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Picture: 123RF/ALEXANDER RATHS
Picture: 123RF/ALEXANDER RATHS

More than half of SA’s tuberculosis (TB) patients face catastrophic costs that drive their households deeper into poverty, new research commissioned by the health department shows.

The findings are important because financial barriers that stand in the way of patients’ ability to travel to clinics to collect test results and medication pose a challenge to the government’s plans for combating the disease, which aim to reduce cases by 80% by 2030.

SA has one of the world’s worst TB epidemics, driven by its high HIV burden. An estimated 280,000 contracted TB and 54,200 died of the disease in SA in 2022, according to the World Health Organisation (WHO).

“TB is not just a health issue but an economic and social catastrophe, and it causes financial ruin for many households,” said Aurum Institute health economist Don Mudzengi, who presented the findings of SA’s first national patient cost survey at a virtual event hosted by the department of health on Wednesday.

It found 56.2% of TB-affected households faced catastrophic related expenses, defined as being more than 20% of the household’s pre-TB annual income. Patients faced direct costs such as out-of-pocket expenses for medical consultations, transport, special foods and vitamins, and indirect costs such as lost wages for patients and caregivers. Some patients consulted private healthcare practitioners and traditional healers before receiving a TB diagnosis.

The survey was conducted in 2020, and included 1,130 patients from 68 health facilities, who were interviewed in their homes due to the disruption caused by Covid-19. Many patients faced long delays in getting a diagnosis: the mean time to diagnosis for patients with drug-susceptible TB (DSTB) was three-and-a-half months (106 days) after their symptoms began.

Most of the patients were from households already living below the poverty line before they became ill, with limited assets to draw on. Only a fifth of patients said they had savings or loans available or had sold items to shore up their household income.

The mean income of TB patients plunged 44.9%, from R1,676 before symptoms to R924 at the time of the interview. Only a third of the respondents said they had obtained social assistance, despite them being eligible for temporary disability grants and the social relief of distress grant.

“Once TB comes, you lose jobs, incomes fall, and you do not have any way to cope with the costs. In addition, there is very little social assistance ... this is not a great story to tell,” said Mudzengi.

The survey found high levels of job losses, food insecurity and social exclusion. Almost a fifth (18%) of patients with drug-susceptible TB and more than a quarter (27%) of those with drug-resistant TB (DRTB) reported job losses. Almost a third (29%) of DSTB patients and almost half (49%) of DRTB patients experienced food insecurity, while just more than a quarter (26%) of DSTB patients and more than half (51%) of DRTB patients reported social exclusion.

The survey used a methodology devised by the WHO to enable international comparisons. SA placed in the middle of the organisation’s ranking of countries conducting these surveys, with its patients faring similarly to those in Burkina Faso and the Democratic Republic of Congo.

The health department’s Lindiwe Mvusi said TB screening needed to improve so that patients were diagnosed sooner. Reducing treatment from six to four months would also help cut clinic visits.

“We should also consider delivering medicines closer to people’s homes,” she said.

kahnt@businesslive.co.za

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