Cash transfers to enhance TB control: lessons from the HIV response

Rudgard, William E.; Carter, Daniel J; Scuffell, James; Cluver, Lucie; Fraser‐Hurt, Nicole; Boccia, Delia

doi:10.1186/s12889-018-5962-z

Cited by 9 publications

(10 citation statements)

References 49 publications

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“…Other studies have shown that the following subpopulations have an increased risk of TB incidence: prisoners (46), migrants (47), health care workers (48), miners (4), and contacts of indexed TB cases (49). Other studies have found that other protective factors against TB incidence include the use of IPT (13, 50), cash transfers (51), as well as early TB detection and treatment initiation (52).…”

Section: Discussionmentioning

confidence: 99%

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Mollel

Maokola

Todd

et al. 2019

Front. Public Health

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Background: HIV and tuberculosis (TB) are leading infectious diseases, with a high risk of co-infection. The risk of TB in people living with HIV (PLHIV) is high soon after sero-conversion and increases as the CD4 counts are depleted.Methodology: We used routinely collected data from Care and Treatment Clinics (CTCs) in three regions in northern Tanzania. All PLHIV attending CTCs between January 2012 to December 2017 were included in the analysis. TB incidence was defined as cases started on anti-TB medications divided by the person-years of follow-up. Poisson regression with frailty models were used to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for predictors of TB incidences among HIV positive patients.Results: Among 78,748 PLHIV, 405 patients developed TB over 195,296 person-years of follow-up, giving an overall TB incidence rate of 2.08 per 1,000 person-years. There was an increased risk of TB incidence, 3.35 per 1,000 person-years, in hospitals compared to lower level health facilities. Compared to CD4 counts of <350 cells/μl, a high CD4 count was associated with lower TB incidence, 81% lower for a CD4 count of 350–500 cells/μl (IRR 0.19, 95% CI 0.04–0.08) and 85% lower for those with a CD4 count above 500 cells/μl (IRR 0.15, 95% CI 0.04–0.64). Independently, those taking ART had 66% lower TB incidences (IRR 0.34, 95% CI 0.15–0.79) compared to those not taking ART. Poor nutritional status and CTC enrollment between 2008 and 2012 were associated with higher TB incidences IRR 9.27 (95% CI 2.15–39.95) and IRR 2.97 (95% CI 1.05–8.43), respectively.Discussion: There has been a decline in TB incidence since 2012, with exception of the year 2017 whereby there was higher TB incidence probably due to better diagnosis of TB following a national initiative. Among HIV positive patients attending CTCs, poor nutritional status, low CD4 counts and not taking ART treatment were associated with higher TB incidence, highlighting the need to get PLHIV on treatment early, and the need for close monitoring of CD4 counts. Data from routinely collected and available health services can be used to provide evidence of the epidemiological risk of TB.

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Section: Discussionmentioning

confidence: 99%

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Mollel

Maokola

Todd

et al. 2019

Front. Public Health

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“…The DBT may be in the form of conditional or unconditional transfers (cash/food). Evidence from South Africa 31,32 revealed that the HIV-risk has been reduced among adolescent girls and boys with the model of "cash plus care" (cash transfers with psychological support). A cross-sectional study in Cameroon found that financial barriers decrease ART adherence 33 .…”

Section: Recommendations and Policy Implicationsmentioning

confidence: 99%

Implementation of social protection schemes for people living with HIV in three districts of Rajasthan state, India – a mixed methods study

Gowthamghosh¹,

Huidrom

Arumugam

et al. 2020

F1000Res

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Background: In India, public social protection schemes for marginalized populations are extended to people living with HIV (PLHIV) and their households. Care and Support Centres (CSCs) linked to antiretroviral therapy (ART) centres play a key role in linking PLHIV to the schemes. In three districts of Rajasthan, India, we assessed the linkage of PLHIV registered at CSCs (2016–18) to social protection schemes and explored PLHIV and provider perspectives into barriers and suggested solutions for improving linkage. Methods: This was an explanatory mixed method study involving a descriptive quantitative phase using secondary data, followed by a descriptive qualitative phase involving face-to-face in-depth (five PLHIV) and key informant (three CSC staff) interviews. Results: Of 1123 registered PLHIV at CSCs, 1026 (91%) expressed willingness to avail social protection schemes. Of 1026, 94% were linked to any one scheme; 52% to Palanhar, 51% to bus fare concession and 42% to widow pension schemes. The perceived barriers were: authenticating Aadhaar number (unique identification number provided to all Indians using their registered mobile phone number), cumbersome application processes for each scheme, limited utility of travel concession, delayed and/or irregular disbursement of benefits and non-availability of comprehensive information, education and communication material with details of all schemes and their application processes. Reaching out to all PLHIV in the designated district was a huge task for outreach workers. Another important barrier was the potential disclosure of positive status to various stakeholders in order to avail the schemes. Suggested solutions were a single window default application process at ART centres with a smart card and a single pamphlet at ART centres with all the required details. Conclusions: Bus fare concession, Palanhar and widow pension schemes were the most widely accepted and linked schemes by PLHIV. Implementation barriers were identified that need to be addressed to improve the linkage.

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“…Studies from other countries indicate that conditional cash transfers (CCTs) have had some impact on HIV prevention (Bujara 2017;Rudgard et al 2018). In Kenya, for example, unconditional cash transfers for orphans and vulnerable children have been associated with reduced risk of early sexual debut.…”

Section: Hivmentioning

confidence: 99%

Risk and Prevention of Infectious Disease

Gupta¹,

Ramandeep²

2020

Handbook of Labor, Human Resources and Population Economics

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The standard reasons for market failure in the health sectorasymmetric information, moral hazard, externalities and public goods nature of a large number of health goods and services interventionsare central in the context of infectious diseases and make it imperative for governments to intervene to improve uptake of prevention services. Behavioral economics (BE) offers a framework to understand individual choices and preferences in the face of risk and uncertainty that might seem less than optimal from a public health perspective and make standard strategies ineffective to deal with the spread of infectious diseases. Globally, countries have attempted to incorporate innovative strategies that elicit behavior changes in their public health programs, and evidence exists to indicate what might have worked and how. This chapter reviews recent lessons from such experiences with prevention strategies that particularly focus on the behavioral dimensions of prevention for four diseases-HIV/AIDS, tuberculosis (TB), malaria, and diarrheal diseases, to

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Cash transfers to enhance TB control: lessons from the HIV response

Cited by 9 publications

References 49 publications

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

Implementation of social protection schemes for people living with HIV in three districts of Rajasthan state, India – a mixed methods study

Risk and Prevention of Infectious Disease

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