Abstract
BACKGROUND: The Democratic Republic of Congo´s free TB care policy and recent progress with universal health coverage are insufficient to remove barriers to TB care access and adherence. As there were no nationally representative data on the economic burden borne by TB patients, the TB programme conducted a national survey to assess the proportion of TB patients facing catastrophic costs, which could also serve as a baseline for monitoring progress.METHODS: A national survey with retrospective data collection and projection, following WHO methods, was administered to 1,118 patients in 43 treatment zones. Each patient was interviewed once on costs, time loss, coping measures, income, household expenditure and asset ownership. Total costs were expressed as a percentage of annual household expenditure.RESULTS: In 2019, 56.5% of households affected by TB experienced costs above 20% of their annual household expenditure. Mean costs amounted to respectively US$400 (range: 328-471) and US$1,224 (range: 762-1,686) per episode of first-line and drug-resistant TB. The risk of catastrophic costs increased with hospitalisation, drug resistance status and lower economic status. Half of households resorted to coping strategies and experienced food insecurity. Only 7.5% received social support.CONCLUSION: TB-affected households incur on average a cost of US$549, despite free TB care policy. Mitigating this burden with medical cost reductions, social and labour market measures will be key.