People with tuberculosis, both while seeking a diagnosis for their symptoms and after TB is confirmed, often incur a heavy economic burden. Although diagnosis and treatment of TB is provided free by the Nepali government, people affected by TB are often extremely poor and must pay the costs of transport to health centers, lose income due to inability to work and pay for other tests and treatments. They often sell assets or incur debts at high interest to cope with these costs. BNMT seeks to understand the costs to patients and their households at various stages of the treatment pathway to cope with the disease. We have shown that active case finding strategies can substantially mitigate these costs and reduce the impact of TB on the patient and their family.
We are also evaluating the health system costs of different TB active case finding strategies and have shown that, although advanced molecular GeneXpert testing for TB is more expensive than smear microscopy, the cost could be substantially reduced through policy changes. Our evidence is being used to develop and advocate for support strategies to address the economic needs and reduce the socioeconomic consequences for people with tuberculosis and their families.