Abstract
BackgroundTackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy. However, evidence informing policies are still scarce. Mathematical modelling has the potential to contribute to fill this knowledge gap, but existing models are inadequate. The S-PROTECT consortium aimed to develop an innovative mathematical modelling approach to better understand the role of social protection to improve TB care, prevention and control.MethodsS-PROTECT used a three-steps approach: 1) the development of a conceptual framework; 2) the extraction from this framework of three high-priority mechanistic pathways amenable for modelling; 3) the development of a revised version of a standard TB transmission model able to capture the structure of these pathways. As a test case we used the Bolsa Familia Programme (BFP), the Brazilian conditional cash transfer scheme.ResultsAssessing one of these pathways, we estimated that BFP can reduce TB prevalence by 4% by improving households income and thus their nutritional status. When looking at the direct impact via malnutrition (not income mediated) the impact was 33%. This variation was due to limited data availability, uncertainties on data transformation and the pathway approach taken. These results are preliminary and only aim to serve as illustrative example of the methodological challenges encountered in this first modelling attempt, nonetheless they suggest the potential added value of integrating TB standard of care with social protection strategies.ConclusionsResults are to be confirmed with further analysis. However, by developing a generalizable modelling framework, S-PROTECT proved that the modelling of social protection is complex, but doable and allowed to draw the research road map for the future in this field.
Highlights
Tackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy
The S-PROTECT (Social PROTection to Enhance the Control of Tuberculosis) consortium was created to respond to these challenges: we developed a combined conceptual-quantitative modelling framework through which existing empirical data could be used to inform estimates of the effect of Cash Transfer Intervention (CTI) on TB control
Critical steps in the development of this tool included: a) advancing a theory-based conceptual framework describing the mechanism through which social protection might affect TB outcomes and translating this conceptual framework into a simplified version suitable for modelling purposes; b) using a modified Delphi process to rank mechanistic pathways within this conceptual framework that would be most suitable for incorporation into a mathematical model. c) developing a mathematical model best reflecting the structure of these pathways
Summary
Tackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy. The S-PROTECT consortium aimed to develop an innovative mathematical modelling approach to better understand the role of social protection to improve TB care, prevention and control. No sustainable health or development goal can be achieved without a truly multisectoral approach. Social protection, which sits at the intersection between health and social interventions, can contribute to Social protection has been defined as a wide range of policies to move people out of extreme poverty and achieve sustainable inclusion and economic growth [3]. Cash transfers interventions (CTIs), whether conditional or unconditional, have become some of the most popular forms of social protection approaches [4] and they are the main focus of this paper. CTIs are increasingly regarded as a potentially powerful tool to enhance TB prevention (by allowing better resilience to TB infection and disease that result from improved material living conditions); TB care (by enabling better and more timely access to quality TB care); and TB support (by mitigating the TB-related catastrophic costs)
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