{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:40:57Z","timestamp":1762929657906,"version":"3.45.0"},"reference-count":83,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007155","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007155","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["MR\/V030825\/1"],"award-info":[{"award-number":["MR\/V030825\/1"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The COVID-19 pandemic had significant widespread financial impacts, resulting in decreased household income, increased unemployment, and disrupted health services. Despite the higher prevalence of infections of tuberculosis (TB) and human immunodeficiency virus (HIV) in poorer populations, research on the financial challenges faced by these populations during the pandemic is still limited. Indonesia recorded the highest COVID-19 cases in Southeast Asia (6 815 156) while contending with the dual burden of HIV and TB. This study investigates the factors influencing out-of-pocket (OOP) payments and catastrophic health spending during the pandemic, alongside patients\u2019 challenges and coping mechanisms in Bandung and Yogyakarta, Indonesia. We employed a parallel convergent mixed-methods approach, combining quantitative analysis of OOP costs with qualitative interviews. The determinants of OOP payments were analysed using a two-part cluster-robust regression model. Catastrophic health spending was defined as OOP payments exceeding 10% of a household\u2019s annual income. Data on OOP spending were recorded via diaries, while qualitative data were gathered from in-depth interviews with TB and HIV patients and healthcare workers from January to October 2022. The findings indicated that 5.13% [95% confidence interval (CI): 2.99\u20137.28] of households incurred catastrophically. The median household spent USD 8.48 OOP, with nonmedical expenses comprising the largest share (median USD 5.93). Key predictors of higher costs included facility location in Yogyakarta (OOP costs difference USD 23.84, 95% CI: 9.90\u201337.77, P &amp;lt; .001), seeking care from public hospitals (USD 17.37, 95% CI: 8.83\u201325.90, P &amp;lt; .001), and the absence of health insurance (USD 10.49, 95% CI: 2.40\u201318.58, P = .011). Patients reported that job losses during lockdowns exacerbated financial strain, while coping strategies documented included borrowing, family contributions, and selling assets. This is the first study to focus on OOP spending and the financial hardships experienced by TB and HIV patients in Indonesia during the pandemic, providing insights for targeted policy and preparedness efforts to alleviate the financial burden during large-scale public health crises.<\/jats:p>","DOI":"10.1093\/heapol\/czaf058","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T11:26:07Z","timestamp":1757330767000},"page":"1102-1115","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: a mixed-method study in Bandung and Yogyakarta, Indonesia"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0306-8612","authenticated-orcid":false,"given":"Nasser","family":"Fardousi","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine , Keppel Street, London WC1E 7HT ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srila Nirmithya Salita","family":"Negara","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanri Wijayanti","family":"Subronto","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]},{"name":"Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]},{"name":"Dr. Sardjito General Hospital , Jl. Kesehatan Sendowo No.1, Yogyakarta 55281 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuf Ari","family":"Mashuri","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]},{"name":"Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret , Jl. Ir. Sutami 36A, Surakarta 57126 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3701-8760","authenticated-orcid":false,"given":"Qinglu","family":"Cheng","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales , Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW, Kensington NSW 2033 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3397-3648","authenticated-orcid":false,"given":"Luh Putu Lila","family":"Wulandari","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales , Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW, Kensington NSW 2033 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I Wayan Cahyadi Surya Distira","family":"Putra","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siska Dian","family":"Wahyuningtias","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari","family":"Probandari","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. Farmako Sekip Utara, Yogyakarta 55281 ,","place":["Indonesia"]},{"name":"Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret , Jl. Ir. Sutami 36A, Surakarta 57126 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasbullah","family":"Thabrany","sequence":"additional","affiliation":[{"name":"ThinkWell.Global , Plaza Bank Index Level11, Jalan MH Thamrin No. 57, Jakarta 10350 ,","place":["Indonesia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Wiseman","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret , Jl. Ir. Sutami 36A, Surakarta 57126 ,","place":["Indonesia"]},{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine , Keppel Street, London WC1E 7HT ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9340-3922","authenticated-orcid":false,"given":"Riris Andono","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Jl. 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