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.

[Social determinants and the Sustainable Development Goals' tuberculosis target in the AmericasDeterminantes sociais e a meta para a tuberculose dos Objetivos de Desenvolvimento Sustentável nas Américas]. / Determinantes sociales y meta de tuberculosis en los Objetivos de Desarrollo Sostenible en las Américas.

OBJECTIVE: Determine patterns of tuberculosis (TB) incidence indicators and number of deaths from TB within the framework of target 3.3 of the Sustainable Development Goals (SDGs) and their correlation with social determinants. METHODS: Ecological study methodology was used, in which the population is the unit of analysis. Social determinants were analyzed using a negative binomial regression model and strength of association. RESULTS: In the Americas, there was an average annual reduction in the TB incidence rate of 0.3% from 2009 to 2018; however, from 2015 to 2018, the rate increased, from 27.6 to 28.8 per 100,000 population. With regard to social determinants, the groups of countries with the lowest human development index (HDI) and gross domestic product (GDP) have a higher incidence of TB. TB risk in the country with the lowest HDI is six times that of the country with the highest HDI. CONCLUSIONS: At the current rate of reduction in the incidence rate and number of deaths from TB, the Region of the Americas will not meet the targets in the SDGs and in the End TB Strategy. Rapid implementation and expansion of interventions for TB prevention and control are required to attain the targets. This involves, among other actions, reducing access barriers to diagnosis and treatment and strengthening initiatives to address social determinants.

OBJETIVO: Determinar o comportamento dos indicadores de incidência da tuberculose (TB) e o número de mortes por TB no quadro da meta 3.3 dos Objetivos de Desenvolvimento Sustentável (ODS) e sua correlação com os determinantes sociais. MÉTODOS: Utilizamos uma metodologia de estudo ecológico, na qual a unidade de análise é a população. Para a análise dos determinantes sociais, utilizamos o modelo de regressão binomial negativo e a avaliamos a força das associações. RESULTADOS: Nas Américas, observou-se uma redução anual média na taxa de incidência de TB de 0,3% entre 2009 e 2018; entretanto, de 2015 a 2018 houve um aumento, de 27,6 para 28,8 por 100.000 habitantes. Com relação aos determinantes sociais, os grupos de países com índice de desenvolvimento humano (IDH) e produto interno bruto (PIB) mais baixos apresentam uma maior incidência de TB. O risco de TB no país com o menor IDH é seis vezes maior que no país com o maior IDH. CONCLUSÕES: Se mantido o ritmo atual de redução na taxa de incidência e no número de mortes por TB, a Região das Américas não alcançará as metas propostas nos ODS e na Estratégia pelo Fim da Tuberculose. É necessária uma implementação e expansão mais rápida das intervenções de prevenção e controle da TB para alcançar este objetivo. Isto implica, entre outras ações, reduzir as barreiras de acesso ao diagnóstico e tratamento e fortalecer as iniciativas que abordam os determinantes sociais.

Determinantes sociales y meta de tuberculosis en los Objetivos de Desarrollo Sostenible en las Américas

[RESUMEN]. Objetivo. Determinar el comportamiento de los indicadores de incidencia de tuberculosis (TB) y número de muertes por TB en el marco de la meta 3.3 de los Objetivos de Desarrollo Sostenible (ODS) y su correlación con los determinantes sociales. Métodos. Se utilizó una metodología de estudio ecológico, en el cual la unidad de análisis es la población. Para el análisis de los determinantes sociales, se hizo uso del modelo de regresión binomial negativo y la fuerza de asociación. Resultados. En las Américas se ha presentado una disminución promedio anual en la tasa de incidencia de TB de 0,3% entre 2009 y 2018; sin embargo, de 2015 a 2018 ha habido un aumento, pasando de 27,6 a 28,8 por 100 000 habitantes. Con respecto a los determinantes sociales, los grupos de países con índice de desarrollo humano (IDH) y producto interno bruto (PIB) más bajos tienen una incidencia de TB más alta. El riesgo de TB en el país con IDH más bajo es seis veces mayor que en el país con IDH más alto. Conclusiones. Al ritmo de la disminución actual de la tasa de incidencia y del número de muertes por TB, la Región de las Américas no alcanzará las metas propuestas en los ODS y en la Estrategia Fin de la TB. Se requiere una implementación y expansión rápidas de las intervenciones en prevención y control de TB para lograrlo. Esto implica, entre otras acciones, reducir las barreras de acceso al diagnóstico y tratamiento y fortalecer las iniciativas para abordar los determinantes sociales.

[ABSTRACT]. Objective. Determine patterns of tuberculosis (TB) incidence indicators and number of deaths from TB within the framework of target 3.3 of the Sustainable Development Goals (SDGs) and their correlation with social determinants. Methods. Ecological study methodology was used, in which the population is the unit of analysis. Social determinants were analyzed using a negative binomial regression model and strength of association. Results. In the Americas, there was an average annual reduction in the TB incidence rate of 0.3% from 2009 to 2018; however, from 2015 to 2018, the rate increased, from 27.6 to 28.8 per 100,000 population. With regard to social determinants, the groups of countries with the lowest human development index (HDI) and gross domestic product (GDP) have a higher incidence of TB. TB risk in the country with the lowest HDI is six times that of the country with the highest HDI. Conclusions. At the current rate of reduction in the incidence rate and number of deaths from TB, the Region of the Americas will not meet the targets in the SDGs and in the End TB Strategy. Rapid implementation and expansion of interventions for TB prevention and control are required to attain the targets. This involves, among other actions, reducing access barriers to diagnosis and treatment and strengthening initiatives to address social determinants.

[RESUMO]. Objetivo. Determinar o comportamento dos indicadores de incidência da tuberculose (TB) e o número de mortes por TB no quadro da meta 3.3 dos Objetivos de Desenvolvimento Sustentável (ODS) e sua correlação com os determinantes sociais. Métodos. Utilizamos uma metodologia de estudo ecológico, na qual a unidade de análise é a população. Para a análise dos determinantes sociais, utilizamos o modelo de regressão binomial negativo e a avaliamos a força das associações. Resultados. Nas Américas, observou-se uma redução anual média na taxa de incidência de TB de 0,3% entre 2009 e 2018; entretanto, de 2015 a 2018 houve um aumento, de 27,6 para 28,8 por 100.000 habitantes. Com relação aos determinantes sociais, os grupos de países com índice de desenvolvimento humano (IDH) e produto interno bruto (PIB) mais baixos apresentam uma maior incidência de TB. O risco de TB no país com o menor IDH é seis vezes maior que no país com o maior IDH. Conclusões. Se mantido o ritmo atual de redução na taxa de incidência e no número de mortes por TB, a Região das Américas não alcançará as metas propostas nos ODS e na Estratégia pelo Fim da Tuberculose. É necessária uma implementação e expansão mais rápida das intervenções de prevenção e controle da TB para alcançar este objetivo. Isto implica, entre outras ações, reduzir as barreiras de acesso ao diagnóstico e tratamento e fortalecer as iniciativas que abordam os determinantes sociais.

[New diagnosis tools for tuberculosis laboratory network in Latin America]. / Consideraciones sobre la implementación de nuevas herramientas diagnósticas en las redes de laboratorios de tuberculosis de Latinoamérica.

Feasibility of rapid and sustainable diagnostic methods that provide useful and timely results to guide the clinical control of tuberculosis patients was analyzed. However, policies guiding the insertion of new diagnostics in the laboratory services that support the tuberculosis control are lacking in developing countries. The introduction of these methods in developing countries laboratories requires rational policies guiding the application of these technologies. In the last few years, some automated systems for culture and molecular testing in laboratory services for tuberculosis diagnosis, which offered accuracy and speed, have been reported. However, their implementation is restricted because of costly resources, logistics and infrastructure. Recently, various economically feasible tests have demonstrated to be applicable in poor-resource labs. The detection of adenosine desaminase (ADA) in pleural fluid is a valuable low-cost approach to the diagnosis of tuberculosis. On the other hand, the microscopic detection of Mycobacterium tuberculosis using thin layer agar is a moderate cost alternative method. Drug susceptibility testing to antituberculous drugs can be expedited by the nitrate reduction assay in tuberculosis laboratories using routine procedures for tuberculosis diagnosis.

Rapid alternative methods for detection of rifampicin resistance in Mycobacterium tuberculosis.

OBJECTIVE: To study the performance of three rapid low cost methods for the detection of rifampicin resistance. METHODS: A panel of 20 coded Mycobacterium tuberculosis strains was tested blindly by the low cost methods: nitrate reductase, MTT and resazurin assays, and compared with the results obtained with the gold standard methods: the proportion method on Löwenstein-Jensen medium and the BACTEC TB 460 system. We have also tested two commercial tests: MGIT and INNO LiPA Rif.TB kit. RESULTS: Complete agreement was observed among all methods. CONCLUSION: These three simple methods might become inexpensive alternative procedures for rapid detection of rifampicin resistance in low-resource countries.