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Original article Evaluation of the accessibility and its equity of the national public-private mix (PPM) program for tuberculosis in South Korea: a multilevel analysis
Hyunjin Son1,3orcid , Changhoon Kim2,3orcid
Epidemiol Health 2022;e2023002
DOI: https://doi.org/10.4178/epih.e2023002 [Accepted]
Published online: December 7, 2022
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1Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea
2Department of Preventive Medicine, College of Medicine, Pusan National University, Busan, Korea
3Busan Center for infectious Disease Control and Prevention, Pusan National University Hospital, Busan, Korea
Corresponding author:  Changhoon Kim,
Email: kchprev@gmail.com
Received: 21 October 2022   • Revised: 29 November 2022   • Accepted: 7 December 2022

Objectives
To examine the effect of area and individual level characteristics on the probability of getting the support for TB treatment by PPM program (PPM coverage) in the early stage of the program.
Methods
A retrospective cohort study based on the national TB notification data in South Korea. 137,865 drug-susceptible new TB patients were followed up. Odds ratios (ORs) of PPM support and PPM coverage were estimated through multilevel logistic regression and empirical Bayesian estimation according to individual, area, and cross level.
Results
The case of 0-29 years old age group, female, Korean nationality, treatment at a general hospital, and a one-time notified were higher for ORs of PPM support. Urbanicity and less deprivation showed a higher PPM coverage. Due to the cross-level interaction, PPM coverage in the urban areas (slope=-0.048, p0.001) was higher but steeper negative deprivation gradient than in rural areas (slope=-0.015, p0.001), and only negative deprivation gradient at general hospital (slope=-0.047, p0.001) according to healthcare facility. In the rural areas. PPM coverage also has a negative deprivation gradient at general hospital (slope=-0.031, p0.001) but a positive deprivation gradient at hospitals and clinics (respectively, 0.046(p0.001), 0.063(p0.001)). Nevertheless, the PPM coverage level in rural areas was generally lower than in urban areas.
Conclusions
The PPM program had created a large disparity in PPM coverage between urban-rural areas and type of healthcare facility according to deprivation. Considering the high risk of tuberculosis incidence in regions with higher deprivation, institutional improvement and program redesign is needed to improve accessibility and its equity.


Epidemiol Health : Epidemiology and Health