Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia’s implementation of universal health coverage

摘要: As well as imposing an economic burden on affected households, the high costs related to tuberculosis (TB) can create access and adherence barriers. This highlights particular urgency of achieving one End TB Strategy’s targets: that no TB-affected households have face catastrophic by 2020. In Indonesia, elsewhere, there is also emerging need provide social protection implementing universal health coverage (UHC). We therefore assessed incidence total due TB, their determinants since implementation UHC. interviewed adult multidrug-resistant (MDR-TB) patients in urban, suburban rural areas Indonesia who had been treated for at least month or finished treatment more than earlier. Following WHO recommendation, we TB. analyzed sensitivity relative several thresholds, measured differences between poor non-poor costs. Generalized linear mixed-model analysis was used identify 282 TB 64 MDR-TB patients. For TB-related services, median (interquartile range) incurred 133 USD (55–576); MDR-TB-related it 2804 (1008–4325). The all 36% (43% 25% households). MDR-TB-affected 83% (83% 83%). were (adjusted odds ratio [aOR] = 3.7, 95% confidence interval [CI]: 1.7–7.8); being a breadwinner (aOR = 2.9, CI: 1.3–6.6); job loss (aOR = 21.2; 8.3–53.9); previous (aOR = 2.9; 1.4–6.1). having income-earning before diagnosis only determinant (aOR = 8.7; 1.8–41.7). Despite UHC, still risk further impoverishment. ensuring healthcare, cost-mitigation policy additional financial should be provided protect relieve income losses.