Feasibility and willingness-to-pay for integrated community-based tuberculosis testing.
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BACKGROUND: Community-based screening for TB, combined with HIV and syphilis testing, faces a number of barriers. One significant barrier is the value that target communities place on such screening. METHODS: Integrated testing for TB, HIV, and syphilis was performed in neighborhoods identified using geographic information systems-based disease mapping. TB testing included skin testing and interferon gamma release assays. Subjects completed a survey describing disease risk factors, healthcare access, healthcare utilization, and willingness to pay for integrated testing. RESULTS: Behavioral and social risk factors among the 113 subjects were prevalent (71% prior incarceration, 27% prior or current crack cocaine use, 35% homelessness), and only 38% had a regular healthcare provider. The initial 24 subjects reported that they would be willing to pay a median $20 (IQR: 0-100) for HIV testing and $10 (IQR: 0-100) for TB testing when the question was asked in an open-ended fashion, but when the question was changed to a multiple-choice format, the next 89 subjects reported that they would pay a median $5 for testing, and 23% reported that they would either not pay anything to get tested or would need to be paid $5 to get tested for TB, HIV, or syphilis. Among persons who received tuberculin skin testing, only 14/78 (18%) participants returned to have their skin tests read. Only 14/109 (13%) persons who underwent HIV testing returned to receive their HIV results. CONCLUSION: The relatively high-risk persons screened in this community outreach study placed low value on testing. Reported willingness to pay for such testing, while low, likely overestimated the true willingness to pay. Successful TB, HIV, and syphilis integrated testing programs in high risk populations will likely require one-visit diagnostic testing and incentives.
Clinical Laboratory Techniques
Interferon-gamma Release Tests
Patient Acceptance of Health Care
Surveys and Questionnaires
Published Version (Please cite this version)10.1186/1471-2334-11-305
Publication InfoGoswami, Neela D; Hecker, Emily; Holland, David P; Naggie, Susanna; Cox, Gary M; Mosher, Ann; ... Stout, Jason E (2011). Feasibility and willingness-to-pay for integrated community-based tuberculosis testing. BMC Infect Dis, 11. pp. 305. 10.1186/1471-2334-11-305. Retrieved from https://hdl.handle.net/10161/13894.
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Professor of Medicine
Associate Professor of Medicine
Dr. Susanna Naggie completed her medical education at Johns Hopkins School of Medicine and her internal medicine training at Duke University Medical Center (DUMC), where she also served as a Chief Resident in Internal Medicine. She completed her Infectious Diseases (ID) fellowship training at Duke and then joined the faculty in the Division of ID. She is an Associate Professor of Medicine with Tenure and currently holds joint appointments at the Duke Clinical Research Institute (DCRI, D
Professor of Medicine
My research focuses on the epidemiology, natural history, and treatment of tuberculosis and nontuberculous mycobacterial infections. I am also interested in the impact of HIV infection on mycobacterial infection and disease, and in examining health disparities as they relate to infectious diseases, particularly in immigrant populations.
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