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. 2024 Apr 1;1(4):181-188.
doi: 10.5588/ijtldopen.23.0607. eCollection 2024 Apr.

TB and poverty: the effect of rifampicin-resistant TB on household income

A Ciobanu  1   2 , V Plesca  3   4 , S Doltu  5 , M Manea  3 , L Domente  6 , A Dadu  2
Affiliations

TB and poverty: the effect of rifampicin-resistant TB on household income

A Ciobanu et al. IJTLD Open. .

Abstract
in English, French

Setting: The Republic of Moldova, one of Europe's poorest countries, also bears one of the highest burdens of rifampicin-resistant TB (RR-TB).

Objectives: To trace the patients' journey through TB in terms of the relationship with poverty and assess its determinants.

Design: This cross-sectional study used secondary data from a survey assessing catastrophic costs in RR-TB-affected households.

Results: Data were obtained from 430 RR-TB patients. The percentage of poor TB-affected households rose from 65% prior to TB to 86% after TB treatment completion (P < 0.001). Social factors leading to poverty were identified for each stage: diagnostic period (history of incarceration: cOR 2.3, 95% CI 1.1-5.2); treatment period (being unemployed or unofficially employed: cOR 6.7, 95% CI 4.3-10.0); and post-treatment (being married or cohabiting: cOR 5.7, 95% CI 2.9-11.0). Participants who had ≥3 members in their households were more likely to be poor at all TB stages: diagnostic period (cOR 5.7, 95% CI 3.7-8.8), treatment period (cOR 3.8, 95% CI 2.5-5.6) and post-treatment (cOR 7.2, 95% CI 3.6-14.3).

Conclusion: The study identified risk factors associated with poverty at each stage of TB. These findings outline that innovative social protection policies are required to protect TB patients against poverty.

Contexte: La République de Moldavie est l'un des pays les plus pauvres d'Europe et l'un des plus touchés par la TB résistante à la rifampicine (RR-TB).

Objectifs: Nous avons cartographié le parcours des patients atteints de TB en lien avec la pauvreté et évalué les déterminants associés.

Méthode: Cette étude transversale a analysé des données secondaires issues d'une enquête évaluant les coûts catastrophiques supportés par les ménages touchés par la RR-TB.

Résultats: Des données ont été recueillies auprès de 430 patients atteints de RR-TB. Le taux de ménages pauvres touchés par la TB est passé de 65% avant le traitement à 86% après la fin du traitement de la TB (P < 0,001). Pour chaque stade de la TB, les facteurs sociaux conduisant à la pauvreté ont été identifiés : période de diagnostic (antécédents d'emprisonnement : rapport de cotes brut (cOR) 2,3, IC à 95% 1,1–5,2) ; période de traitement (être au chômage ou employé officieux : cOR 6,7 ; IC 95% 4,3–10,0) ; et post-traitement (être marié ou cohabitant : cOR 5,7, IC 95% 2,9–11,0). Les participants dont le ménage comptait ≥3 membres étaient plus susceptibles d'être pauvres à tous les stades de la TB : période de diagnostic (cOR 5,7 ; IC à 95% 3,7–8,8), période de traitement (cOR 3,8 ; IC à 95% 2,5–5,6) et post-traitement (cOR 7,2 ; IC à 95% 3,6–14,3).

Conclusion: L'étude a permis d'identifier des facteurs de risque liés à la pauvreté à toutes les étapes de la TB. Ces résultats soulignent l’importance de mettre en place des politiques de protection sociale novatrices pour prévenir l'appauvrissement des patients atteints de TB.

Keywords: RR-TB; Republic of Moldova; income; out-of-pocket payment; rifampicin-resistant tuberculosis.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure 1.
Figure 1.
Change in household income over time according to TB treatment stage for patients with RR-TB. Alluvial plot representing economic changes of poor (orange) and non-poor (blue) patients with RR-TB during TB stages from before being diagnosed with TB to after TB treatment completion. The three bars represent the TB stages: diagnostic period, treatment period and post-treatment period. Comparison between three groups (diagnostic period, treatment period, post-treatment) P < 0.001 using the Cochran test. RR-TB = rifampicin-resistant TB.
Figure 2.
Figure 2.
Median household income of poor (defined as household income ≤US$1.90 person/day) and non-poor (defined as household income >US$1.90 person/day) patients with RR-TB by TB treatment stage, Republic of Moldova, 2016. *Kruskal-Wallis test. RR-TB = rifampicin-resistant TB; IQR = interquartile range.
Figure 3.
Figure 3.
Sources of finance used to cover out-of-pocket payments in (defined as household income ≤US$1.90 person/day) and non-poor (defined as household income >US$1.90 person/day) households. Error bars represent 95% confidence intervals. χ2 tests used for proportions. *Based on household income prior to TB.
See this image and copyright information in PMC

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