Abstract

The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) Tuberculosis (TB) high burden countries in the world. Despite free TB diagnostics and treatment, TB patients face substantial economic losses and this may impact overall treatment outcomes. We assessed if there is an association between TB-related catastrophic costs and TB treatment outcomes. We conducted a cohort study using data from patient records and a survey that quantified catastrophic costs among RR/MDR-TB affected households in the Republic of Moldova in 2016. We included adult patients (age ≥18 years) with RR/MDR-TB who had been in inpatient (intensive phase) or outpatient (continuous phase) treatment for at least 2 months. Unfavourable treatment outcome, such as failure, death or lost to follow-up, was the primary outcome variable. The definition of catastrophic TB-related costs followed the World Health Organisation (WHO) guidelines: costs due to TB ≥20% of annual household income. Log-binomial regression was used to assess association between the outcome and catastrophic TB-related costs adjusting for other socio-demographic, behavioural and clinical covariates. In total 287 RR/MDR-TB patients (78% males, mean age 42 years) were included. Of them, 30% experienced catastrophic TB-related costs. Overall, one in five patients (21%) had unfavourable treatment outcome, such as treatment failure (5%), death (8%) or lost to follow-up (8%). The experience of catastrophic TB-related costs was not associated with unfavourable treatment outcome [adjusted relative risk (aRR)=0.88, 95% CI: 0.50–1.50]. Major factors independently associated with unfavourable TB treatment outcomes were poverty (aRR=2.07; 95% CI: 1.06-4.07), urban residence (aRR=1.99; 95% CI: 1.12-3.52) and positive HIV (Human Immunodeficiency Virus) status (aRR=2.61; 95% CI: 1.31-4.89). As a result, we failed to find an association between catastrophic costs and treatment outcomes of RR/MDR-TB patients in the Republic of Moldova. However, we found that patients from poor households and urban areas were twice more likely to achieve unfavourable TB treatment outcomes disregarding whether they experienced catastrophic costs or not. Also, TB/HIV patients and urban residents were identified as the most vulnerable groups with higher risk of unfavourable treatment outcome and TB-related costs.

Highlights

  • Welfare benefits are available in the Republic of Moldova for resistant and/or multidrug-resistant (RR/MDR)-TB patients, including temporary disability allowances and incentives provided to patients adhering to treatment during outpatient care

  • relative risk (RR)-TB patients have infections that are resistant to rifampicin (RIF), while MDR-TB patients have infections resistant to at least rifampicin (RIF) and isoniazid (INH), confirmed by culture, line probe assay, or any other drug susceptibility test

  • Considering that catastrophic TB-related costs could be on the causal pathway between income and treatment outcomes, we calculated proportion of patients with unfavourable outcome stratified by the experience of catastrophic costs and wealth index, and measured the association by the Mantel-Haenszel Chi-square test

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Summary

The authors thank the national tuberculosis

Andrei Dadu research questions and providing data for this study. It is worth mentioning Kostyantyn Dumchev (Institute on Public Health, Kyiv, Ukraine) for his contribution to the data analysis stage. All authors 3 participated in the design, discussion of the results interpretation, read, n edited, and agreed with the decision to submit the final version of the paper. The funder played no role in the o study design, data collection and analysis, decision to publish or preparation of the manuscript. C World Health Organization Research Ethics Review Committee based e in Geneva, Switzerland (ERC.0003311/09.03.2020). A waiver of tiv informed consent was granted by ethics review bodies, as the study collected and analysed secondary research data and de-identified routine a recording and reporting data. Cre Disclaimer: The authors alone are responsible for the views expressed

General setting
National TB control
Study population
Data sources and variables
Data analysis
Labor migration Yes No
Results
TB treatment outcome
HIV status
Full Text
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