Abstract
Tuberculosis (TB) is a poverty infectious disease that affects millions of people worldwide. Evidences suggest that social protection strategies (SPS) can improve TB treatment outcomes. This study aimed to synthesize such evidences through systematic literature review and meta-analysis. We searched for studies conducted in low- or middle-income and in high TB-burden countries, published during 1995-2016. The review was performed by searching PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and LILACS. We included only studies that investigated the effects of SPS on TB treatment outcomes. We retained 25 studies for qualitative synthesis. Meta-analyses were performed with 9 randomized controlled trials, including a total of 1,687 participants. Pooled results showed that SPS was associated with TB treatment success (RR = 1.09; 95%CI: 1.03-1.14), cure of TB patients (RR = 1.11; 95%CI: 1.01-1.22) and with reduction in risk of TB treatment default (RR = 0.63; 95%CI: 0.45-0.89). We did not detect effects of SPS on the outcomes treatment failure and death. These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease. However, the overall quality of evidences regarding these effect estimates is low and further well-conducted randomized studies are needed.
Highlights
Tuberculosis (TB) is still considered a major global health problem, mainly in socially vulnerable population groups living in low- and middle-income countries 1
Following the reporting guidelines recommended in PRISMA statement 12, we conducted a systematic review to identify studies that have investigated the effects of Social protection strategies (SPS) on TB treatment outcomes
161 abstracts of the selected titles were independently screened by the same reviewers, retaining 40 articles for full-text review
Summary
Tuberculosis (TB) is still considered a major global health problem, mainly in socially vulnerable population groups living in low- and middle-income countries 1. According to the United Nations Sustainable Development Goals (2016-2030), the World Health Organization (WHO) set a 2030 target of 90% reduction in deaths, 80% decline in TB incidence and zero TB-affected families facing catastrophic costs because of this disease [3,4,5]. In low-income countries, approximately 17% of TB-deaths affect the economically productive age group of [15-49] years 6. In those countries, investments in prevention, diagnostics and treatment should consider social protection and urban planning interventions in order to improve access to TB care and treatment adherence [7,8]
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