Abstract
ObjectiveTo assess cash transfer interventions for improving treatment outcomes of active pulmonary tuberculosis in low- and middle-income countries.MethodsWe searched PubMed®, Embase®, Cochrane Library and ClinicalTrials.gov for studies published until 4 August 2017 that reported on cash transfer interventions during the treatment of active pulmonary tuberculosis in low- and middle-income countries. Our primary outcome was a positive clinical outcome, defined as treatment success, treatment completion or microbiologic cure. Using the purchasing power parity conversion factor, we converted the amount of cash received per patient within each study into international dollars (Int$). We calculated odds ratio (OR) for the primary outcome using a random effects meta-analysis.FindingsEight studies met eligibility criteria for review inclusion. Seven studies assessed a tuberculosis-specific intervention, with average amount of cash ranging from Int$ 193–858. One study assessed a tuberculosis-sensitive intervention, with average amount of Int$ 101. Four studies included non-cash co-interventions. All studies showed better primary outcome for the intervention group than the control group. After excluding three studies with high risk of bias, patients receiving tuberculosis-specific cash transfer were more likely to have a positive clinical outcome than patients in the control groups (OR: 1.77; 95% confidence interval: 1.57–2.01).ConclusionThe evidence available suggests that patients in low- and middle-income countries receiving cash during treatment for active pulmonary tuberculosis are more likely to have a positive clinical outcome. These findings support the incorporation of cash transfer interventions into social protection schemes within tuberculosis treatment programmes.
Highlights
Tuberculosis remains one of the top 10 causes of death worldwide, with the highest burden of disease in low- and middle-income countries.[1]
The single tuberculosis-sensitive intervention we identified provided cash equivalent to 3.8% of estimated annual individual income
None of the interventions we identified had a completely unconditional cash transfer intervention
Summary
Tuberculosis remains one of the top 10 causes of death worldwide, with the highest burden of disease in low- and middle-income countries.[1]. In 2015, the World Health Organization’s (WHO’s) End TB Strategy set the goal of a 90% reduction in tuberculosis deaths, an 80% reduction in tuberculosis incidence rate and zero catastrophic costs for tuberculosis-affected families by 2030.3 These goals explicitly acknowledge the need to both directly treat people infected with the disease and address social determinants of health to improve tuberculosis outcomes. Social protection policies protect individuals or households during periods when they are unable to financially support themselves because of a range of conditions, such as illness or disability.[4] Cash transfer interventions, defined as cash payments provided to selected beneficiaries by formal institutions, are one form of social protection that has been proposed in the setting of tuberculosis.[5,6] Such interventions can either be tuberculosis-specific or tuberculosis-sensitive.[6] Tuberculosis-specific interventions target directly tuberculosis patients and their households, and are typically incorporated into existing tuberculosis treatment programmes.[6] A tuberculosis-sensitive intervention is part of a broader social protection scheme, potentially affecting tuberculosis outcomes by targeting communities and groups that are at high risk for tuberculosis. The effect on health outcomes, cost–effectiveness and feasibility of these two strategies are not well established and likely to vary based on the local social protection and health-care infrastructure
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