Comments on: When it comes to Tuberculosis, testing isn’t exactly free http://www.conversationsforabetterworld.com/2009/09/when-it-comes-to-tuberculosis-testing-isn%e2%80%99t-exactly-free/ A shared Blog on Population, Gender and Health Sat, 24 Jul 2010 19:03:27 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Isobel Hoskins http://www.conversationsforabetterworld.com/2009/09/when-it-comes-to-tuberculosis-testing-isn%e2%80%99t-exactly-free/comment-page-1/#comment-742 Isobel Hoskins Fri, 09 Oct 2009 11:26:41 +0000 http://www.conversationsforabetterworld.com/?p=668#comment-742 I think this DILO account shows the importance of knowing your potential patients and their priorities. It brings to life ‘cost’ and distance’ often cited in papers about healthcare access and shows what they could mean. And I entirely agree this is a global issue, rural and poor populations worldwide have issues with accessing care. As well as organisational and cultural issues there are technical ones that if overcome could help. TB is a good example for this. Tests for TB take a long time -days or weeks- or they are not very accurate. Simple testing while you wait would be a great step forward, saving repeat trips to distant clinics. The bibliographic database I work on- Global Health- shows that a lot of research on rapid diagnosis of TB is in progress especially using PCR and ELISA. Unfortunately these methods need labs to do. I saw one exciting idea - breath testing- - see this abstract in Tuberculosis (http://www.tuberculosisjournal.com/article/S1472-9792(09)00031-6/abstract). My second comment is that the problems of accessing healthcare don’t stop with testing. Testing may be 'free' but is treatment? If the man Tanya describes was diagnosed positive he likely wouldn’t be able to comply with the treatment if the tablets cost money and he might still have to travel somewhere daily to be observed taking his tablets possibly for months. What is the ethics if you offer free testing but then the affordability/accessibility of treatment is beyond the patient? I think this DILO account shows the importance of knowing your potential patients and their priorities. It brings to life ‘cost’ and distance’ often cited in papers about healthcare access and shows what they could mean. And I entirely agree this is a global issue, rural and poor populations worldwide have issues with accessing care.

As well as organisational and cultural issues there are technical ones that if overcome could help. TB is a good example for this. Tests for TB take a long time -days or weeks- or they are not very accurate. Simple testing while you wait would be a great step forward, saving repeat trips to distant clinics. The bibliographic database I work on- Global Health- shows that a lot of research on rapid diagnosis of TB is in progress especially using PCR and ELISA. Unfortunately these methods need labs to do. I saw one exciting idea – breath testing- – see this abstract in Tuberculosis (http://www.tuberculosisjournal.com/article/S1472-9792(09)00031-6/abstract).

My second comment is that the problems of accessing healthcare don’t stop with testing. Testing may be ‘free’ but is treatment? If the man Tanya describes was diagnosed positive he likely wouldn’t be able to comply with the treatment if the tablets cost money and he might still have to travel somewhere daily to be observed taking his tablets possibly for months.

What is the ethics if you offer free testing but then the affordability/accessibility of treatment is beyond the patient?

]]> By: rumbleth http://www.conversationsforabetterworld.com/2009/09/when-it-comes-to-tuberculosis-testing-isn%e2%80%99t-exactly-free/comment-page-1/#comment-534 rumbleth Fri, 18 Sep 2009 01:44:05 +0000 http://www.conversationsforabetterworld.com/?p=668#comment-534 Great posts, and thank-you for engaging in the conversation. I hope to continue this dialogue about health disparities in different posts and from different perspectives. While my work in Public Health is focused on chronic disease prevention- non-communicable chronic diseases, the TB example is just that, an example of the barriers that exist in as fundamental design flaws in our health and social development interventions. A truly person-centered approach is absolutely more expensive, and time intensive, the outcomes are however qualitative and quantitative. I certainly agree training would better prepare the health workforce to ensure they are inclusive in their approach. Additionally a socio-ecological approach would include policies to support inclusive and equitable program design, through to organizational culture that supports the time required to go through the 'DILO', and to the individual professional making a commitment to remove all barriers for all clients. Also appreciate the comments from Jennifer and Leila in that this analogy could be equally applied within the context of the Global North or 'developed world' and that care must be taken to remove barriers in all programs to serve the most at risk. Great posts, and thank-you for engaging in the conversation. I hope to continue this dialogue about health disparities in different posts and from different perspectives. While my work in Public Health is focused on chronic disease prevention- non-communicable chronic diseases, the TB example is just that, an example of the barriers that exist in as fundamental design flaws in our health and social development interventions. A truly person-centered approach is absolutely more expensive, and time intensive, the outcomes are however qualitative and quantitative. I certainly agree training would better prepare the health workforce to ensure they are inclusive in their approach. Additionally a socio-ecological approach would include policies to support inclusive and equitable program design, through to organizational culture that supports the time required to go through the ‘DILO’, and to the individual professional making a commitment to remove all barriers for all clients. Also appreciate the comments from Jennifer and Leila in that this analogy could be equally applied within the context of the Global North or ‘developed world’ and that care must be taken to remove barriers in all programs to serve the most at risk.

]]> By: leila http://www.conversationsforabetterworld.com/2009/09/when-it-comes-to-tuberculosis-testing-isn%e2%80%99t-exactly-free/comment-page-1/#comment-525 leila Thu, 17 Sep 2009 14:43:12 +0000 http://www.conversationsforabetterworld.com/?p=668#comment-525 Great article. I thought of the times I had to contemplate taking off work to go see the OB while I was pregnant because shes open only certain days and hours of the week, it is difficult especially for those relying on public transportation or other means and having to take time off work, especially in economic difficulties today where a lot of people make hourly wages can't afford a couple hours off or as some other employers dictate that you have to take a half day off regardless of how long you are going to be away from work. There was an article on the internet I believe on msn.com yesterday saying that if peoples paychecks were one week late many would miss payments and go into credit and financial ruin. Great article. I thought of the times I had to contemplate taking off work to go see the OB while I was pregnant because shes open only certain days and hours of the week, it is difficult especially for those relying on public transportation or other means and having to take time off work, especially in economic difficulties today where a lot of people make hourly wages can’t afford a couple hours off or as some other employers dictate that you have to take a half day off regardless of how long you are going to be away from work. There was an article on the internet I believe on msn.com yesterday saying that if peoples paychecks were one week late many would miss payments and go into credit and financial ruin.

]]> By: Jennifer Jenkins http://www.conversationsforabetterworld.com/2009/09/when-it-comes-to-tuberculosis-testing-isn%e2%80%99t-exactly-free/comment-page-1/#comment-513 Jennifer Jenkins Thu, 17 Sep 2009 01:41:39 +0000 http://www.conversationsforabetterworld.com/?p=668#comment-513 As a health care professional for 25 years the story I read above rings true on many levels. We often schedule health for the compromised/ at risk population from 9-5 ,not acknowledging this does not fit well with their way of life. Bravo on this article; and lets look at policy , procedure and organization of health so that it truley benefits those most at risk! As a health care professional for 25 years the story I read above rings true on many levels. We often schedule health for the compromised/ at risk population from 9-5 ,not acknowledging this does not fit well with their way of life. Bravo on this article; and lets look at policy , procedure and organization of health so that it truley benefits those most at risk!

]]> By: kim Yi Dionne http://www.conversationsforabetterworld.com/2009/09/when-it-comes-to-tuberculosis-testing-isn%e2%80%99t-exactly-free/comment-page-1/#comment-502 kim Yi Dionne Wed, 16 Sep 2009 19:47:45 +0000 http://www.conversationsforabetterworld.com/?p=668#comment-502 I work with a group of researchers conducting a longitudinal study in rural Malawi. We collect demographic and health data, including results of an HIV test. More than 90% of respondents accepted HIV testing when offered in the comfort of their own home. Why not train the community health workers campaigning to increase TB testing to give TB screening tests? (Better yet, why not train them on how to ask the series of questions to determine whether the person is high risk before giving them a screening test?) My hunch is that Community Health Workers would welcome new training, an opportunity to be in the capital (or some other metropolitan location) for the duration of the training, and they are the ones who know best how to reach people in far-flung areas. I'm unfamiliar with the testing logistics for TB (perhaps there are supply chain issues, refrigeration requirements?), but when it comes to HIV testing, mobile door-to-door testing is welcomed by those who we would propose are the intended beneficiaries of such a public health intervention. I work with a group of researchers conducting a longitudinal study in rural Malawi. We collect demographic and health data, including results of an HIV test. More than 90% of respondents accepted HIV testing when offered in the comfort of their own home. Why not train the community health workers campaigning to increase TB testing to give TB screening tests? (Better yet, why not train them on how to ask the series of questions to determine whether the person is high risk before giving them a screening test?) My hunch is that Community Health Workers would welcome new training, an opportunity to be in the capital (or some other metropolitan location) for the duration of the training, and they are the ones who know best how to reach people in far-flung areas. I’m unfamiliar with the testing logistics for TB (perhaps there are supply chain issues, refrigeration requirements?), but when it comes to HIV testing, mobile door-to-door testing is welcomed by those who we would propose are the intended beneficiaries of such a public health intervention.

]]>