The Association Between Household Financial Burden and Patient Mobility and Their Impact on Loss to Follow-Up Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China

Purpose: We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU). Methods: A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient’s address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC. Results: Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (OR adj =2.2, 95% CI: 1.1– 4.1) or with CTC (OR adj =2.6, 95% CI: 1.1– 6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: OR adj =4.1, 95% CI 1.6– 10.5 in Model I; CTC: OR adj =4.8, 95% CI 1.0– 22.9 in Model II), patients who were movers (OR adj =6.1, 95% CI 2.5– 14.8 in Model I; OR adj =7.4, 95% CI 3.0– 18.7 in Model II) and primary income earners (OR adj =2.5, 95% CI: 1.0– 5.9 in Model I; OR adj =2.7, 95% CI 1.1– 6.6 in Model II) had an increased risk of LTFU. Conclusion: There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients’ treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU. Keywords: household catastrophic costs, migration, loss to follow-up, Guizhou, MDR-TB