Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

Andrade, Kaio Vinicius Freitas de; Nery, Joilda Silva; Souza, Ramon Andrade de; Pereira, Susan Martins

doi:10.1590/0102-311x00153116

Cited by 47 publications

(43 citation statements)

References 31 publications

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“…Conditional cash transfer; cash incentives; nutritional support; catastrophic expenditure; operational research; SORT IT Background Tuberculosis remains a leading infectious cause of mortality and morbidity globally, disproportionally affecting the poor, undernourished, vulnerable and marginalized populations [1,2]. This is witnessed by the low TB burden in countries with high social protection and vice-versa [3]. Evidence from several countries including India shows that TB causes catastrophic economic effects on the patients and their households [4][5][6][7][8][9][10].…”

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confidence: 99%

‘I am on treatment since 5 months but I have not received any money’: coverage, delays and implementation challenges of ‘Direct Benefit Transfer’ for tuberculosis patients – a mixed-methods study from South India

Nirgude

Kumar

Timire

et al. 2019

Global Health Action

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Background : In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India’s national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives : To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods : This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results : Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion : DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action.

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‘I am on treatment since 5 months but I have not received any money’: coverage, delays and implementation challenges of ‘Direct Benefit Transfer’ for tuberculosis patients – a mixed-methods study from South India

Nirgude

Kumar

Timire

et al. 2019

Global Health Action

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“…7 Worldwide, conditional cash transfer programmes, including the Brazilian Government's social welfare Programa Bolsa Família (family allowance programme; PBF) implemented in 2004, have benefitted recipient families by reducing poverty, 8 improving health-care use, 9,10 and increasing cure rates for chronic infections such as tuberculosis. [11][12][13][14][15] Although increased PBF coverage has been associated with reduced leprosy incidence in Brazilian municipalities, 16,17 the influence of conditional cash transfers on leprosy treatment patterns is unknown. We hypothesised that participation in the PBF has the potential to increase leprosy treatment adherence and cure by reducing the financial consequences of a leprosy diagnosis and strengthening the interaction of patients with health services (figure 1).…”

Section: Introductionmentioning

confidence: 99%

Effect of a conditional cash transfer programme on leprosy treatment adherence and cure in patients from the nationwide 100 Million Brazilian Cohort: a quasi-experimental study

Pescarini

Williamson

Nery

et al. 2020

The Lancet Infectious Diseases

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Background Indirect financial costs and barriers to health-care access might contribute to leprosy treatment nonadherence. We estimated the association of the Brazilian conditional cash transfer programme, the Programa Bolsa Família (PBF), on leprosy treatment adherence and cure in patients in Brazil. Methods In this quasi-experimental study, we linked baseline demographic and socioeconomic information for individuals who entered the 100 Million Brazilian Cohort between Jan 1, 2007, and Dec 31, 2014, with the PBF payroll database and the Information System for Notifiable Diseases, which includes nationwide leprosy registries. Individuals were eligible for inclusion if they had a household member older than 15 years and had not received PBF aid or been diagnosed with leprosy before entering the 100 Million Brazilian Cohort; they were excluded if they were partial receivers of PBF benefits, had missing data, or had a monthly per-capita income greater than BRL200 (US$50). Individuals who were PBF beneficiaries before leprosy diagnosis were matched to those who were not beneficiaries through propensityscore matching (1:1) with replacement on the basis of baseline covariates, including sex, age, race or ethnicity, education, work, income, place of residence, and household characteristics. We used logistic regression to assess the average treatment effect on the treated of receipt of PBF benefits on leprosy treatment adherence (six or more multidrug therapy doses for paucibacillary cases or 12 or more doses for multibacillary cases) and cure in individuals of all ages. We stratified our analysis according to operational disease classification (paucibacillary or multibacillary). We also did a subgroup analysis of paediatric leprosy restricted to children aged up to 15 years. Findings We included 11 456 new leprosy cases, of whom 8750 (76•3%) had received PBF before diagnosis and 2706 (23•6%) had not. Overall, 9508 (83•0%) patients adhered to treatment and 10 077 (88•0%) were cured. After propensity score matching, receiving PBF before diagnosis was associated with adherence to treatment (OR 1•22, 95% CI 1•01-1•48) and cure (1•26, 1•01-1•58). PBF receipt did not significantly improve treatment adherence (1•37, 0•98-1•91) or cure (1•12, 0•75-1•67) in patients with paucibacillary leprosy. For patients with multibacillary disease, PBF beneficiaries had better treatment adherence (1•37, 1•08-1•74) and cure (1•43, 1•09-1•90) than non-beneficiaries. In the propensity score-matched analysis in 2654 children younger than 15 years with leprosy, PBF exposure was not associated with leprosy treatment adherence (1•55, 0•89-2•68) or cure (1•57, 0•83-2•97). Interpretation Our results suggest that being a beneficiary of the PBF, which facilitates cash transfers and improved access to health care, is associated with greater leprosy multidrug therapy adherence and cure in multibacillary cases. These results are especially relevant for patients with multibacillary disease, who are treated for a longer period and have lower cure rates than...

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“…Although about 10 million new TB cases were reported in 2017, over a third of estimated TB cases are not yet detected globally. 1 Developing countries are highly affected by TB incidence, and deaths which might be related to high population growth, poor economy and nutrition, 2,3 low healthcare coverage and service quality [4][5][6][7][8] drug resistance and high comorbidities with HIV and diabetes mellitus. 1,[9][10][11][12] Similarly, TB is one of the top leading diseases claiming millions of lives in Ethiopia with varying magnitude across its regions.…”

Section: Introductionmentioning

confidence: 99%

<p>Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design</p>

Asemahagn¹,

Alene²,

Yimer³

2020

RRTM

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Background: Tuberculosis (TB) remains a foremost global public health threat. Active TB control needs geographically accessible health facilities that have quality diagnostics, equipment, supplies, medicines, and staff. Objective: This study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities for TB services in East Gojjam zone, Ethiopia. Methods: A convergent parallel design was applied using health facility and geographic data. Data on facility attributes, service availability and readiness were collected by inteviewing TB officers, laboratory heads and onsite facility visits. Coordinates of health facilities and kebele centroids were collected by GPS. We used ArcGIS 10.6 to measure Euclidean distance from each kebele centroids to the nearest health facility. Descriptive statistics were computed by using SPSS version 25. Barriers to TB service readiness were explored by in-depth interviews. NVivo12 was used to thematically analyze the qualitative data. Results: The overall TB health service coverage (THSC) was 23% (ranging: 10-85%). The mean distance from the nearest health facility was 8km (ranging: 0.5-16km). About 132 (32%) kebeles had poor geographic accessibility to TB services (over 10km distance from the nearest health facility) and had poor facility readiness. Although 114 (95%) health facilities offered at least one TB service, 44 (38.6%) of them had no sputum smear microscopy. The overall TB readiness index was 63.5%: first-line anti-TB drugs (97%), diagnostics (63%), trained staffs, diagnostic and treatment guidelines (53%) and laboratory supplies (41%). Lack of health workers (laboratory personnel), inadequate budget, poor management practice and TB program support, inadequate TB commodity suppliers, and less accessible geographic locations of health facilities were identified as barriers to TB service readiness distribution. Conclusion: Considerable proportion of the population in the study area have poor access to quality TB diagnostic services due to low THSC and poor facility readiness. Barriers to TB service availability and readiness were health system related. Regular refresher training of health workers on TB, creating mechanisms to attract laboratory personnel to work in the study area and scaling up of sputum smear microscopy services, establishing an efficient mechanism for procurement, distribution, utilization and reporting of TB commodity supplies, and good management practices are crucial to enhance TB service readiness in the study zone.

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Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

Cited by 47 publications

References 31 publications

‘I am on treatment since 5 months but I have not received any money’: coverage, delays and implementation challenges of ‘Direct Benefit Transfer’ for tuberculosis patients – a mixed-methods study from South India

‘I am on treatment since 5 months but I have not received any money’: coverage, delays and implementation challenges of ‘Direct Benefit Transfer’ for tuberculosis patients – a mixed-methods study from South India

Effect of a conditional cash transfer programme on leprosy treatment adherence and cure in patients from the nationwide 100 Million Brazilian Cohort: a quasi-experimental study

<p>Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design</p>

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