{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T18:27:25Z","timestamp":1786991245246,"version":"build-2736575974"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the prevalence of catastrophic costs incurred by households of people with tuberculosis (TB) in Guatemala, and to assess the potential wealth inequalities and the associated factors with the catastrophic costs, social consequences and coping strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A national representative survey, employing a clustered sampling based on health facilities, was conducted in 2023. The participants were people with TB and the data was collected by trained professionals using a standardized questionnaire. Catastrophic costs were defined as costs incurred by TB treatment that exceeds 20% of annual household income. We estimated the burden of catastrophic costs, social consequences and coping strategies. The primary analysis encompassed the output approach, while sensitivity analyses were conducted with the human capital approach and income loss adjustments. The associations were assessed using Poisson regression models with robust variance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The First Guatemala National Tuberculosis Costs Survey had 530 participants enrolled in 42 clusters. The estimated catastrophic costs incurred by people with TB, through the output approach, was 36% (95% CI 29% \u2212 43%). The prevalence among the poorest wealth quintile was 66%, while among the richest it was 50%, throughout the output approach adjusted for income loss (sensitivity analysis). Catastrophic costs were twice as high for 15\u201344-years old, but lower for people in the South West (PR 0.72; 95% CI 0.55\u20130.94), those in five-plus-person households (PR 0.73; 95% CI 0.57\u20130.93), and those treated in primary\/secondary facilities (PR 0.69; 95% CI 0.49\u20130.97). Social effects were related with sociodemographic characteristics and catastrophic costs (PR 1.21; 95% CI 1.09\u20131.34). Coping strategies were associated with sociodemographic factors, presence of social support (PR 1.11; 95% CI 1.01\u20131.22), and TB type (PR 1.16; 95% CI 1.01\u20131.33).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Guatemala, catastrophic costs were identified as a burden characterized by inequities, posing a challenge to the country in achieving zero to this indicator. However, the analyses revealed pathways that could be prioritized when formulating policies to effectively address this issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351164","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:39:12Z","timestamp":1786988352000},"page":"e0351164","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of catastrophic costs, income inequalities and associated factors in Guatemala: First national tuberculosis costs survey, 2023"],"prefix":"10.1371","volume":"21","author":[{"given":"Hibeb Alejandra","family":"Silvestre Tuch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maritza","family":"Samayoa-Pel\u00e1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belkys Asuncion","family":"Marcelino Martinez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Montoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Avedillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6952-0352","authenticated-orcid":true,"given":"Barbara","family":"Reis-Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"pone.0351164.ref001","unstructured":"World Health Organization. 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Censo de Poblaci\u00f3n y Vivienda 2018, ENCOVI 2020\u20131 [Internet]. Guatemala: INE; 2025. https:\/\/www.ine.gob.gt"},{"issue":"2","key":"pone.0351164.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0264689","article-title":"Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines","volume":"17","author":"JL Florentino","year":"2022","journal-title":"PLoS One"},{"key":"pone.0351164.ref026","author":"MSPAS Ministerio de Salud P\u00fablica y Asistencia Social","journal-title":"Situaci\u00f3n de Salud Guatemala 2022, Boletines Epidemiol\u00f3gicos. Guatemala: MSPAS"},{"key":"pone.0351164.ref027","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/s12913-015-1138-z","article-title":"What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India","volume":"15","author":"J Madan","year":"2015","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"pone.0351164.ref028","doi-asserted-by":"crossref","first-page":"489","DOI":"10.26719\/emhj.22.049","article-title":"Household catastrophic total cost due to tuberculosis in Egypt: incidence, cost drivers and policy implication","volume":"28","author":"M Gadallah","year":"2022","journal-title":"East Mediterr Health J"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351164","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:39:18Z","timestamp":1786988358000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351164"}},"subtitle":[],"editor":[{"given":"Tom E.","family":"Wingfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351164","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]}}}