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. 2024 Jun 1;1(6):266-273.
doi: 10.5588/ijtldopen.23.0608. eCollection 2024 Jun.

Determinant of catastrophic costs associated with treatment for rifampicin-resistant TB in households in the Republic of Moldova

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

Determinant of catastrophic costs associated with treatment for rifampicin-resistant TB in households in the Republic of Moldova

A Ciobanu et al. IJTLD Open. .

Abstract
in English, French

Setting: The Republic of Moldova is a lower-middle-income country. Patients with TB face some barriers to accessing TB services. Welfare benefits are available during TB treatment.

Objectives: We aimed to determine the proportion of rifampicin-resistant TB (RR-TB) households that experienced catastrophic costs due to TB at a threshold of ≥20% of household income and investigate the associated risk factors.

Design: A cross-sectional countrywide study comprised 430 patients with RR-TB who had received TB treatment as an inpatient or outpatient for at least 2 months.

Results: RR-TB patients lost 30% of their household income in inpatient and 70% in outpatient TB care. TB-related costs were associated with being unofficially employed or unemployed (aOR 1.9, 95% CI 1.1-3.3), having fewer household members (aOR 2.1, 95% CI 1.3-3.5), having an income that accounted for over 50% of household income (aOR 2.4, 95% CI 1.5-3.8), and being a poor household (aOR 2.2, 95% CI 1.2-3.9).

Conclusion: Although TB health services are provided to patients free of charge, 26% of RR-TB households experienced catastrophic TB costs. The associated factors should be considered to improve patient-centred TB care, especially in vulnerable groups. Welfare payments mitigate TB costs.

Cadre: La République de Moldova est un pays à revenu intermédiaire de la tranche inférieure. Les patients atteints de TB se heurtent à certains obstacles pour accéder aux services de lutte contre la TB. Des prestations sociales sont disponibles pendant le traitement de la TB.

Objectifs: Nous avons cherché à déterminer la proportion de ménages atteints de TB résistant à la rifampicine (RR-TB) qui ont subi des coûts catastrophiques dus à la TB à un seuil de ≥20% du revenu du ménage et à étudier les facteurs de risque associés.

Méthode: Une étude transversale à l'échelle nationale a porté sur 430 patients atteints de RR-TB qui avaient reçu un traitement antituberculeux en hospitalisation ou en consultation externe pendant au moins 2 mois.

Résultats: Les patients atteints de RR-TB ont perdu 30% du revenu de leur ménage en hospitalisation et 70% en soins ambulatoires. Les coûts liés à la TB étaient associés au fait d'avoir un emploi non officiel ou un chômeur (OR ajusté [ORa] 1,9 ; IC à 95% 1,1 à 3,3), d'avoir moins de membres du ménage (ORa 2,1 ; IC à 95% 1,3 à 3,5), d'avoir un revenu représentant plus de 50 % du revenu du ménage (ORa 2,4 ; IC à 95% 1,5 à 3,8) et d'être un ménage pauvre (ORa 2,2 ; IC à 95% 1,2 à 3,9).

Conclusion: Bien que les services de santé liés à la TB soient fournis gratuitement aux patients, 26% des ménages atteints de RR-TB ont subi des coûts catastrophiques. Les facteurs associés doivent être pris en compte pour améliorer les soins de la TB centrés sur le patient, en particulier dans les groupes vulnérables. Les prestations sociales atténuent les coûts de la TB.

Keywords: Moldova; RR-TB; household income; out-of-pocket payment; poverty; tuberculosis.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure.
Figure.
Proportion of catastrophic costs due to TB (with and without incentives) by income at household level, Republic of Moldova, 2016.†* *According to World Bank criterion (poor household: household earning <US$1.9 per capita per day; non-poor household: ≥US$1.9 per capita per day) and based on household income prior to TB diagnosis. Missing data were excluded during hypothesis testing. †Two proportion Z-test (catastrophic costs with incentives, P < 0.01; catastrophic costs without incentives, P < 0.001).
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References

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