Research protocol for a mixed-methods study to characterise and address the socioeconomic impact of accessing TB diagnosis and care in Nepal

Wellcome Open Research

article

Kritika Dixit¹  Bhola Rai¹  Tara Prasad Aryal¹  Gokul Mishra¹  Noemia Teixeira de Siqueira-Filha³  Puskar Raj Paudel⁴  Jens W. Levy⁴  Job van Rest⁴  Suman Chandra Gurung¹  Raghu Dhital¹  Olivia Biermann²  Kerri Viney²  Knut Lonnroth²  S Bertel Squire³  Maxine Caws¹  Tom Wingfield² 

[1] Birat Nepal Medical Trust;Social medicine, Infectious diseases, and Migration ,(SIM) Group, Department of Public Health Sciences, Karolinska Institute;Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine;KNCV Tuberculosis Foundation;Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust

关键词: Tuberculosis;    poverty;    catastrophic costs;    socioeconomic support;    social protection;    healthcare access;    Nepal;   

DOI  :  10.12688/wellcomeopenres.15677.2

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Background: WHO’s 2015 End TB Strategy advocates social and economic (socioeconomic) support for TB-affected households to improve TB control. However, evidence concerning socioeconomic support for TB-affected households remains limited, especially in low-income countries.Protocol: This mixed-methods study in Nepal will: evaluate the socioeconomic impact of accessing TB diagnosis and care (Project 1); and create a shortlist of feasible, locally-appropriate interventions to mitigate this impact (Project 2). The study will be conducted in the Chitwan, Mahottari, Makawanpur, and Dhanusha districts of Nepal, which have frequent TB and poverty. The study population will include: approximately 200 people with TB (Cases) starting TB treatment with Nepal’s National TB Program and 100 randomly-selected people without TB (Controls) in the same sites (Project 1); and approximately 40 key in-country stakeholders from Nepal including people with TB, community leaders, and TB healthcare professionals (Project 2). During Project 1, visits will be made to people with TB’s households during months 3 and 6 of TB treatment, and a single visit made to Control households. During visits, participants will be asked about: TB-related costs (if receiving treatment), food insecurity, stigma; TB-related knowledge; household poverty level; social capital; and quality of life. During Project 2, stakeholders will be invited to participate in: a survey and focus group discussion (FGD) to characterise socioeconomic impact, barriers and facilitators to accessing and engaging with TB care in Nepal; and a one-day workshop to review FGD findings and suggest interventions to mitigate the barriers identified.Ethics and dissemination: The study has received ethical approval. Results will be disseminated through scientific meetings, open access publications, and a national workshop in Nepal. Conclusions: This research will strengthen understanding of the socioeconomic impact of TB in Nepal and generate a shortlist of feasible and locally-appropriate socioeconomic interventions for TB-affected households for trial evaluation.

【 授权许可】

CC BY