Where will it end? Pathways to care and catastrophic costs following negative TB evaluation in Uganda

Thomas H A Samuels, Priya B Shete, Chris Ojok, Talemwa Nalugwa, Katherine Farr, Stavia Turyahabwe, Achilles Katamba, Adithya Cattamanchi and David A J Moore

PLOS ONE, 2021, vol. 16, issue 7, 1-12

Abstract: Introduction: Catastrophic costs incurred by tuberculosis (TB) patients have received considerable attention, however little is known about costs and pathways to care after a negative TB evaluation. Materials and methods: We conducted a cross-sectional study of 70 patients with a negative TB evaluation at four community health centres in rural and peri-urban Uganda. Patients were traced 9 months post-evaluation using contact information from TB registers. We collected information on healthcare visits and implemented locally-validated costing questionnaires to assess the financial impact of their symptoms post-evaluation. Results: Of 70 participants, 57 (81%) were traced and 53 completed the survey. 31/53 (58%) surveyed participants returned to healthcare facilities post-evaluation, making a median of 2 visits each (interquartile range [IQR] 1–3). 11.3% (95%CI 4.3–23.0%) of surveyed patients and 16.1% (95%CI 5.5–33.7%) of those returning to healthcare facilities incurred catastrophic costs (i.e., spent >20% annual household income). Indirect costs related to lost work represented 80% (IQR 32–100%) of total participant costs. Conclusions: Patients with TB symptoms who experience financial catastrophe after negative TB evaluation may represent a larger absolute number of patients than those suffering from costs due to TB. They may not be captured by existing definitions of non-TB catastrophic health expenditure.

Date: 2021
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0253927

DOI: 10.1371/journal.pone.0253927

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