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dc.contributor.authorGurung, Suman Chandra
dc.contributor.authorDixit, Kritika
dc.contributor.authorRai, Bhola
dc.contributor.authorCaws, Maxine
dc.contributor.authorPaudel, Puskar Raj
dc.contributor.authorDhital, Raghu
dc.contributor.authorAcharya, Shraddha
dc.contributor.authorBudhathoki, Gangaram
dc.contributor.authorMalla, Deepak
dc.contributor.authorLevy, Jens W.
dc.contributor.authorvan Rest, Job
dc.contributor.authorLönnroth, Knut
dc.contributor.authorViney, Kerri
dc.contributor.authorRamsay, Andrew
dc.contributor.authorWingfield, Tom
dc.contributor.authorBasnyat, Buddha
dc.contributor.authorThapa, Anil
dc.contributor.authorSquire, Bertie
dc.contributor.authorWang, Duolao
dc.contributor.authorMishra, Gokul
dc.contributor.authorShah, Kashim
dc.contributor.authorShrestha, Anil
dc.contributor.authorde Siqueira-Filha, Noemia Teixeira
dc.identifier.citationGurung , S C , Dixit , K , Rai , B , Caws , M , Paudel , P R , Dhital , R , Acharya , S , Budhathoki , G , Malla , D , Levy , J W , van Rest , J , Lönnroth , K , Viney , K , Ramsay , A , Wingfield , T , Basnyat , B , Thapa , A , Squire , B , Wang , D , Mishra , G , Shah , K , Shrestha , A & de Siqueira-Filha , N T 2019 , ' The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal ' , Infectious Diseases of Poverty , vol. 8 , 99 .
dc.identifier.otherRIS: urn:59488EF2A07EE94807F3223A13D08205
dc.identifier.otherRIS: Gurung2019
dc.descriptionStop TB Partnership/UNOPS – TB REACH project (grant number: 5–31); European Union, Horizon 2020 – IMPACT TB project (grant number: 733174).en
dc.description.abstractBackground The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.
dc.relation.ispartofInfectious Diseases of Povertyen
dc.subjectCase findingen
dc.subjectCatastrophic costen
dc.subjectPatient-incurred costen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectSDG 1 - No Povertyen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.titleThe role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepalen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.description.statusPeer revieweden

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