Tuberculosis patients face high treatment support costs in Colombia, 2021.

OBJECTIVE: To estimate the baseline to measure one of the three indicators of the World Health Organization (WHO) End TB strategy (2015-2035), measure the costs incurred by patients affected by tuberculosis (TB) during a treatment episode and estimate the proportion of households facing catastrophic costs (CC) and associated risk factors, in Colombia, 2021. MATERIAL AND METHODS: A nationally representative cross-sectional survey was conducted among participants on TB treatment in Colombia, using telephone interviews due to the exceptional context of the COVID-19 pandemic. The survey collected household costs (direct [medical and non-medical out-of-pocket expenses] and indirect) over an episode of TB, loss of time, coping measures, self-reported income, and asset ownership. Total costs were expressed as a proportion of annual household income and analyzed for risk factors of CC (defined as costs above 20% annual household income). RESULTS: The proportion of TB-affected households incurring in costs above 20% annual household income (CC) was 51.7% (95%CI: 45.4-58.0) overall, 51.3% (95%CI: 44.9-57.7) among patients with drug-sensitive (DS) TB, and 65.0% (95%CI: 48.0-82.0) among drug-resistant (DR). The average patient cost of a TB case in Colombia was $1,218 (95%CI 1,106-1,330) including $860.9 (95%CI 776.1-945.7) for non-medical costs, $339 (95%CI 257-421) for the indirect costs, and $18.1 (95%CI 11.9-24.4) for the medical costs. The factors that influenced the probability of facing CC were income quintile, job loss, DR-TB patient, and TB type. CONCLUSION: Main cost drivers for CC were non-medical out-of-pocket expenses and income loss (indirect costs). Current social protection programs ought to be expanded to mitigate the proportion of TB-affected households facing CC in Colombia, especially those with lower income levels.

Biobancos y COVID-19: implicaciones éticas / Biobanks and COVID-19: Ethical implications / Biobanks e COVID-19: Implicações éticas

Propósito/Contexto: De acuerdo con los antecedentes de epidemias anteriores, y en el contexto de la emergencia actual por COVID19, se ha reconocido como prioritario el desarrollo de investigaciones y la creación de biobancos o biorepositorios, que permitan el acceso a muestras e información para comprender la enfermedad, formular intervenciones, evaluar la seguridad y eficacia de exámenes, pruebas de diagnóstico, tratamientos, vacunas y estrategias de manejo. Aunque la investigación durante eventos de importancia en salud pública es fundamental, los estudios con seres humanos durante las emergencias deben contar con mayores garantías éticas que en las situaciones ordinarias. Metodología/Enfoque: para esta revisión se realizó la búsqueda de literatura relacionada con normatividad y legislación, biobancos, colecciones de muestras, y su relevancia en el contexto de la pandemia. Discusión/Conclusiones/Contribuciones: En esta revisión incluimos algunas reflexiones sobre el establecimiento y uso de los biobancos en el contexto de la pandemia que aqueja al mundo actualmente.

Purpose/Context. According to the history of previous epidemics, and in the context of the current emergency caused by COVID-19, it is a priority to carry out research and create biobanks or biorepositories. These allow accessing samples and information to understand the disease, formulate interventions, and evaluate the safety and efficacy of examinations, diagnostic tests, treatments, vaccines, and management strategies. Although research during significant public health emergencies is essential, studies on human beings in these cases must have higher ethical guarantees than ordinary situations. Method/Approach. This review includes literature related to regulations and legislation, biobanks, sample collections, and their relevance to the context of the pandemic. Results/Findings. Accelerated sample collection and the establishment of biobanks have been typical during this pandemic, which induces the adoption of sample management guidelines with major ethical, legal, and social differences among countries. Discussion/Conclusions/Contributions. This review comprises reflections on the establishment and use of biobanks during the pandemic that is currently afflicting the world.

Objetivo/Contexto. De acordo com os antecedentes de epidemias anteriores e no contexto da atual emergência causada pelo COVID-19, tem-se reconhecido como prioritário o desenvolvimento de pesquisas e a criação de biobancos ou bio-repositórios, que permitam o acesso a amostras e informações para entender a doença, formular intervenções, avaliar a segurança e eficácia dos exames, dos testes de diagnóstico, dos tratamentos, as vacinas e as estratégias de manejo. Embora a pesquisa durante eventos importantes em saúde pública seja essencial, os estudos com seres humanos em situações de emergência devem ter maiores garantias éticas do que em situações comuns. Metodologia/Abordagem. Para esta revisão, se efetuo a busca de literatura relacionada com o regulamento e legislação, biobancos, coletas de amostras e sua relevância no contexto da pandemia. Resultados/Descobertas. Achamos que, no contexto da pandemia, é comum a coleta acelerada de amostras e o estabelecimento de biobancos, o que induz à adoção de diretrizes para o tratamento dessas amostras, com diferenças importantes em aspectos éticos, legais e sociais entre os diferentes países. Discussão/Conclusões/Contribuições. Nesta revisão, incluímos algumas reflexões sobre o estabelecimento e o uso de biobancos no contexto da pandemia que atualmente afeta o mundo.

La Lepra: una enfermedad vigente / Leprosy: an ongoing disease

El libro resalta que la lepra continúa siendo una enfermedad presente en Colombia y que aún constituye un problema de salud pública importante por los costos sociales, económicos y de sufrimiento humano que conlleva. Sabiendo que la literatura sobre el tema es escasa en nuestro medio, este libro surge como una herramienta de consulta creada para médicos y otros profesionales de salud, con la certeza de que es preciso mejorar la oportunidad del diagnóstico. Siendo fundamental que, durante su proceso formativo, todos los profesionales de la salud adquieran conocimientos sobre dicha enfermedad, que cada día se hace más visible por sus secuelas y diagnóstico tardío.

The book highlights the fact that leprosy continues to be a disease present in Colombia and that it is still a major public health problem due to the social, economic and human suffering costs it entails. Knowing that the literature on the subject is scarce in our country, this book is intended as a reference tool for doctors and other health professionals, in the knowledge that it is necessary to improve the timeliness of diagnosis. It is essential that, during their training process, all health professionals acquire knowledge about this disease, which is becoming more and more visible every day due to its sequelae and late diagnosis.