Effects of financial incentives for treatment supporters on tuberculosis treatment outcomes in Swaziland: a pragmatic interventional study.

Merav Kliner,John Walley,Mamvura Canaan,John Wright,Fred Busulwa,William Welfare,Sifiso Zwide Ndwandwe,Marty Richardson

doi:10.1186/s40249-015-0059-8

Abstract

BackgroundSwaziland has the highest national incidence of tuberculosis (TB) in the world, with treatment success rates well below the 85 % international target. Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy. This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland.MethodsThis was a controlled study that compared treatment outcomes for patients with a treatment supporter who received or did not receive a financial incentive.ResultsThe intervention group had a higher chance of treatment success as compared with the control group: 73 % (95 % confidence intervals [CIs] 66–80 %) versus 60 % (95 % CIs 57–64 %), respectively, p = 0.003. This improvement remained significant when treatment success rates were adjusted for differences in baseline characteristics, with the effect of incentivised treatment supporters on treatment outcomes having an odds ratio (OR) of 1.8. There was also a significant improvement in the death rate in the intervention group, as compared with the control group (10.6 versus 23.5 %, p = <0.001).ConclusionIncentives provided to TB treatment supporters appear to significantly improve TB treatment outcomes. Incentivising treatment support may be appropriate as an effective addition to support and supervision measures (199 words).Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0059-8) contains supplementary material, which is available to authorized users.

Highlights

Swaziland has the highest national incidence of tuberculosis (TB) in the world, with treatment success rates well below the 85 % international target
This study presents the findings from the Good Shepherd Hospital (GSH) TB Programme, the Community-based organisation (CBO) supporting the largest number of patients in the multi-centre study
There were no statistical differences for age and gender between the two groups, but they did differ in Human immunodeficiency virus (HIV) status, with the intervention group having a lower proportion of patients with co-infection (77.4 versus 68.9 %, p = 0.021)

Summary

Introduction

Swaziland has the highest national incidence of tuberculosis (TB) in the world, with treatment success rates well below the 85 % international target. Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy. This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland. The Stop TB Strategy places a significant emphasis on patient support and supervision as part of the comprehensive TB services, including directly observed therapy (DOT) [1]. A 2011 Cochrane Review of randomised controlled trials (RCTs) investigating the impact of material incentives in the investigation or treatment of TB, identified 11. A controlled before-and-after study of rural-to-urban migrants in China found a significant increase in treatment completion in those receiving financial incentives [8]. No studies were identified that focused on incentives been given to treatment supporters rather than directly to the patients

Methods

Results

Discussion

Conclusion