Tuberculosis patients with higher levels of poverty face equal or greater costs of illness

• Published in: The international journal of tuberculosis and lung disease 2019-11, Vol.23 (11), p.1205-1212
• Main Authors: Erlinger, S., Stracker, N., Hanrahan, C., Nonyane, S., Mmolawa, L., Tampi, R., Tucker, A., West, N., Lebina, L., Martinson, N. A., Dowdy, D.
• Format: Article
• Language: English
• Subjects: Adult; Cost of Illness; Costs; Cross-Sectional Studies; Deprivation; Female; Health Expenditures; HIV; Human immunodeficiency virus; Humans; Income; Linear Models; Male; Middle Aged; Multidimensional Poverty Index; Patient Costs; Poverty; South Africa; Travel; Travel time; Tuberculosis; Tuberculosis, Pulmonary - economics; Viruses
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0814

SETTING: Fifty-six public clinics in Limpopo Province, South Africa.OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index.DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, human immunodeficiency virus status and travel time.RESULTS: Among 323 participants, 108 (33%) were 'deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97-1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00-1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46-0.62).CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.