Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers

Winters Muttamba,Frank Mugabe,Abel Nkolo,Levicatus Mugenyi,Stavia Turyahabwe,Charles Batte,Robert Kaos Majwala,Racheal Tumwebaze,Rogers Sekibira,Bruce Kirenga,Ines Garcia Baena,Seyoum Dejene,Claudio Marra,Achilles Katamba,Estella Birabwa,Peter Lochoro,Kaggwa Mugagga,Simon Kasasa

doi:10.1186/s12889-020-09524-5

Abstract

BackgroundTuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers.MethodsA cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities.ResultsOf the 1178 respondents, 62.7% were male, 44.7% were aged 15–34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food.ConclusionDespite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.

Highlights

Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care
Uganda is a high Tuberculosis/Human Immunodeficiency Virus (TB/HIV) burden country, and the Tuberculosis prevalence survey conducted in 2014 put the prevalence at 253 per 100,000 population [1] while data available for 2018 puts the incidence at 200 per 100,000 population [2]
For the private health facilities designated as diagnostic and treatment units (DTU), the TB drugs are provided free of charge

Summary

Introduction

Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. TB patients often navigate complex healthcare systems before and after a TB diagnosis has been made This often results in them incurring large costs related to illness and disability, as well as seeking and receiving health care. Low income countries like Uganda have TB patients that face costs that could amount to half their annual income [5] despite TB services being provided free of charge in public health facilities [6]. TB affects the poorest segment of society disproportionately and the poverty-aggravating effects of TB are gravest for those who are already vulnerable [7]

Methods

Results

Discussion

Conclusion