Annual Report: Challenge TB – Catastrophic Costs Year 2

The project had two specific objectives: to identify patient and health system predictors and reasons for catastrophic costs, and to determine the baseline and periodically measure the percentage of TB patients treated in the National TB Program (NTP) network who incur catastrophic costs. The project was implemented in Vietnam from May 2016 to September 2016, with a nationally representative patient cost survey involving 720 eligible TB patients in health facilities across 20 clusters. The survey included questions on the patient's current treatment and retrospective questions on the costs incurred by patients for their TB episode before they were diagnosed as having TB. The survey was conducted using a web-based data collection and management tool, ONA, and was supported by the WHO country office and headquarters. The survey aimed to estimate a total cost for each household by extrapolating reported costs and comparing these to household income. If the proportion of total costs exceeded 20% of annual household income, the TB-affected household was deemed to have faced catastrophic costs. The preliminary results of the survey were expected by October 2016 and would follow the WHO-recommended methodology. The project was highly relevant for Vietnam, which has expanded its social health insurance system with the aim of achieving universal health coverage by 2020. Vietnam is a lower-middle-income country and ranks amongst the 30 highest TB burden globally. The survey was among the first to apply the new WHO-recommended protocol for TB patient cost surveys and to adapt the generic instrument to the Vietnam context. The project was supported by the United States Agency for International Development (USAID) under the terms of cooperative agreement number AID-OAA-A-14-00029. The authors' views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. The project's findings will be used to inform policies on cost mitigation and to influence financial and social protection policies in Vietnam. The results of the survey will be disseminated at the end of 2016, and a meeting will be convened with the Ministry of Health and other key government representatives to discuss the findings. The project's methodology involved a cross-sectional survey with retrospective data collection and projections. The survey included all patients with TB, MDR or TB and HIV co-infected with no age restriction, and required a minimum of 14 days on treatment. All private and public health facilities within the National TB Program network were included as part of the random sampling. The project's implementation was supported by the existing operational research capacity within the Vietnam National TB Program, with minimum in-country technical assistance from WHO. The project's timeline included adaptation of the generic protocol and questionnaire, kick-off meeting in Vietnam, data collection and analysis, and GTB and local WHO staff involvement through WHO for project management. The project's results will contribute to the establishment of a global catastrophic cost baseline assessment, which will start in 2015-16 and accelerate in 2017-2020. Similar field testing is being conducted in parallel in six other countries, including Ghana, Mongolia, Myanmar, Philippines, Solomon Islands, and Timor Leste.