costs of seeking and accessing TB and MDR-TB care. This will enable better assessment and targeting of appropriate financial support for identified vulnerable groups and geographic development of relevant services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4089-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Financial barriers and coping strategies: a qualitative study of accessing multidrug-resistant tuberculosis and tuberculosis care in Yunnan, China

et al. 2017

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“…In response to the WHO’s call for UHC and the Chinese government’s determination to tackle rising MDR-TB, the Chinese Center for Disease Control and Prevention (China CDC) and Chinese Medical Association (CMA) implemented a comprehensive pilot programme to provide universal care for patients with MDR-TB, including the use of rapid diagnostic tests, standardised treatment and financial protection against catastrophic health costs 12. Within the four pilot cities, there were reductions in delay to diagnosis and treatment initiation, improved case detection and treatment outcome rates and reduced patient expenses for diagnosis and treatment 13 14…”

Section: Introductionmentioning

confidence: 99%

Is knowledge retained by healthcare providers after training? A pragmatic evaluation of drug-resistant tuberculosis management in China

et al. 2019

BMJ Open

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ObjectivesConsidering the urgent need of training to improve standardised management of drug-resistant infectious disease and the lack of evidence on the impact of training, this study evaluates whether training participants’ knowledge on multidrug-resistant tuberculosis (MDR-TB) is improved immediately and a year after training.Setting and participantsThe study involved 91 MDR-TB healthcare providers (HCPs), including clinical doctors, nurses and CDC staff, who attended a new MDR-TB HCP training programme in Liaoning and Jiangxi provinces, China.Main outcome measuresA phone-based assessment of participants’ long-term retention of knowledge about MDR-TB management was conducted in July 2017, approximately 1 year after training. The proportion of correct responses in the long-term knowledge assessment was compared with a pretraining test and an immediate post-training test using a χ2 test. Factors influencing participants’ performance in the long-term knowledge assessment were analysed using linear regression.ResultsAcross both provinces, knowledge of definitions of drug-resistant TB, standardised MDR-TB case detection protocols and laboratory diagnosis was improved 1 year after the training by 14.5% (p=0.037), 32.4% (p<0.001) and 31% (p<0.001) relative to pretraining. However, compared with immediately after training, the knowledge of the three topics declined by 26.5% (p=0.003), 19.8% (p=0.018) and 52.7% (p<0.001) respectively in Jiangxi, while no significant decline was observed in Liaoning. Additionally, we found that obtaining a higher score in the long-term knowledge assessment was associated with longer years of clinical experience (coefficient=0.51; 95 CI% 0.02 to 0.99; p=0.041) and attending training in Liaoning (coefficient=0.50; 95% CI 0.14 to 0.85; p=0.007).ConclusionOur study, the first to assess knowledge retention of MDR-TB HCPs 1 year after training, showed an overall positive long-term impact of lecture-style group training on participants’ knowledge. Knowledge decline 1 year after training was observed in one province, Jiangxi, and this may be partly addressed by targeted support to HCPs with fewer years of clinical experience.

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“…As an incentive to therapy adherence, financial support is strongly related to treatment outcome. MDR‐TB is a disease of the poor . Although the costs of TB drugs and laboratory tests were covered by the GF programme, patients still face heavy economic burden owing to the high living costs in large cities and expensive auxiliary medicines .…”

Section: Discussionmentioning

confidence: 99%

The relationship between social support, treatment interruption and treatment outcome in patients with multidrug‐resistant tuberculosis in China: a mixed‐methods study

Yin

Zhou

Wei

2018

Tropical Med Int Health

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The affordability for patients of a new universal MDR-TB coverage model in China

Abstract: The objectives of the pilot model are aligned with health reform in China and universal health coverage globally. Enrollment would almost certainly be higher with 100% reimbursement of medical fees, but patient enablers will be required to truly eliminate catastrophic costs.

Cited by 18 publications

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Financial barriers and coping strategies: a qualitative study of accessing multidrug-resistant tuberculosis and tuberculosis care in Yunnan, China

Financial barriers and coping strategies: a qualitative study of accessing multidrug-resistant tuberculosis and tuberculosis care in Yunnan, China

Is knowledge retained by healthcare providers after training? A pragmatic evaluation of drug-resistant tuberculosis management in China

The relationship between social support, treatment interruption and treatment outcome in patients with multidrug‐resistant tuberculosis in China: a mixed‐methods study

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