@article{27419,
  author = {Cuevas RA and Lawson L and Al-Sonboli N and Al-Aghbari N and Arbide I and Sherchand J and Nnamdi EE and Aseffa A and Yassin MA and Abdurrahman ST and Obasanya J and Olanrewaju O and Datiko D and Theobald S and Ramsay A and Squire BS and Cuevas L},
  title = {Patients direct costs to undergo TB diagnosis.},
  abstract = {<p><strong>BACKGROUND: </strong>A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.</p>

<p><strong>METHODS: </strong>We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults &gt;18&nbsp;years with cough &gt;2&nbsp;weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs &gt;75(th) quartile were considered to have high expenditure (cases) and compared with patients with costs &lt;75(th) quartile to identify factors associated with high expenditure.</p>

<p><strong>RESULTS: </strong>The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy.</p>

<p><strong>CONCLUSIONS: </strong>The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.</p>
},
  year = {2016},
  journal = {Infectious diseases of poverty},
  volume = {5},
  pages = {24},
  issn = {2049-9957},
  url = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806474/pdf/40249_2016_Article_117.pdf},
  doi = {10.1186/s40249-016-0117-x},
  language = {eng},
}