Feasibility and willingness-to-pay for integrated community-based tuberculosis testing.
Abstract
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.
Type
Journal articleSubject
AdultClinical Laboratory Techniques
Female
HIV Infections
Humans
Interferon-gamma Release Tests
Male
Middle Aged
Patient Acceptance of Health Care
Surveys and Questionnaires
Syphilis
Tuberculin Test
Tuberculosis
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https://hdl.handle.net/10161/13894Published Version (Please cite this version)
10.1186/1471-2334-11-305Publication Info
Goswami, 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Gary Matthew Cox
Professor of Medicine
Susanna Naggie
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
Jason Eric Stout
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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