{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:36:03Z","timestamp":1793075763536,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID\u2010OAA\u2010A\u201014\u201000029"],"award-info":[{"award-number":["AID\u2010OAA\u2010A\u201014\u201000029"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the incidence and major drivers of catastrophic costs among TB\u2010affected households in Zimbabwe.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a nationally representative health facility\u2010based survey with random cluster sampling among consecutively enrolled drug\u2010susceptible (DS\u2010TB) and drug\u2010resistant TB (DR\u2010TB) patients. Costs incurred and income lost due to TB illness were captured using an interviewer\u2010administered standardised questionnaire. We used multivariable logistic regression to determine the risk factors for experiencing catastrophic costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 841 patients were enrolled and were weighted to 900 during data analysis. There were 500 (56%) males and 46 (6%) DR\u2010TB patients. Thirty\u2010five (72%) DR\u2010TB patients were HIV co\u2010infected. Overall, 80% (95% CI: 77\u201382) of TB patients and their households experienced catastrophic costs. The major cost driver pre\u2010TB diagnosis was direct medical costs. Nutritional supplements were the major cost driver post\u2010TB diagnosis, with a median cost of US$360 (IQR: 240\u2013600). Post\u2010TB median diagnosis costs were three times higher among DR\u2010TB (US$1,659 [653\u20132,787]) than drug DS\u2010TB\u2010affected households (US$537 [204\u20131,134]). Income loss was five times higher among DR\u2010TB than DS\u2010TB patients. In multivariable analysis, household wealth was the only covariate that remained significantly associated with catastrophic costs: The poorest households had 16 times the odds of incurring catastrophic costs versus the wealthiest households (adjusted odds ratio [aOR: 15.7 95% CI: 7.5\u201333.1]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The majority of TB\u2010affected households, especially those affected by DR\u2010TB, experienced catastrophic costs. Since the major cost drivers fall outside the healthcare system, multi\u2010sectoral approaches to TB control and linking TB patients to social protection may reduce catastrophic costs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13647","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T09:10:02Z","timestamp":1625130602000},"page":"1248-1255","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Catastrophic costs among tuberculosis\u2010affected households in Zimbabwe: A national health facility\u2010based survey"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0997-9799","authenticated-orcid":false,"given":"Collins","family":"Timire","sequence":"first","affiliation":[{"name":"AIDS &amp; TB Control Programme Ministry of Health and Child Care Harare Zimbabwe"},{"name":"International Union Against Tuberculosis and Lung Disease Paris France"},{"name":"Faculty of Infectious &amp; Tropical Diseases London School of Hygiene &amp;Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mkhokheli","family":"Ngwenya","sequence":"additional","affiliation":[{"name":"Zimbabwe Country Office World Health Organization Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2441-3304","authenticated-orcid":false,"given":"Joconiah","family":"Chirenda","sequence":"additional","affiliation":[{"name":"College of Health Sciences University of Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Z","family":"Metcalfe","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5691-7270","authenticated-orcid":false,"given":"Katharina","family":"Kranzer","sequence":"additional","affiliation":[{"name":"Faculty of Infectious &amp; Tropical Diseases London School of Hygiene &amp;Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Pedrazzoli","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology &amp; Population Health London School of Hygiene &amp;Tropical Medicine London UK"},{"name":"World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2980-7735","authenticated-orcid":false,"given":"Kudakwashe C.","family":"Takarinda","sequence":"additional","affiliation":[{"name":"AIDS &amp; TB Control Programme Ministry of Health and Child Care Harare Zimbabwe"},{"name":"International Union Against Tuberculosis and Lung Disease Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0875-0549","authenticated-orcid":false,"given":"Peter","family":"Nguhiu","sequence":"additional","affiliation":[{"name":"Health Economics Research Unit Kenya Medical Research Institute Wellcome Trust Research Programme Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geshem","family":"Madzingaidzo","sequence":"additional","affiliation":[{"name":"AIDS &amp; TB Control Programme Ministry of Health and Child Care Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwenzikweyinkosi","family":"Ndlovu","sequence":"additional","affiliation":[{"name":"AIDS &amp; TB Control Programme Ministry of Health and Child Care Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawanda","family":"Mapuranga","sequence":"additional","affiliation":[{"name":"AIDS &amp; TB Control Programme Ministry of Health and Child Care Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7149-8799","authenticated-orcid":false,"given":"Morna","family":"Cornell","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0264-7900","authenticated-orcid":false,"given":"Charles","family":"Sandy","sequence":"additional","affiliation":[{"name":"AIDS &amp; TB Control Programme Ministry of Health and Child Care Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Global Tuberculosis Report 2020","author":"World Health Organisation","year":"2020"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2019.07.021"},{"key":"e_1_2_7_4_1","volume-title":"Global Tuberculosis Report 2018","author":"World Health Organisation","year":"2018"},{"key":"e_1_2_7_5_1","volume-title":"The paradigm shift 2016\u20132020: Global plan to End TB","author":"STOP Tb Partnership","year":"2015"},{"key":"e_1_2_7_6_1","first-page":"1396","article-title":"The economic effects of supporting tuberculosis\u2010affected households in Peru","volume":"48","author":"Wingfield T","year":"2016","journal-title":"Eur Radiol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00193413"},{"issue":"3","key":"e_1_2_7_8_1","first-page":"1","article-title":"Catastrophic total costs in tuberculosis\u2010 affected households and their determinants since Indonesia\u2019s implementation of universal health coverage","volume":"7","author":"Fuady A","year":"2018","journal-title":"Infect Dis Poverty"},{"key":"e_1_2_7_9_1","volume-title":"The First Kenya Tuberculosis Patient Cost Survey, 2017","author":"Ministry of Health Kenya","year":"2017"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.13085"},{"issue":"21","key":"e_1_2_7_11_1","first-page":"1","article-title":"Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage","volume":"2","author":"Ukwaja KN","year":"2013","journal-title":"Infect Dis Poverty"},{"key":"e_1_2_7_12_1","unstructured":"Worldometer.Zimbabwe population (live) [Internet];2020. Available from:https:\/\/www.worldometers.info\/world\u2010population\/zimbabwe\u2010population\/[cited 2020 Sep 21]."},{"key":"e_1_2_7_13_1","volume-title":"Global Tuberculosis Report 2019","author":"World Health Organisation","year":"2019"},{"key":"e_1_2_7_14_1","volume-title":"Tuberculosis patient cost surveys: A handbook","author":"World Health Organization","year":"2018"},{"key":"e_1_2_7_15_1","volume-title":"Availability and coverage of social protection services for TB patients in Zimbabwe","author":"Ministry of Health and Child Care","year":"2019"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.17.0859"},{"issue":"10","key":"e_1_2_7_17_1","first-page":"1","article-title":"Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis\u2010affected households in Indonesia: eight simulated scenarios","volume":"8","author":"Fuady A","year":"2019","journal-title":"Infect Dis Poverty"},{"issue":"100274","key":"e_1_2_7_18_1","first-page":"1","article-title":"Uptake of governmental social protection and financial hardship during drug\u2010\u201eresistant tuberculosis treatment in Rio de Janeiro, Brazil","volume":"51","author":"Rudgard WE","year":"2018","journal-title":"Eur Respir J"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.13647","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tmi.13647","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.13647","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T16:47:57Z","timestamp":1692982077000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.13647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,3]]},"references-count":17,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1111\/tmi.13647"],"URL":"https:\/\/doi.org\/10.1111\/tmi.13647","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,3]]},"assertion":[{"value":"2021-08-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}