Costs of tuberculosis care and associated factors among patients with HIV or diabetes mellitus comorbidities attending selected health facilities in Kampala from a societal perspective

Abstract

Introduction In Uganda, the Tuberculosis (TB) burden among Human immunodeficiency virus (HIV) patients is still high and increasing significantly among DM patients due to the looming DM epidemic. Although TB drugs and diagnostics are free in Ugandan public and not-for-profit health facilities, TB patients with HIV or DM comorbidities incur significant costs due to out-of-pocket fees, travel costs, and productivity losses. This high economic burden contributes to poverty as well as access and adherence barriers which adversely affect health outcomes. However, little is known about the costs of TB comorbidities (HIV or DM) in Uganda. General Objective To determine the costs of tuberculosis care and associated factors in patients with DM or HIV co-morbidities attending selected health facilities in Kampala from a societal perspective. Methods A cross-sectional costing study was conducted among 326 consecutively sampled TB patients with either HIV or DM or both comorbidities recruited from TB outpatient clinics in selected health facilities in Kampala. Data on patient characteristics and costs from a societal perspective was collected from patients and health facility records. Using STATA 15, descriptive statistics were used to summarize patients’ characteristics and the mean, and median costs. The extrapolation of costs in the different TB treatment phases, beyond and until the completion of treatment was done using the mean values reported by the patients in the study. Generalized linear regression analysis was performed to measure the association of selected patient socioeconomic and disease characteristics with the mean societal costs per TB episode.

Results The mean cost of TB care for HIV and DM patients from a societal perspective per TB episode was USD 71.8(95% CI 58.35, 85.19). TB-DM costs (USD 76.6, SD:68) were higher than TB-HIV (USD 71.7, SD:13). Factors significantly associated with the costs of TB care included HIV USD-19.5(95%CI: -29.6,-9.5), hospitalization USD 178.9(95%CI:147.6,210.2) and alcohol USD-30.9(95%CI: -44.9, -16.9). Interaction between hospitalisation and tertiary educationUSD402.6 (95% CI: 35.9,769.3) as well as between HIV and alcohol were significant USD29.2 (95% CI: 19.7, 38.7). Conclusion TB-DM/HIV patients endure high costs of care with the major cost drivers being direct medical and travel costs. Therefore, healthcare insurance reimbursement strategies should be adopted for direct medical costs. Introduction of TB-DM care integration and once-weekly isoniazid rifapentine for 12 weeks (3HP) treatment for latent TB in high-risk DM patients can potentially minimize the financial burden on patients