Evaluation of a social protection policy on tuberculosis treatment outcomes: A prospective cohort study

Abstract

Background Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. Methods and findings Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs’ characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. Conclusions The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.

Towards TB elimination: how are macro-level factors perceived and addressed in policy initiatives in a high burden country?

“…This added further evidence to previous predictive modelling that demonstrated that global TB incidence would be reduced by 84•3% if poverty were eliminated; and implementation of social protection measures alone would reduce tuberculosis incidence by 76•1% [7]. Various recent studies have indeed shown that cash transfers to patients with TB might improve treatment outcomes [8][9][10][11].…”

Risk and Prevention of Infectious Disease

“…A similar study in Argentina also indicated that those registered for the CCT program had a significant and positive effect on treatment adherence after controlling for socioeconomic and demographic variables (Klein et al 2019).…”

Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy

“…The consideration of societal topics should be better addressed in the education of sleep and respiratory physicians. Additionally, studies are needed to investigate the impact of health policy interventions on PAP adherence, as has been done for medications in vulnerable populations (34).…”