Cost and Effectiveness Evaluation of the Telecare System Strategy for People with Tuberculosis

• Grant number: 23/01879-8
• Support Opportunities: Regular Research Grants
• Start date: October 01, 2023
• End date: September 30, 2025
• Field of knowledge: Health Sciences - Nursing - Public Health Nursing
• Principal Investigator: Ione Carvalho Pinto
• Grantee: Ione Carvalho Pinto
• Host Institution: Escola de Enfermagem de Ribeirão Preto (EERP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
• Associated researchers: Alexandre Favero Bulgarelli ; Aline Aparecida Monroe ; Dulce Maria de Oliveira Gomes ; Fabiana Costa Machado Zacharias ; Jaqueline Garcia de Almeida Ballestero ; Luciana Aparecida Fabriz ; Maria Del Pilar Serrano Gallardo ; Maria Fernandez Elorriaga ; Pedro Fredemir Palha ; Ricardo Alexandre Arcêncio ; Rubia Laine de Paula Andrade ; Tatiele Estefani Schonholzer
• Associated scholarship(s): 24/17881-4 - Cost and Effectiveness Evaluation of the Telecare System Strategy for People with Tuberculosis, BP.TT; 23/15557-2 - Cost and Effectiveness Evaluation of the Telecare System Strategy for People with Tuberculosis, BP.TT

Abstract

Although Brazil has made significant progress in recent decades in the control of tuberculosis (TB), which in a way signaled the achievement of the World Health Organization's (WHO) End-TB strategy of eliminating the disease by 2035 (less than one case per 100,000 population), with the pandemic of COVID-19, and its consequences, we have observed setbacks in this epidemiological evolution. A great impact has been felt in the health system regarding TB control actions, especially in the monitoring of cases, due to the reduction or complete suspension of visits within the strategy of Directly Observed Treatment (DOT). Faced with the challenge, new forms of monitoring and support for people on TB treatment have been envisioned to ensure that DOT is sustained and available throughout the country. The purpose of the study is to evaluate the cost and effectiveness of the Telecare System for People with Tuberculosis (VDOT) strategy, regarding accessibility and treatment, compared to conventional DOT-C treatment. This is an evaluative study, of the convergent parallel mixed method type, carried out in health units in the city of Ribeirão Preto, with the VDOT implemented. People diagnosed with TB will be identified based on the records of the Health Department of the municipality by data from the TbWeb platform and interviewed. In the health units, the groups of people diagnosed with TB will be followed up according to the DOT-C and VDOT treatment modalities. Inclusion criteria for both study groups (DOT-C and VDOT) will be people diagnosed with sensitive TB who started treatment in 2023, according to the criteria defined by the Ministry of Health, and aged 18 years or older. Managers and health professionals directly involved in the monitoring and treatment of people diagnosed with TB (nurses, nursing technicians and assistants, doctors, health visitors, and other related professionals) will also be interviewed. We will include those professionals who have been working for more than 6 months in the follow-up of DOT-C and/or VDOT and who are not on vacation or away from their activities during data collection. The interviews will be recorded with prior authorization from the participants and the audio recordings will be transcribed verbatim, preserving the reliability of the information. The literal transcription of the interviews will be consolidated through a first reading of the transcribed material and the insertion of phrases or words recorded by the researchers, as the speeches call attention. Thematic analysis will be used. To identify the costs related to the DOT-C and VDOT strategies; and to estimate the health service costs, the ABC - Activity Based Costing system technique will be used, building a mapping of the processes for each strategy, by means of interviews. In the sequence, the specific instruments for data collection will be elaborated, and the costs will be analyzed through descriptive statistics, generalized linear models, as well as other statistical methodologies that fit the nature and purpose of the collected data. The development of the project will make it possible to expand the scope of studies focused on the cost and effectiveness of strategies for the treatment of people diagnosed with TB, anchored in the perspective of health evaluation, especially from the point of view of social impact, involving the production of theoretical and operational knowledge that will allow reflections and interventions in the decision-making of managers and professionals. (AU)