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Jeyashree K, Shanmugasundaram P, Shanmugasundaram D, Priya G SL, Thangaraj JWV, Ts S, Pandey S, Ramasamy S, Sharma R, Arunachalam S, Shah V, Janagaraj V, Sundari S S, Chadwick J, Shewade HD, Chowdhury A, Iyer S, Rao R, Mattoo SK, Murhekar MV. Direct benefit transfer for nutritional support of patients with TB in India-analysis of national TB program data of 3.7 million patients, 2018-2022. BMC Public Health 2024; 24:299. [PMID: 38273246 PMCID: PMC10811802 DOI: 10.1186/s12889-024-17777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Patients with TB have additional nutritional requirements and thus additional costs to the household. Ni-kshay Poshan Yojana(NPY) is a Direct Benefit Transfer (DBT) scheme under the National Tuberculosis Elimination Programme(NTEP) in India which offers INR 500 monthly to all notified patients with TB for nutritional support during the period of anti-TB treatment. Five years after its implementation, we conducted the first nationwide evaluation of NPY. METHODS In our retrospective cohort study using programmatic data of patients notified with TB in nine randomly selected Indian states between 2018 and 2022, we estimated the proportion of patients who received at least one NPY instalment and the median time to receive the first instalment. We determined the factors associated (i) with non-receipt of NPY using a generalised linear model with Poisson family and log link and (ii) with time taken to receive first NPY benefit in 2022 using quantile regression at 50th percentile. RESULTS Overall, 3,712,551 patients were notified between 2018 and 2022. During this period, the proportion who received at least one NPY instalment had increased from 56.9% to 76.1%. Non-receipt was significantly higher among patients notified by private sector (aRR 2.10;2.08,2.12), reactive for HIV (aRR 1.69;1.64,1.74) and with missing/undetermined diabetic status (aRR 2.02;1.98,2.05). The median(IQR) time to receive the first instalment had reduced from 200(109,331) days in 2018 to 91(51,149) days in 2022. Patients from private sector(106.9;106.3,107.4days), those with HIV-reactive (103.7;101.8,105.7days), DRTB(104.6;102.6,106.7days) and missing/undetermined diabetic status (115.3;114,116.6days) experienced longer delays. CONCLUSIONS The coverage of NPY among patients with TB had increased and the time to receipt of benefit had halved in the past five years. Three-fourths of the patients received at least one NPY instalment, more than half of whom had waited over three months to receive the first instalment. NTEP has to focus on timely transfer of benefits to enable patients to meet their additional nutritional demands, experience treatment success and avoid catastrophic expenditure.
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Affiliation(s)
- Kathiresan Jeyashree
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India.
| | - Prema Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Devika Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sri Lakshmi Priya G
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Jeromie W V Thangaraj
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumitha Ts
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumit Pandey
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sabarinathan Ramasamy
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Rahul Sharma
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Vaibhav Shah
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Sivakami Sundari S
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Joshua Chadwick
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Hemant Deepak Shewade
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Aniket Chowdhury
- TB support network, WHO Country Office for India, New Delhi, India
| | - Swati Iyer
- TB support network, WHO Country Office for India, New Delhi, India
| | | | | | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
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Bosma CB, Toromo JJ, Ayers MJ, Foster ED, McHenry M, Enane LA. Effects of economic interventions on pediatric and adolescent HIV care outcomes: a systematic review. AIDS Care 2024; 36:1-16. [PMID: 37607246 PMCID: PMC10843852 DOI: 10.1080/09540121.2023.2240071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023]
Abstract
Economic insecurity and poverty present major barriers to HIV care for young people. We conducted a systematic review of the current evidence for the effect of economic interventions on HIV care outcomes among pediatric populations encompassing young children, adolescents, and youth (ages 0-24). We conducted a search of PubMed MEDLINE, Cochrane, Embase, Scopus, CINAHL, and Global Health databases on October 12, 2022 using a search strategy curated by a medical librarian. Studies included economic interventions targeting participants <25 years in age which measured clinical HIV outcomes. Study characteristics, care outcomes, and quality were independently assessed, and findings were synthesized. Title/abstract screening was performed for 1934 unique records. Thirteen studies met inclusion criteria, reporting on nine distinct interventions. Economic interventions included incentives (n = 5), savings and lending programs (n = 3), and government cash transfers (n = 1). Study designs included three randomized controlled trials, an observational cohort study, a matched retrospective cohort study, and pilot intervention studies. While evidence is very limited, some promising findings were observed supporting retention and viral suppression, particularly for those with suboptimal care engagement or with detectable viral load. There is a need to further study and optimize economic interventions for children and adolescents living with HIV.
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Affiliation(s)
- Christopher B. Bosma
- Departments of Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Judith J. Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Morgan J. Ayers
- Departments of Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erin D. Foster
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, USA
- Berkeley Library, University of California Berkeley, Berkeley, California, USA
| | - Megan McHenry
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Global Health Equity, Indianapolis, IN, USA
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Global Health Equity, Indianapolis, IN, USA
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Forse R, Nguyen TT, Dam T, Vo LNQ, Codlin AJ, Caws M, Minh HDT, Nguyen LH, Nguyen HB, Nguyen NV, Lönnroth K, Annerstedt KS. A qualitative assessment on the acceptability of providing cash transfers and social health insurance for tuberculosis-affected families in Ho Chi Minh City, Vietnam. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002439. [PMID: 38055709 DOI: 10.1371/journal.pgph.0002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/09/2023] [Indexed: 12/08/2023]
Abstract
To achieve the Sustainable Development Goal's targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general population has enrolled in its social health insurance (SHI) scheme. However, an estimated 63% of tuberculosis (TB)-affected households in Vietnam still face catastrophic costs and little is known about the optimal strategies to mitigate the costs of TB care for vulnerable families. This study assessed the acceptability of a social protection package containing cash transfers and SHI using individual interviews (n = 19) and focus group discussions (n = 3 groups). Interviews were analyzed through framework analysis. The study's main finding indicated that both conditional and unconditional cash transfers paired with SHI were acceptable, across six dimensions of acceptability. Cash transfers were considered beneficial for mitigating out-of-pocket expenditure, increasing TB treatment adherence, and improving mental health and general well-being, but the value provided was inadequate to fully alleviate the economic burden of the illness. The conditionality of the cash transfers was not viewed by participants as inappropriate, but it increased the workload of the TB program, which brought into question the feasibility of scale-up. SHI was viewed as a necessity by almost all participants, but people with TB questioned the quality of care received when utilizing it for auxiliary TB services. Access to multiple sources of social protection was deemed necessary to fully offset the costs of TB care. Additional research is needed to assess the impact of cash transfer interventions on health and economic outcomes in order to create an enabling policy environment for scale-up.
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Affiliation(s)
- Rachel Forse
- Friends for International TB Relief, Hanoi, Vietnam
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | | | - Thu Dam
- Friends for International TB Relief, Hanoi, Vietnam
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Hanoi, Vietnam
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | - Andrew James Codlin
- Friends for International TB Relief, Hanoi, Vietnam
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Hoa Binh Nguyen
- National Lung Hospital/National TB Control Programme, Hanoi, Vietnam
| | - Nhung Viet Nguyen
- National Lung Hospital/National TB Control Programme, Hanoi, Vietnam
- University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, WHO Collaboration Centre on Tuberculosis and Social Medicine, Stockholm, Sweden
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Sillah AK, Devoid I, Ndenkeh JJ, Moonga G, Loum I, Touray A, Owolabi O, Sutherland J, Rachow A, Ivanova O, Evans D, Kampmann B. Socio-economic burden of TB and its impact on child contacts in The Gambia. Public Health Action 2023; 13:130-135. [PMID: 38077726 PMCID: PMC10703137 DOI: 10.5588/pha.23.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/17/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. METHODS This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. RESULTS While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001). CONCLUSION Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.
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Affiliation(s)
- A K Sillah
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - I Devoid
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - J J Ndenkeh
- Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - G Moonga
- Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - I Loum
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - A Touray
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - O Owolabi
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - J Sutherland
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B Kampmann
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Charité Centre for Global Health, Charité Universitatsmedizin-Berlin, Berlin, Germany
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Treloar C, Beadman K, Beadman M, Smith KA, Christian J, Jackson AC, Tyson B, Anderson C, Smyth L, Walker M, Heslop J, Gahan G, Tawil V, Sheaves F, Maher L, Page J, Tilley D, Ryan A, Grant K, Donovan B, Stevens A, Slattery T, Pearce K, John-Leader F, Walden A, Lenton J, Crowley M, Cama E. Evaluating a complex health promotion program to reduce hepatitis C among Aboriginal and Torres Strait Islander peoples in New South Wales, Australia: the Deadly Liver Mob. Harm Reduct J 2023; 20:153. [PMID: 37864234 PMCID: PMC10588051 DOI: 10.1186/s12954-023-00885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians, and was introduced in response to the disproportionate number of Aboriginal and Torres Strait Islander Australians who are impacted by blood borne viruses (BBVs) and sexually transmitted infections (STIs). The goal of the program is to increase access to BBV and STI education, screening, treatment, and vaccination in recognition and response to the systemic barriers that Aboriginal and Torres Strait Islander peoples face in accessing health care. This commentary introduces a series of papers that report on various aspects of the evaluation of the Deadly Liver Mob (DLM) program. In this paper, we explain what DLM is and how we constructed an evaluation framework for this complex health promotion intervention.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Kerri-Anne Smith
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Sydney, NSW, 2770, Australia
| | - Jade Christian
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Aunty Clair Jackson
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Beverley Tyson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Clayton Anderson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Larissa Smyth
- Byron Central Hospital, Mid North Coast and Northern NSW Local Health District, Byron Bay, NSW, 2481, Australia
| | - Melinda Walker
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Jennifer Heslop
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Gary Gahan
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, NSW, 1340, Australia
| | - Victor Tawil
- Centre for Population Health, Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Felicity Sheaves
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Louise Maher
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Julie Page
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Donna Tilley
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, 2150, Australia
| | - Ann Ryan
- HIV & Related Programs (HARP) Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kim Grant
- HIV & Related Programs (HARP) Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Annabelle Stevens
- Centre for Population Health, Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Trevor Slattery
- HIV & Related Programs (HARP) Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kate Pearce
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Sydney, NSW, 2770, Australia
| | - Franklin John-Leader
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Andrew Walden
- Needle and Syringe Program, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Jo Lenton
- Broken Hill Community Centre, Far West Local Health District, Broken Hill, NSW, 2880, Australia
| | - Margaret Crowley
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Elena Cama
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
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Smith I, Forse R, Sidney Annerstedt K, Thanh NT, Nguyen L, Phan THY, Nguyen H, Codlin A, Vo LNQ, Nguyen NTT, Khan A, Creswell J, Pham Huy M, Basu L, Lönnroth K, Nguyen BH, Nguyen VN, Atkins S. What matters most? A qualitative study exploring priorities for supportive interventions for people with tuberculosis in urban Viet Nam. BMJ Open 2023; 13:e076076. [PMID: 37612116 PMCID: PMC10450053 DOI: 10.1136/bmjopen-2023-076076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The health and economic burden of tuberculosis (TB) in urban Viet Nam is high. Social protection and support interventions can improve treatment outcomes and reduce costs. However, evidence regarding optimal strategies in this context is lacking. This study aimed to increase understanding of what people with TB and healthcare providers (HCPs) perceive as important to improve TB treatment outcomes and reduce costs. METHODS We conducted qualitative focus group discussions (seven groups, n=30) and key informant interviews (n=4) with people with drug-susceptible and multidrug-resistant TB and HCPs in Ha Noi and Ho Chi Minh City. Topic guides covered perspectives on and prioritisation of different forms of social protection and support. Data were analysed using reflexive thematic analysis and interpreted using a Framework for Transformative Social Protection. RESULTS We identified three themes and seven subthemes. The first theme, 'Existing financial safety nets are essential, but could go further to support people affected by TB', highlights that support to meet the medical costs of TB treatment and flexible cash transfers are a priority for people with TB and HCPs. The second, 'It is important to promote "physical and spiritual health" during TB treatment', demonstrates that extended psychosocial and nutritional support would encourage people with TB during their treatment. The third, 'Accessibility and acceptability are critical in designing social support interventions for people with TB', shows the importance of ensuring that support is accessible and proportional to the needs of people with TB and their families. CONCLUSIONS Accessible interventions that incorporate financial risk protection, nutritional and psychosocial support matter most to people with TB and HCPs in urban Viet Nam to improve their treatment outcomes and reduce catastrophic costs. This study can inform the design of stronger person-centred interventions to advance progress towards the goals of the WHO's End TB Strategy.
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Affiliation(s)
- Isabel Smith
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
| | - Rachel Forse
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
- Friends for International TB Relief, Ha Noi, Viet Nam
| | - Kristi Sidney Annerstedt
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
| | - Nguyen Thi Thanh
- Centre for Development of Community Health Initiatives, Ha Noi, Viet Nam
| | | | - Thi Hoang Yen Phan
- Centre for Development of Community Health Initiatives, Ha Noi, Viet Nam
| | - Han Nguyen
- Friends for International TB Relief, Ha Noi, Viet Nam
| | - Andrew Codlin
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
- Friends for International TB Relief, Ha Noi, Viet Nam
| | - Luan Nguyen Quang Vo
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | - Amera Khan
- Stop TB Partnership, Geneva, Switzerland
| | | | | | | | - Knut Lönnroth
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
| | - Binh Hoa Nguyen
- National TB Program, National Lung Hospital, Ha Noi, Viet Nam
| | | | - Salla Atkins
- Department of Global Public Health Sciences, WHO Collaborating Centre for Social Medicine and Tuberculosis, Karolinska Institutet, Stockholm, Sweden
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Todd H, Hudson M, Grolmusova N, Kazibwe J, Pearman J, Skender K, Tran PB, Boccia D, Shete PB, Wingfield T. Social Protection Interventions for TB-Affected Households: A Scoping Review. Am J Trop Med Hyg 2023; 108:650-659. [PMID: 36806490 PMCID: PMC10076998 DOI: 10.4269/ajtmh.22-0470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/28/2022] [Indexed: 02/22/2023] Open
Abstract
Tuberculosis (TB) and poverty are inextricably linked. Catastrophic costs of TB illness drive TB-affected households into worsening impoverishment and hamper treatment success. The WHO's End TB Strategy recommends social protection for TB-affected households to mitigate financial shock and improve TB outcomes. This scoping review maps the landscape of social protection interventions for people with TB and their households in low- and middle-income countries with high TB burden. A systematic search of Medline, Embase, PubMed, and Web of Science for relevant articles was performed, supplemented with a gray literature search of key databases. Articles were included if they described social protection available to people with TB and TB-affected households in a low- or middle-income country. Data were synthesized in tabular form, and descriptive narrative outlined the successes and challenges of the social protection interventions identified. The search identified 33,360 articles. After abstract screening, 74 articles underwent full text screening, and 49 were included in the final analysis. Forty-three types of social protection were identified, of which 24 were TB specific (i.e., only people with TB were eligible). Varying definitions were used to describe similar social protection interventions, which limited cross-study comparison. Intervention successes included acceptability and increased financial autonomy among recipients. Challenges included delays in intervention delivery and unexpected additional bank transfer fees. A wide range of acceptable social protection interventions are available, with cash transfer schemes predominating. Use of standardized definitions of social protection interventions would facilitate consolidation of evidence and enhance design and implementation in future.
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Affiliation(s)
- Heather Todd
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mollie Hudson
- School of Nursing, University of California San Francisco, San Francisco, California
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Natalia Grolmusova
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joseph Kazibwe
- London School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Joseph Pearman
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kristina Skender
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Phuong B. Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Delia Boccia
- London School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
| | - Priya B. Shete
- Center for Tuberculosis University of California, San Francisco, San Francisco, California
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, California
| | - Tom Wingfield
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Hanrahan CF, Nonyane BAS, Lebina L, Mmolawa L, Siwelana T, West NS, Albaugh N, Martinson N, Dowdy DW. Household- Versus Incentive-Based Contact Investigation for Tuberculosis in Rural South Africa: A Cluster-Randomized Trial. Clin Infect Dis 2023; 76:1164-1172. [PMID: 36458857 PMCID: PMC10319771 DOI: 10.1093/cid/ciac920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Household contact investigation for people newly diagnosed with tuberculosis (TB) is poorly implemented, particularly in low- and middle-income countries. Conditional cash incentives may improve uptake. METHODS We conducted a pragmatic, cluster-randomized, crossover trial of 2 TB contact investigation approaches (household-based and incentive-based) in 28 public primary care clinics in South Africa. Each clinic used 1 approach for 18 months, followed by a 6-month washout period, after which the opposite approach was used. Fourteen clinics were randomized to each approach. In the household-based arm, we conducted TB screening and testing of contacts at the household. In the incentive-based arm, both index patients and ≤10 of their close contacts (either within or outside the household) were given small cash incentives for presenting to study clinics for TB screening. The primary outcome was the number of people with incident TB who were diagnosed and started on treatment at study clinics. RESULTS From July 2016 to January 2020, we randomized 28 clinics to each study arm, and enrolled 782 index TB patients and 1882 contacts in the household-based arm and 780 index patients and 1940 contacts in the incentive-based arm. A total of 1413 individuals started on TB treatment in the household-based arm and 1510 in the incentive-based arm. The adjusted incidence rate ratio of TB treatment initiation in the incentive- versus household-based arms was 1.05 (95% confidence interval: .97-1.13). CONCLUSIONS Incentive-based contact investigation for TB has similar effectiveness to traditional household-based approaches and may be a viable alternative or complementary approach to household-based investigation.
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Affiliation(s)
- Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bareng Aletta Sanny Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lesego Mmolawa
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, South Africa
| | - Tsundzukani Siwelana
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, South Africa
| | - Nora S West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas Albaugh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neil Martinson
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Diepkloof, Soweto, South Africa
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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9
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Aia P, Viney K, Kal M, Kisomb J, Yasi R, Wangchuk LZ, Islam T, Jadambaa N, Rehan R, Nishikori N, Labelle S, Ershova J. The economic burden of TB faced by patients and affected families in Papua New Guinea. Int J Tuberc Lung Dis 2022; 26:934-941. [PMID: 36163675 PMCID: PMC11285074 DOI: 10.5588/ijtld.21.0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The costs associated with TB disease can be catastrophic for patients, affecting health and socioeconomic outcomes. Papua New Guinea (PNG) is a high TB burden country and the costs associated with TB are unknown.METHODS We undertook a national survey of TB patients to determine the magnitude of costs associated with TB in PNG, the proportion of households with catastrophic costs and cost drivers. We used a cluster sampling approach and recruited TB patients from health facilities. Descriptive statistics were used to analyse the costs and cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs.RESULTS We interviewed 1,000 TB patients; 19 (1.9%) of them had multidrug-resistant TB (MDR-TB). Costs due to TB were attributable to income loss (64.4%), non-medical (29.9%) and medical (5.7%) expenses. Catastrophic costs were experienced by 33.9% (95% CI 31.0-36.9) of households and were associated with MDR-TB (aOR 4.47, 95% CI 1.21-16.50), hospitalization (aOR 3.94, 95% CI 2.69-5.77), being in the poorest (aOR 3.52, 95% CI 2.43-5.10) or middle wealth tertiles (aOR 1.51, 95% CI 1.03-2.21) or being employed (aOR 2.02, 95% CI 1.43-2.89).CONCLUSION The costs due to TB disease were catastrophic for one third of TB-affected households in PNG. Current support measures could be continued, while new cost mitigation interventions may be considered where needed.
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Affiliation(s)
- P Aia
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | - K Viney
- The Karolinska Institutet, Stockholm, Sweden, Australian National University, Canberra ACT, Australia, Global TB Programme, World Health Organization (WHO), Geneva, Switzerland
| | - M Kal
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | - J Kisomb
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | - R Yasi
- National TB Control Programme, National Department of Health, Port Moresby, Papua New Guinea
| | | | - T Islam
- WHO Regional Office for the Western Pacific, Manila, The Philippines
| | - N Jadambaa
- WHO Papua New Guinea Country Office, Port Moresby, Papua New Guinea
| | - R Rehan
- WHO Papua New Guinea Country Office, Port Moresby, Papua New Guinea
| | - N Nishikori
- Global TB Programme, World Health Organization (WHO), Geneva, Switzerland
| | - S Labelle
- Global TB Programme, World Health Organization (WHO), Geneva, Switzerland
| | - J Ershova
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Vassall A, Sweeney S, Barasa E, Prinja S, Keogh-Brown MR, Tarp Jensen H, Smith R, Baltussen R, M Eggo R, Jit M. Integrating economic and health evidence to inform Covid-19 policy in low- and middle- income countries. Wellcome Open Res 2022; 5:272. [PMID: 36081645 PMCID: PMC9433912 DOI: 10.12688/wellcomeopenres.16380.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Covid-19 requires policy makers to consider evidence on both population health and economic welfare. Over the last two decades, the field of health economics has developed a range of analytical approaches and contributed to the institutionalisation of processes to employ economic evidence in health policy. We present a discussion outlining how these approaches and processes need to be applied more widely to inform Covid-19 policy; highlighting where they may need to be adapted conceptually and methodologically, and providing examples of work to date. We focus on the evidential and policy needs of low- and middle-income countries; where there is an urgent need for evidence to navigate the policy trade-offs between health and economic well-being posed by the Covid-19 pandemic.
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Affiliation(s)
- Anna Vassall
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Sedona Sweeney
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Kenya and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marcus R Keogh-Brown
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Henning Tarp Jensen
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rob Baltussen
- Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - Rosalind M Eggo
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
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11
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Wanahari TA, Bakhriansyah M, Haryati H, Rudiansyah M, Isa M, Djallalluddin D, Prenggono MD. Socioeconomic Determinants of Tuberculosis Cases in Indonesia, 2010–2013: An Ecological Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Indonesia encounters a serious issue of disparity in tuberculosis cases among provinces. These disparities are crucial since they may reflect a macro-level factor that could be modified to further reduce the cases. Some factors are identified contributing to this variation, including socioeconomic determinants.
AIM: This study investigated whether these socioeconomic determinants (i.e., poverty, unemployment, income inequality, and low education) can predict the variation of tuberculosis cases across provinces in Indonesia.
METHODS: We conducted an ecological analysis by using public-use data files of the Annual Indonesian Health Profile Report and The Indonesian Social and Population Profile Report consisting of data from 33 provinces, 2010–2013. The main outcome measures were province-level tuberculosis notification cases for all form of tuberculosis cases and new smear-positive cases. The correlation between socioeconomic determinants and tuberculosis notification cases was analyzed with bivariate analyses and multivariate linear regression analyses.
RESULTS: This study showed that poverty was strongly and positively correlated with tuberculosis notification cases, either all form or new smear-positive cases. Unemployment was also positively correlated with tuberculosis notification cases, but the power was lower. In contrast, income inequality and low education level were not statistically correlated with tuberculosis notification cases. In multivariate linear regression analyses, poverty is the strongest predictor for tuberculosis notification cases. Poverty had a bigger impact than unemployment in the increased tuberculosis notification cases.
CONCLUSION: Findings from this study suggest that poverty has a profound influence on the variation for tuberculosis notification cases across provinces in Indonesia.
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12
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Vanleeuw L, Zembe-Mkabile W, Atkins S. "I'm suffering for food": Food insecurity and access to social protection for TB patients and their households in Cape Town, South Africa. PLoS One 2022; 17:e0266356. [PMID: 35472210 PMCID: PMC9041827 DOI: 10.1371/journal.pone.0266356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major health concern and the number one cause of death in South Africa. Social protection programmes can strengthen the resilience of TB patients, their families and households. This study aimed to get a better understanding of the role of social protection and other forms of support in relation to the burden of TB on patients and their households in South Africa. METHODS This is a cross-sectional exploratory qualitative study using a phenomenological approach to focus on the lived experiences and perceptions of TB patients and healthcare workers. We interviewed 16 patients and six healthcare workers and analysed data thematically. RESULTS The challenges faced by participants were closely related to household challenges. Participants reported a heavy physical burden, aggravated by a lack of nutritious food and that households could not provide the food they needed. Some needed to resort to charity. At the same time, households were significantly affected by the burden of caring for the patient-and remained the main source of financial, emotional and physical support. Participants reported challenges and costs associated with the application process and high levels of discretion by the assessing doctor allowing doctors' opinions and beliefs to influence their assessment. CONCLUSION Access to adequate nutritious food was a key issue for many patients and this need strained already stretched households and budgets. Few participants reported obtaining state social protection support during their illness, but many reported challenges and high costs of trying to access it. Further research should be conducted on support mechanisms and interventions for TB patients, but also their households, including food support, social protection and contact tracing. In deciding eligibility for grants, the situation of the household should be considered in addition to the individual patient.
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Affiliation(s)
- Lieve Vanleeuw
- Health Systems Research unit, South African Medical Research Council, Tygerberg, South Africa
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Wanga Zembe-Mkabile
- Health Systems Research unit, South African Medical Research Council, Tygerberg, South Africa
- Archie Mafeje Social Policy Research Institute, School of Transdisciplinary Research and Graduate, Studies, University of South Africa, Pretoria, South Africa
| | - Salla Atkins
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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13
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Pega F, Pabayo R, Benny C, Lee EY, Lhachimi SK, Liu SY. Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries. Cochrane Database Syst Rev 2022; 3:CD011135. [PMID: 35348196 PMCID: PMC8962215 DOI: 10.1002/14651858.cd011135.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age, or HIV infection) are a social protection intervention addressing a key social determinant of health (income) in low- and middle-income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided only if recipients follow prescribed behaviours, e.g. use a health service or attend school) is unknown. OBJECTIVES To assess the effects of UCTs on health services use and health outcomes in children and adults in LMICs. Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure, and to compare the effects of UCTs versus CCTs. SEARCH METHODS For this update, we searched 15 electronic academic databases, including CENTRAL, MEDLINE and EconLit, in September 2021. We also searched four electronic grey literature databases, websites of key organisations and reference lists of previous systematic reviews, key journals and included study records. SELECTION CRITERIA We included both parallel-group and cluster-randomised controlled trials (C-RCTs), quasi-RCTs, cohort studies, controlled before-and-after studies (CBAs), and interrupted time series studies of UCT interventions in children (0 to 17 years) and adults (≥ 18 years) in LMICs. Comparison groups received either no UCT, a smaller UCT or a CCT. Our primary outcomes were any health services use or health outcome. DATA COLLECTION AND ANALYSIS Two review authors independently screened potentially relevant records for inclusion, extracted data and assessed the risk of bias. We obtained missing data from study authors if feasible. For C-RCTs, we generally calculated risk ratios for dichotomous outcomes from crude frequency measures in approximately correct analyses. Meta-analyses applied the inverse variance or Mantel-Haenszel method using a random-effects model. Where meta-analysis was impossible, we synthesised results using vote counting based on effect direction. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 34 studies (25 studies of 20 C-RCTs, six CBAs, and three cohort studies) involving 1,140,385 participants (45,538 children, 1,094,847 adults) and 50,095 households in Africa, the Americas and South-East Asia in our meta-analyses and narrative syntheses. These analysed 29 independent data sets. The 24 UCTs identified, including one basic universal income intervention, were pilot or established government programmes or research experiments. The cash value was equivalent to 1.3% to 81.9% of the annualised gross domestic product per capita. All studies compared a UCT with no UCT; three studies also compared a UCT with a CCT. Most studies carried an overall high risk of bias (i.e. often selection or performance bias, or both). Most studies were funded by national governments or international organisations, or both. Throughout the review, we use the words 'probably' to indicate moderate-certainty evidence, 'may/maybe' for low-certainty evidence, and 'uncertain' for very low-certainty evidence. Health services use We assumed greater use of any health services to be beneficial. UCTs may not have impacted the likelihood of having used any health service in the previous 1 to 12 months, when participants were followed up between 12 and 24 months into the intervention (risk ratio (RR) 1.04, 95% confidence interval (CI) 1.00 to 1.09; I2 = 2%; 5 C-RCTs, 4972 participants; low-certainty evidence). Health outcomes At one to two years, UCTs probably led to a clinically meaningful, very large reduction in the likelihood of having had any illness in the previous two weeks to three months (RR 0.79, 95% CI 0.67 to 0.92; I2 = 53%; 6 C-RCTs, 9367 participants; moderate-certainty evidence). UCTs may have increased the likelihood of having been food secure over the previous month, at 13 to 36 months into the intervention (RR 1.25, 95% CI 1.09 to 1.45; I2 = 85%; 5 C-RCTs, 2687 participants; low-certainty evidence). UCTs may have increased participants' level of dietary diversity over the previous week, when assessed with the Household Dietary Diversity Score and followed up 24 months into the intervention (mean difference (MD) 0.59 food categories, 95% CI 0.18 to 1.01; I2 = 79%; 4 C-RCTs, 9347 participants; low-certainty evidence). Despite several studies providing relevant evidence, the effects of UCTs on the likelihood of being moderately stunted and on the level of depression remain uncertain. We found no study on the effect of UCTs on mortality risk. Social determinants of health UCTs probably led to a clinically meaningful, moderate increase in the likelihood of currently attending school, when assessed at 12 to 24 months into the intervention (RR 1.06, 95% CI 1.04 to 1.09; I2 = 0%; 8 C-RCTs, 7136 participants; moderate-certainty evidence). UCTs may have reduced the likelihood of households being extremely poor, at 12 to 36 months into the intervention (RR 0.92, 95% CI 0.87 to 0.97; I2 = 63%; 6 C-RCTs, 3805 participants; low-certainty evidence). The evidence was uncertain for whether UCTs impacted livestock ownership, participation in labour, and parenting quality. Healthcare expenditure Evidence from eight cluster-RCTs on healthcare expenditure was too inconsistent to be combined in a meta-analysis, but it suggested that UCTs may have increased the amount of money spent on health care at 7 to 36 months into the intervention (low-certainty evidence). Equity, harms and comparison with CCTs The effects of UCTs on health equity (or unfair and remedial health inequalities) were very uncertain. We did not identify any harms from UCTs. Three cluster-RCTs compared UCTs versus CCTs with regard to the likelihood of having used any health services or had any illness, or the level of dietary diversity, but evidence was limited to one study per outcome and was very uncertain for all three. AUTHORS' CONCLUSIONS This body of evidence suggests that unconditional cash transfers (UCTs) may not impact a summary measure of health service use in children and adults in LMICs. However, UCTs probably or may improve some health outcomes (i.e. the likelihood of having had any illness, the likelihood of having been food secure, and the level of dietary diversity), two social determinants of health (i.e. the likelihoods of attending school and being extremely poor), and healthcare expenditure. The evidence on the relative effectiveness of UCTs and CCTs remains very uncertain.
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Affiliation(s)
- Frank Pega
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Claire Benny
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Eun-Young Lee
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Stefan K Lhachimi
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Sze Yan Liu
- Public Health, Montclair State University, Montclair, NJ, USA
- Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA
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14
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Hayward SE, Deal A, Rustage K, Nellums LB, Sweetland AC, Boccia D, Hargreaves S, Friedland JS. The relationship between mental health and risk of active tuberculosis: a systematic review. BMJ Open 2022; 12:e048945. [PMID: 34992103 PMCID: PMC8739435 DOI: 10.1136/bmjopen-2021-048945] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) and mental illnesses are highly prevalent globally and often coexist. While poor mental health is known to modulate immune function, whether mental disorders play a causal role in TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and public health measures. DESIGN Systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. SEARCH STRATEGY AND SELECTION CRITERIA MEDLINE, PsycINFO and PsycEXTRA databases were searched alongside reference list and citation searching. Inclusion criteria were original research studies published 1 January 1970-11 May 2020 reporting data on the association between mental health and TB risk. DATA EXTRACTION, APPRAISAL AND SYNTHESIS Data were extracted on study design and setting, sample characteristics, measurement of mental illness and TB, and outcomes including effect size or prevalence. Studies were critically appraised using Critical Appraisal Skills Programme (CASP) and Appraisal Tool for Cross-Sectional Studies (AXIS) checklists. RESULTS 1546 records published over 50 years were screened, resulting in 10 studies included reporting data from 607 184 individuals. Studies span across Asia, South America and Africa, and include mood and psychotic disorders. There is robust evidence from cohort studies in Asia demonstrating that depression and schizophrenia can increase risk of active TB, with effect estimates ranging from HR=1.15 (95% CI 1.03 to 1.28) to 2.63 (95% CI 1.74 to 3.96) for depression and HR=1.52 (95% CI 1.29 to 1.79) to RR=3.04 for schizophrenia. These data align with evidence from cross-sectional studies, for example, a large survey across low-income and middle-income countries (n=242 952) reports OR=3.68 (95% CI 3.01 to 4.50) for a depressive episode in those with TB symptoms versus those without. CONCLUSIONS Individuals with mental illnesses including depression and schizophrenia experience increased TB incidence and represent a high-risk population to target for screening and treatment. Integrated care for mental health and TB is needed, and interventions tackling mental illnesses and underlying drivers may help reduce TB incidence globally. PROSPERO REGISTRATION NUMBER CRD42019158071.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kieran Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Laura B Nellums
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Annika C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Delia Boccia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Jon S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
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15
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Darnton-Hill I, Mandal PP, de Silva A, Bhatia V, Sharma M. Opportunities to prevent and manage undernutrition to amplify efforts to end TB. Int J Tuberc Lung Dis 2022; 26:6-11. [PMID: 34969422 PMCID: PMC8734190 DOI: 10.5588/ijtld.21.0488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The bidirectional relationship between TB and nutrition is well recognized - primary undernutrition is a risk factor for developing TB disease, while TB results in wasting. Although nutrition support is acknowledged as an important intervention in TB programmes, it is seldom afforded commensurate priority for action. TB incidence and deaths worldwide are falling too slowly to meet WHO End TB Strategy milestones, and the number of undernourished people is increasing, likely to be further exacerbated by the ongoing COVID-19 pandemic. Undernutrition needs to be more urgently and intensively addressed. This is especially true for the WHO South-East Asia Region, where the high rates of undernutrition are a key driver of the TB epidemic. The evidence base has been sufficiently robust for clear and workable programmatic guidance to be formulated on assessment, counselling and interventions for TB patients. Many high-burden countries have developed policies addressing TB and nutrition. Gaps in research to date have frustrated the development of more refined programmatic approaches related to addressing TB and malnutrition. Future research can be shaped to inform targeted, actionable policies and programmes delivering dual benefits in terms of undernutrition and TB. There are clear opportunities for policy-makers to amplify efforts to end TB by addressing undernutrition.
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Affiliation(s)
- I Darnton-Hill
- The Boden Collaboration on Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia
| | - P P Mandal
- Tuberculosis Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - A de Silva
- Nutrition and Health for Development Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - V Bhatia
- Tuberculosis Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - M Sharma
- Tuberculosis Unit, World Health Organization Regional Office for South-East Asia, New Delhi, India
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16
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Varshney K, Anaele B, Molaei M, Frasso R, Maio V. Risk Factors for Poor Outcomes Among Patients with Extensively Drug-Resistant Tuberculosis (XDR-TB): A Scoping Review. Infect Drug Resist 2021; 14:5429-5448. [PMID: 34938089 PMCID: PMC8687707 DOI: 10.2147/idr.s339972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
In recent years, there has been an upsurge in cases of drug-resistant TB, and strains of TB resistant to all forms of treatment have begun to emerge; the highest level of resistance is classified as extensively drug-resistant tuberculosis (XDR-TB). There is an urgent need to prevent poor outcomes (death/default/failed treatment) of XDR-TB, and knowing the risk factors can inform such efforts. The objective of this scoping review was to therefore identify risk factors for poor outcomes among XDR-TB patients. We searched three scientific databases, PubMed, Scopus, and ProQuest, and identified 25 articles that examined relevant risk factors. Across the included studies, the proportion of patients with poor outcomes ranged from 8.6 to 88.7%. We found that the most commonly reported risk factor for patients with XDR-TB developing poor outcomes was having a history of TB. Other risk factors were human immunodeficiency virus (HIV), a history of incarceration, low body mass, being a smoker, alcohol use, unemployment, being male, and being middle-aged. Knowledge and understanding of the risk factors associated with poor outcomes of XDR-TB can help policy makers and organizations in the process of designing and implementing effective programs.
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Affiliation(s)
- Karan Varshney
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Beverly Anaele
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Molaei
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vittorio Maio
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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17
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Nidoi J, Muttamba W, Walusimbi S, Imoko JF, Lochoro P, Ictho J, Mugenyi L, Sekibira R, Turyahabwe S, Byaruhanga R, Putoto G, Villa S, Raviglione MC, Kirenga B. Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study. BMC Public Health 2021; 21:2167. [PMID: 34836521 PMCID: PMC8620143 DOI: 10.1186/s12889-021-12056-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. METHODS We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. RESULTS A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. CONCLUSIONS This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
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Affiliation(s)
- Jasper Nidoi
- Makerere University Lung Institute (MLI), Kampala, Uganda.
| | | | | | - Joseph F Imoko
- Makerere University Lung Institute (MLI), Kampala, Uganda
| | | | | | | | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | - Raymond Byaruhanga
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | | | - Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Bruce Kirenga
- Makerere University Lung Institute (MLI), Kampala, Uganda
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Viney K, Itogo N, Yamanaka T, Jebeniani R, Hazarika A, Morishita F, Nishikiori N, Nery SV. Economic evaluation of patient costs associated with tuberculosis diagnosis and care in Solomon Islands. BMC Public Health 2021; 21:1928. [PMID: 34688266 PMCID: PMC8542301 DOI: 10.1186/s12889-021-11938-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) care can be costly for patients and their families. The End TB Strategy includes a target that zero TB affected households should experience catastrophic costs associated with TB care. Costs are catastrophic when a patient spends 20% or more of their annual household income on their TB diagnosis and care. In Solomon Islands the costs of TB care are unknown. The aim of this study was to determine the costs of TB diagnosis and care, the types of costs and the proportion of patients with catastrophic costs. METHODS This was a nationally representative cross-sectional survey of TB patients carried out between 2017 and 2019. Patients were recruited from health care facilities, from all ten provinces in Solomon Islands. During an interview they were asked about the costs of TB diagnosis and care. These data were analysed using descriptive statistics to describe the costs overall and the proportions of different types of costs. The proportion of patients with catastrophic costs was calculated and a multivariate logistic regression was undertaken to determine factors associated with catastrophic costs. RESULTS One hundred and eighty-three TB patients participated in the survey. They spent a mean of 716 USD (inter quartile range: 348-1217 USD) on their TB diagnosis and care. Overall, 62.1% of costs were attributable to non-medical costs, while income loss and medical costs comprised 28.5 and 9.4%, respectively. Overall, 19.7% (n = 36) of patients used savings, borrowed money, or sold assets as a financial coping mechanism. Three patients (1.6%) had health insurance. A total of 92.3% (95% CI: 88.5-96.2) experienced catastrophic costs, using the output approach. Being in the first, second or third poorest wealth quintile was significantly associated with catastrophic costs (adjusted odds ratio: 67.3, 95% CI: 15.86-489.74%, p < 0.001). CONCLUSION The costs of TB care are catastrophic for almost all patients in Solomon Islands. The provision of TB specific social and financial protection measures from the National TB and Leprosy Programme may be needed in the short term to ameliorate these costs. In the longer term, advancement of universal health coverage and other social and financial protection measures should be pursued.
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Affiliation(s)
- Kerri Viney
- Research School of Population Health, Australian National University, Canberra, Australia.
- Global TB Programme, World Health Organization Headquarters, Geneva, Switzerland.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Noel Itogo
- National TB Programme, Ministry of Health and Medical Services, Honiara, Solomon Islands
- World Health Organization Country Office, Honiara, Solomon Islands
| | - Takuya Yamanaka
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Anupama Hazarika
- World Health Organization Country Office, Honiara, Solomon Islands
| | - Fukushi Morishita
- End TB and Leprosy Unit, World Health Organization Regional Office of the Western Pacific, Manila, Philippines
| | - Nobuyuki Nishikiori
- Global TB Programme, World Health Organization Headquarters, Geneva, Switzerland
| | - Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
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Kianersi S, Jules R, Zhang Y, Luetke M, Rosenberg M. Associations between hurricane exposure, food insecurity, and microfinance; a cross-sectional study in Haiti. WORLD DEVELOPMENT 2021; 145:105530. [PMID: 34177044 PMCID: PMC8224831 DOI: 10.1016/j.worlddev.2021.105530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Natural disaster and food insecurity are prevalent in Haiti. Natural disasters may cause long-term food insecurity. Microfinance programs may provide resilience against this outcome. The objectives of this study were 1) to assess the association between the impact of Hurricane Matthew and long-term food insecurity and 2) to understand whether this association varies by participants' membership in a microfinance program. In 2017-2018, we interviewed 304 Haitian female microfinance clients. We used log-binomial regression to evaluate the association between hurricane Matthew impact and long-term food insecurity, with evaluation of effect modification by timing of microfinance exposure. We found that one year after the hurricane, participants who were severely impacted by the hurricane were more likely to report poor dietary diversity and moderate to severe household hunger, compared to the less severely impacted participants. Both associations became insignificant among those who received their first microfinance loan before the hurricane. Natural disasters like hurricanes are associated with long-term food insecurity at individual and household levels. Microfinance programs might improve post-hurricane long-term food security.
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Affiliation(s)
- Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
| | | | - Yijia Zhang
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
| | - Maya Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
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Bustos M, Luu K, Lau LL, Dodd W. Addressing tuberculosis through complex community-based socioeconomic interventions in low- and middle-income countries: A systematic realist review. Glob Public Health 2021; 17:1924-1944. [PMID: 34403306 DOI: 10.1080/17441692.2021.1966487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The established relationship between poverty and tuberculosis has led to the implementation of complex socioeconomic interventions to address poverty as both a risk factor for and consequence of tuberculosis. However, limited research to date has examined the conditions that facilitate the successful implementation of these interventions. We conducted a systematic realist review to examine how complex socioeconomic interventions for tuberculosis treatment and care were defined, implemented, and evaluated in low- and middle-income countries. We used a systematic search to identify published work that implemented complex socioeconomic interventions for tuberculosis, followed by a realist analysis informed by existing programme theories. From a total of 2825 collected records, 36 peer-reviewed articles and 17 grey literature reports were included in this review. The realist analysis identified three main contexts (sociopolitical and cultural; relational and interpersonal; operational and administrative) and ten mechanisms that facilitated successful implementation of interventions. Overall, this review highlights the importance of political commitment in shaping sustainable programme delivery, the role of healthcare and community-based provider training in creating patient-centred treatment environments, and the opportunity to leverage operational research for evidence-based decision making to address the socioeconomic needs of tuberculosis patients experiencing poverty.
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Affiliation(s)
- Monica Bustos
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kathy Luu
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.,International Care Ministries, Manila, Philippines.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Vassall A, Sweeney S, Barasa E, Prinja S, Keogh-Brown MR, Tarp Jensen H, Smith R, Baltussen R, M Eggo R, Jit M. Integrating economic and health evidence to inform Covid-19 policy in low- and middle- income countries. Wellcome Open Res 2020; 5:272. [PMID: 36081645 PMCID: PMC9433912 DOI: 10.12688/wellcomeopenres.16380.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 09/04/2024] Open
Abstract
Covid-19 requires policy makers to consider evidence on both population health and economic welfare. Over the last two decades, the field of health economics has developed a range of analytical approaches and contributed to the institutionalisation of processes to employ economic evidence in health policy. We present a discussion outlining how these approaches and processes need to be applied more widely to inform Covid-19 policy; highlighting where they may need to be adapted conceptually and methodologically, and providing examples of work to date. We focus on the evidential and policy needs of low- and middle-income countries; where there is an urgent need for evidence to navigate the policy trade-offs between health and economic well-being posed by the Covid-19 pandemic.
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Affiliation(s)
- Anna Vassall
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Sedona Sweeney
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Kenya and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marcus R Keogh-Brown
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
| | - Henning Tarp Jensen
- Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London, UK
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rob Baltussen
- Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - Rosalind M Eggo
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK
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Wen S, Yin J, Sun Q. Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMJ Open 2020; 10:e036985. [PMID: 33033087 PMCID: PMC7545632 DOI: 10.1136/bmjopen-2020-036985] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB). DESIGN We searched Pubmed, Web of Science, Embase, Scopus and Medline databases until 18 June 2020 for interventional or mixed-method studies which reported social support and treatment outcomes of DR-TB patients. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. Random-effects meta-analysis was performed to calculate the OR and 95% CI for the effects of social support on the improvement of treatment outcomes and the heterogeneity and risk of bias were assessed. SETTING Low-income and middle-income countries. PARTICIPANTS DR-TB patients. OUTCOMES Treatment success is defined as the combination of the cured and treatment completion, and LTFU is measured as treatment being interrupted for two consecutive months or more. RESULTS Among 173 articles selected for full-text review, 162 were excluded through independent review (kappa=0.87) and 10 studies enrolling 1621 DR-TB patients in eight countries were included for qualitative analysis. In these studies, the most frequently introduced social support was material support (10 studies), followed by informational (eight studies), emotional (seven studies) and companionship support (four studies). Seven studies that reported treatment outcomes in both intervention arm and control arm are qualified for meta-analysis. An encouraging improvement on treatment success rate (OR: 2.58; 95% CI: 1.80 to 3.69) was found when material support was integrated into social support packages and no heterogeneity was observed (I1 of 0%, Q test p=0.72). Reduction on LTFU rate (OR: 0.17; 95% CI: 0.05 to 0.55) was also noted when material support was available but substantial heterogeneity was found (I2 of 80%, Q test p=0.002). CONCLUSION Material support appeared feasible and effective to improve treatment success for DR-TB patients combined with other social support interventions. PROSPERO REGISTRATION NUMBER CRD42019140824.
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Affiliation(s)
- Shuqin Wen
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Jia Yin
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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Developing Feasible, Locally Appropriate Socioeconomic Support for TB-Affected Households in Nepal. Trop Med Infect Dis 2020; 5:tropicalmed5020098. [PMID: 32532101 PMCID: PMC7345977 DOI: 10.3390/tropicalmed5020098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
Tuberculosis (TB), the leading single infectious diseases killer globally, is driven by poverty. Conversely, having TB worsens impoverishment. During TB illness, lost income and out-of-pocket costs can become “catastrophic”, leading patients to abandon treatment, develop drug-resistance, and die. WHO’s 2015 End TB Strategy recommends eliminating catastrophic costs and providing socioeconomic support for TB-affected people. However, there is negligible evidence to guide the design and implementation of such socioeconomic support, especially in low-income, TB-endemic countries. A national, multi-sectoral workshop was held in Kathmandu, Nepal, on the 11th and 12th September 2019, to develop a shortlist of feasible, locally appropriate socioeconomic support interventions for TB-affected households in Nepal, a low-income country with significant TB burden. The workshop brought together key stakeholders in Nepal including from the Ministry of Health and Population, Department of Health Services, Provincial Health Directorate, Health Offices, National TB Program (NTP); and TB/Leprosy Officers, healthcare workers, community health volunteers, TB-affected people, and external development partners (EDP). During the workshop, participants reviewed current Nepal NTP data and strategy, discussed the preliminary results of a mixed-methods study of the socioeconomic determinants and consequences of TB in Nepal, described existing and potential socioeconomic interventions for TB-affected households in Nepal, and selected the most promising interventions for future randomized controlled trial evaluations in Nepal. This report describes the activities, outcomes, and recommendations from the workshop.
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24
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Hayward SE, Dowd JB, Fletcher H, Nellums LB, Wurie F, Boccia D. A systematic review of the impact of psychosocial factors on immunity: Implications for enhancing BCG response against tuberculosis. SSM Popul Health 2020; 10:100522. [PMID: 31909166 PMCID: PMC6939020 DOI: 10.1016/j.ssmph.2019.100522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains an urgent global public health priority, causing 1.5 million deaths worldwide in 2018. There is evidence that psychosocial factors modulate immune function; however, how this may influence TB risk or BCG vaccine response, and whether this pathway can be modified through social protection, has not been investigated. This paper aims to: a) systematically review evidence of how psychosocial factors influence the expression of biomarkers of immunity, and b) apply this general evidence to propose plausible TB-specific pathways for future study. METHODS Papers reporting on the impact of psychosocial stressors on immune biomarkers in relation to infectious disease risk were identified through a search of the databases MEDLINE, PsycINFO, Global Health and PsycEXTRA alongside reference list and citation searching of key papers. Data extraction and critical appraisal were carried out using a standardised form. The findings were tabulated and synthesised narratively by infectious disease category, and used to propose plausible mechanisms for how psychosocial exposures might influence immune outcomes relevant to TB and BCG response. RESULTS 27,026 citations were identified, of which 51 met the inclusion criteria. The literature provides evidence of a relationship between psychosocial factors and immune biomarkers. While the direction and strength of associations is heterogenous, some overarching patterns emerged: adverse psychosocial factors (e.g. stress) were generally associated with compromised vaccine response and higher antibody titres to herpesviruses, and vice versa for positive psychosocial factors (e.g. social support). CONCLUSIONS The evidence identifies pathways linking psychosocial factors and immune response: co-viral infection and immune suppression, both of which are potentially relevant to TB and BCG response. However, the heterogeneity in the strength and nature of the impact of psychosocial factors on immune function, and lack of research on the implications of this relationship for TB, underscore the need for TB-specific research.
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Affiliation(s)
- Sally E. Hayward
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Institute of Infection & Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Jennifer B. Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, 42-43 Park End Street, Oxford, OX1 1JD, UK
| | - Helen Fletcher
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laura B. Nellums
- Institute of Infection & Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Fatima Wurie
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Delia Boccia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Pelissari DM, Diaz-Quijano FA. Impact of incarceration on tuberculosis incidence and its interaction with income distribution inequality in Brazil. Trans R Soc Trop Med Hyg 2020; 114:23-30. [PMID: 31667507 DOI: 10.1093/trstmh/trz088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/24/2019] [Accepted: 08/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deteriorated conditions in the non-prison population can lead to an approximation of its tuberculosis (TB) risk to that in the prison population. We evaluated the association between incarceration and TB incidence rate and its interaction with population income distribution inequality in Brazilian municipalities (2013-2015). METHODS We included 954 municipalities with at least one prison. Interaction between the Gini coefficient and prison exposure was analysed in a multiple regression model. We estimated the fraction of TB in the population attributable fraction (PAF) to exposure to prisons according the Gini coefficient. RESULTS Compared with the non-prison population, the prisoners had 22.07 times (95% confidence interval [CI] 20.38 to 23.89) the risk of TB in municipalities where the Gini coefficient was <0.60 and 14.96 times (95% CI 11.00 to 18.92) the risk where the Gini coefficient was ≥0.60. A negative interaction in the multiplicative scale was explained by a higher TB incidence in the non-prison population in municipalities with a Gini coefficient ≥0.60. The PAF ranged from 50.06% to 5.19% in municipalities with Gini coefficients <0.40 and ≥0.60, respectively. CONCLUSIONS Interventions to reduce prison exposure would have an ostensible impact in population TB incidence rates mainly in settings with lower Gini coefficients. In those with extreme inequality in income distribution, strategies focused on mitigating the effects of socio-economic factors should also be prioritized.
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Affiliation(s)
- Daniele Maria Pelissari
- Postgraduate Program in Epidemiology, School of Public Health. Av. Dr. Arnaldo, 715. São Paulo/SP. Brazil 01246-904
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Shete PB, Boccia D, Dhavan P, Gebreselassie N, Lönnroth K, Marks S, Matteelli A, Posey DL, van der Werf MJ, Winston CA, Lienhardt C. Defining a migrant-inclusive tuberculosis research agenda to end TB. Int J Tuberc Lung Dis 2019; 22:835-843. [PMID: 29991390 DOI: 10.5588/ijtld.17.0503] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pillar 3 of the End TB Strategy calls for the promotion of research and innovation at the country level to facilitate improved implementation of existing and novel interventions to end tuberculosis (TB). In an era of increasing cross-border migration, there is a specific need to integrate migration-related issues into national TB research agendas. The objective of the present review is to provide a conceptual framework to guide countries in the development and operationalization of a migrant-inclusive TB research agenda. METHODS We conducted a literature review, complemented by expert opinion and the previous articles in this State of the Art series, to identify important themes central to migration-related TB. We categorized these themes into a framework for a migration-inclusive global TB research agenda across a comprehensive spectrum of research. We developed this conceptual framework taking into account: 1) the biomedical, social and structural determinants of TB; 2) the epidemiologic impact of the migration pathway; and 3) the feasibility of various types of research based on a country's capacity. DISCUSSION The conceptual framework presented here is based on the key principle that migrants are not inherently different from other populations in terms of susceptibility to known TB determinants, but that they often have exacerbated or additional risks related to their country of origin and the migration process, which must be accounted for in developing comprehensive TB prevention and care strategies. A migrant-inclusive research agenda should systematically consider this wider context to have the highest impact.
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Affiliation(s)
- P B Shete
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
| | - D Boccia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - P Dhavan
- International Organization of Migration, Geneva, Switzerland
| | - N Gebreselassie
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland
| | - K Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - S Marks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - A Matteelli
- Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV collaborative activities and for the TB elimination strategy, University of Brescia, Brescia, Italy
| | - D L Posey
- Division Global Quarantine and Migration, CDC, Atlanta, Georgia, USA
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C A Winston
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - C Lienhardt
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland, Institut de Recherche pour le Développement, Unité Mixte de Recherche 233, Montpellier, France
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Saenz V, Mazzanti di Ruggiero MDLA. Propuestas bioéticas frente a los problemas sociales y éticos que generan las enfermedades infecciosas desatendidas. PERSONA Y BIOÉTICA 2019. [DOI: 10.5294/pebi.2019.23.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Este artículo de revisión se centra en el tema de las enfermedades infecciosas desatendidas (EID), grupo de 18 patologías de carácter incapacitante, a veces mortales y frecuentemente deformantes, que prevalecen en poblaciones de Asia, África y en las zonas tropicales de Sur América. Mediante una revisión bibliográfica se plantean los elementos que se relacionan con estas enfermedades, se categorizan y se analizan a la luz de la Declaración Universal sobre Bioética y Derechos Humanos de 2005, en cuanto a igualdad, justicia y equidad, el enfoque de no discriminación y estigmatización, responsabilidad social y salud. A lo largo de la revisión se concluye que la problemática alrededor de las EID es multifactorial y se presentan propuestas, desde una mirada de la bioética centrada en el respeto por la dignidad de la persona y de las poblaciones afectadas, para mitigar y solucionar la atención a partir de estrategias posibles que aborden determinantes sociales. Se propone incluir la bioética en el debate sobre la atención de las EID para analizar los problemas y examinar soluciones por medio de proyectos de investigación transdisciplinaria que impliquen un trabajo colaborativo y formativo entre las comunidades afectadas, entidades gubernamentales y profesionales de la salud y de las ciencias veterinarias.
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Duvendack M, Mader P. Impact of financial inclusion in low- and middle-income countries: A systematic review of reviews. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1012. [PMID: 37131469 PMCID: PMC8356488 DOI: 10.4073/csr.2019.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Maren Duvendack
- School of International DevelopmentUniversity of East AngliaNorwichNR4 7TJUK
| | - Philip Mader
- Institute of Development StudiesUniversity of SussexBrightonEast SussexBN19REUK
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Synthesis, biological evaluation and computational study of novel isoniazid containing 4H-Pyrimido[2,1-b]benzothiazoles derivatives. Eur J Med Chem 2019; 177:12-31. [PMID: 31129451 DOI: 10.1016/j.ejmech.2019.05.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/23/2019] [Accepted: 05/07/2019] [Indexed: 12/17/2022]
Abstract
Synthesis of novel and potent hit molecules has an eternal demand. It is our continuous study to search novel bioactive hit molecules and as a part of this, a series of novel N'-isonicotinoyl-2-methyl-4-(pyridin-2-yl)-4H-benzo[4,5]thiazolo[3,2-a]pyrimidine-3-carbohydrazide analogs (5a-5n) were synthesized with good yields by the conventional method. The various novel compounds have been characterized and identified by many analytical technique such as IR, 1H NMR, 13C NMR, mass spectral analysis, and elemental analysis. All the synthetic analogs (5a-5n) are evaluated for their in vitro antibacterial and anti-mycobacterial activities against different bacterial strains. Molecular docking and Molecular dynamics studies were helped in revealing the mode of action of these compounds through their interactions with the active site of the Mycobacterium tuberculosis enoyl reductase (InhA) enzyme. The calculated ADMET descriptors for the synthesized compounds validated good pharmacokinetic properties, confirming that these compounds could be used as templates for the development of new Anti-mycobacterial agents.
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Balinda IG, Sugrue DD, Ivers LC. More Than Malnutrition: A Review of the Relationship Between Food Insecurity and Tuberculosis. Open Forum Infect Dis 2019; 6:ofz102. [PMID: 30949541 PMCID: PMC6441779 DOI: 10.1093/ofid/ofz102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Despite a significant reduction in tuberculosis (TB) mortality over the past decade, TB remains a leading cause of death worldwide. Food insecurity-through pathways such as malnutrition, mental health impact, and high-risk health behaviors-affects the risk of TB disease, treatment failure, and mortality. We searched the literature for studies reporting on the links between food insecurity and TB. In contrast to the well-documented interactions between food insecurity and HIV/AIDS, we found that the association between food insecurity and TB remains largely understudied-this is especially true with regard to non-nutritional correlations. Mental health and behavioral linkages between TB and food insecurity deserve further attention. An improved understanding of the pathways through which food insecurity impacts TB is crucial to inform evidence-based integration of interventions such as psychological counseling, psychiatric care, harm reduction programs, and efforts to address social determinants of disease within current TB programs.
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Affiliation(s)
- Ingabire G Balinda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Klein K, Bernachea MP, Irribarren S, Gibbons L, Chirico C, Rubinstein F. Evaluation of a social protection policy on tuberculosis treatment outcomes: A prospective cohort study. PLoS Med 2019; 16:e1002788. [PMID: 31039158 PMCID: PMC6490910 DOI: 10.1371/journal.pmed.1002788] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/25/2019] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Karen Klein
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Paula Bernachea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Sarah Irribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, School of Nursing HSB, Seattle, Washington, United States of America
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Cristina Chirico
- Tuberculosis Control Program of the 5th Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Fernando Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- * E-mail:
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Bhatt R, Chopra K, Vashisht R. Impact of integrated psycho-socio-economic support on treatment outcome in drug resistant tuberculosis - A retrospective cohort study. Indian J Tuberc 2019; 66:105-110. [PMID: 30797265 DOI: 10.1016/j.ijtb.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/28/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the impact of providing integrated psycho-socio-economic support to drug resistant tuberculosis (DRTB) patients on the treatment outcome under programmatic conditions. STUDY DESIGN Retrospective cohort study. SETTING An urban district TB centre in India under the Revised National Tuberculosis Control Programme. PARTICIPANTS A cohort of 123 patients who started DRTB treatment between June 2010 and May 2013. METHODS Patients started on treatment for DRTB between June 2010 and May 2013 who were provided with the integrated support package for at least 3 months formed the supported group while the other patients of the cohort formed the non-supported group. The treatment outcomes and sputum culture conversion rates were compared between the two groups. RESULTS The supported group consisted of 60 patients and the non-supported group of 63 patients. The treatment success rate was found to be significantly higher in the supported group (65% vs 46.03%; p=0.0349). Support duration was significantly associated with lower incidence of death [HR 0.876, 95% CI 0.811-0.947; p=0.0009] and loss to follow up [OR: 0.752, 95% CI 0.597-0.873; p=0.0023]. The treatment failure rate was higher in the supported group (16.66% vs 4.76%) with 60% of the failures in the supported group occurring after 24 months of compliant treatment. There was no significant association found between support duration and treatment failure or sputum culture conversion. CONCLUSION Integrated support seems to significantly increase the treatment success rate and improve survival and treatment adherence of DRTB patients. However, early diagnosis and effective pharmacotherapy are crucial for reducing treatment failures.
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Affiliation(s)
- Rama Bhatt
- District TB Officer, Ramakrishna Mission Free TB Clinic, Karol Bagh, New Delhi 110005, India.
| | - Kamal Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi 110002, India
| | - Rohit Vashisht
- Post-doctoral Research Fellow (Biomedical Informatics), Stanford University, Stanford 94305, USA
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Reis-Santos B, Shete P, Bertolde A, Sales CM, Sanchez MN, Arakaki-Sanchez D, Andrade KB, Gomes MGM, Boccia D, Lienhardt C, Maciel EL. Tuberculosis in Brazil and cash transfer programs: A longitudinal database study of the effect of cash transfer on cure rates. PLoS One 2019; 14:e0212617. [PMID: 30794615 PMCID: PMC6386534 DOI: 10.1371/journal.pone.0212617] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 02/06/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates. Methods We conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching. Results In 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06–0.11) in subjects with pulmonary TB]. Conclusion Our study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates.
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Affiliation(s)
- Barbara Reis-Santos
- Laboratory of Epidemiology of Federal University of Espírito Santo, Vitória/ES, Brazil
- * E-mail:
| | - Priya Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Adelmo Bertolde
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória/ES, Brazil
| | - Carolina M. Sales
- Laboratory of Epidemiology of Federal University of Espírito Santo, Vitória/ES, Brazil
| | - Mauro N. Sanchez
- Departamento de Saúde Coletiva, Universidade de Brasília: Asa Norte, Brasília/DF, Brazil
| | | | - Kleydson B. Andrade
- Programa Nacional de Controle da Tuberculose—Ministério da Saúde, Brasília/DF, Brazil
| | - M. Gabriela M. Gomes
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
| | - Delia Boccia
- London School of Hygiene and Tropical Medicine: Keppel St., Bloomsbury, London, United Kingdom
| | - Christian Lienhardt
- Global TB Programme, World Health Organisation, Geneva, Switzerland
- Unité Mixte Internationale TransVIHMI (UMI 233 IRD–U1175 INSERM—Université de Montpellier), Institut de Recherche pour le Développement, Montpellier, France
| | - Ethel L. Maciel
- Laboratory of Epidemiology of Federal University of Espírito Santo, Vitória/ES, Brazil
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Effect of the Bolsa Familia Programme on the outcome of tuberculosis treatment: a prospective cohort study. LANCET GLOBAL HEALTH 2019; 7:e219-e226. [DOI: 10.1016/s2214-109x(18)30478-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/23/2018] [Accepted: 10/12/2018] [Indexed: 12/18/2022]
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Murshid NS. Microfinance Participation, Control Over Resources, and Justification of IPV: Results From a Nationally Representative Sample of Women. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:475-495. [PMID: 27080306 DOI: 10.1177/0886260516641284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A high percentage of men and women are purported to justify intimate partner violence (IPV) in countries that are steeped in patriarchy even in the presence of programs such as microfinance that aim to address gender equity. This article examines two assertions that emerge from the literature on microfinance and its potential for positive outcomes for women who participate in it: (a) Microfinance participation is associated with reduced justification of IPV, and (b) microfinance participants with control over their own resources are less likely to justify IPV when compared with microfinance participants who do not have control over their resources. Couples data from a nationally representative survey, the Bangladesh Demographic and Health Survey, were used in the present study. Propensity score matching and logistic regression analyses were conducted to reveal that (a) microfinance participation was not associated with justification of IPV and that (b) women who participated in microfinance were less likely to justify IPV when they had no control over their resources. Implications for practitioners and policymakers are discussed.
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Malacarne J, Kolte IV, Freitas LP, Orellana JDY, Souza MLPD, Souza-Santos R, Basta PC. Factors associated with TB in an indigenous population in Brazil: the effect of a cash transfer program. Rev Inst Med Trop Sao Paulo 2018; 60:e63. [PMID: 30379230 PMCID: PMC6201742 DOI: 10.1590/s1678-9946201860063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
The Mato Grosso do Sul State (MS) has the second-largest indigenous population
and the highest incidence rates of TB among indigenous people in Brazil.
However, little is known about the risk factors associated with active TB in
indigenous people in the region, especially regarding socioeconomic factors. The
aim of this study is to assess the effect of the Family Allowance Program (BFP)
and of other predictors of active TB in a high-risk indigenous population in
Brazil. We conducted a case-control study with incident TB cases matched by age
and by village of residence (1:2 proportion) between March 2011 and December
2012. We used a conditional logistic regression for data analysis. A total of
153 cases and 306 controls were enrolled. The final model included the following
risk factors: alcohol consumption (low-risk use OR=2.2; 95% CI 1.1-4.3; risky
use OR=2.4; 95% CI 1.0-6.0; dependent/ damaging use OR=9.1; 95% CI 2.9-29.1);
recent contact with a TB patient (OR=2.0; 95% CI 1.2-3.5); and male sex (OR=1.9;
95% CI 1.1-3.2). BFP participation (OR=0.5; 95% CI 0.3-0.6) and BCG vaccination
(OR=0.5; 95% CI 0.3-0.9) were found to be protective factors against TB.
Although the BFP was not designed to target TB-affected households specifically,
our findings reveal the importance of the BFP in preventing one of the most
important infectious diseases among adults in indigenous villages in Brazil.
This result is in line with the End-TB strategy, which identifies social
protection, poverty alleviation and targeting other determinants of TB as key
actions.
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Affiliation(s)
- Jocieli Malacarne
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ida Viktoria Kolte
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lais Picinini Freitas
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Reinaldo Souza-Santos
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Cesar Basta
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
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Qiu M, Jessani N, Bennett S. Identifying health policy and systems research priorities for the sustainable development goals: social protection for health. Int J Equity Health 2018; 17:155. [PMID: 30261882 PMCID: PMC6161373 DOI: 10.1186/s12939-018-0868-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an established body of evidence linking systems of social protection to health systems and health outcomes. The Sustainable Development Goals (SDGs) provide further emphasis on this linkage as necessary to achieving health and non-health goals. Existing literature on social protection and health has focused primarily on cash transfers. We sought to identify potential research priorities concerning social protection and health in low and middle-income countries, from multiple perspectives. METHODS Priority research questions were identified through two sources: 1) research reviews on social protection interventions and health, 2) interviews with 54 policy makers from Ministries of Health, multi-lateral or bilateral organizations, and NGOs. Data was collated and summarized using a framework analysis approach. The final refining and ranking of the questions was completed by researchers from around the globe through an online platform. RESULTS The overview of reviews identified 5 main categories of social protection interventions: cash transfers; financial incentives and other demand side financing interventions; food aid and nutritional interventions; parental leave; and livelihood/social welfare interventions. Policy-makers focused on the implementation and practice of social protection and health, how social protection programs could be integrated with other sectors, and how they should be monitored/evaluated. A collated list resulted in 31 priority research questions. Scale and sustainability of social protection programs ranked highest. The top 10 research questions focused heavily on design, implementation, and context, with a range of interventions that included cash transfers, social insurance, and labor market interventions. CONCLUSIONS There is potentially a rich field of enquiry into the linkages between health systems and social protection programs, but research within this field has focused on a few relatively narrowly defined areas. The SDGs provide an impetus to the expansion of research of this nature, with priority setting exercises such as this helping to align funder investment with researcher effort and policy-maker evidence needs.
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Affiliation(s)
- Mary Qiu
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. .,, Washington, 20010, USA.
| | - Nasreen Jessani
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Shelby T, Meyer AJ, Ochom E, Turimumahoro P, Babirye D, Katamba A, Davis JL, Armstrong-Hough M. Social determinants of tuberculosis evaluation among household contacts: a secondary analysis. Public Health Action 2018; 8:118-123. [PMID: 30271727 PMCID: PMC6147061 DOI: 10.5588/pha.18.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/25/2018] [Indexed: 12/25/2022] Open
Abstract
Setting: Seven public sector tuberculosis (TB) units and surrounding communities in Kampala, Uganda. Objective: To evaluate the influence of household-level socio-economic characteristics on completion of TB evaluation during household contact investigation. Design: A cross-sectional study nested within the control arm of a randomized, controlled trial evaluating home-based sputum collection and short messaging service communications. We used generalized estimating equations to estimate the association between completion of TB evaluation and socio-economic determinants. Results: Of 116 household contacts referred to clinics for TB evaluation, 32 (28%) completed evaluation. Completing evaluation was strongly clustered by household. Controlling for individual symptoms, contacts from households earning below-median income (adjusted risk ratio [aRR] 0.28, 95%CI 0.09-0.88, P = 0.029) and contacts from households in which the head of household had no more than primary-level education (aRR 0.40, 95%CI 0.18-0.89, P = 0.025) were significantly less likely to complete evaluation for TB. Conclusion: Socio-economic factors such as low income and education increase the risk that household contacts of TB patients will experience barriers to completing TB evaluation themselves. Further research is needed to identify specific mechanisms by which these underlying social determinants modify the capability and motivation of contacts to complete contact investigation.
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Affiliation(s)
- T Shelby
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - A J Meyer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
| | - M Armstrong-Hough
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
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Sweeney S, Mukora R, Candfield S, Guinness L, Grant AD, Vassall A. Measuring income for catastrophic cost estimates: Limitations and policy implications of current approaches. Soc Sci Med 2018; 215:7-15. [PMID: 30196149 PMCID: PMC6171470 DOI: 10.1016/j.socscimed.2018.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/29/2022]
Abstract
There is increasing global policy interest in estimating catastrophic costs incurred by households because of ill health, and growing need for information on disease-specific household cost data. There are several methodological approaches used to estimate income and no current consensus on the best method for estimating income in the context of a survey at the health facility. We compared six different approaches to estimate catastrophic cost among patients attending a health facility in South Africa. We used patient cost and income data collected June 2014-March 2015 from 66 participants enrolled in a clinical trial in South Africa (TB FastTrack) to explore the variation arising from different income estimation approaches and compared the number of households encountering catastrophic costs derived for each approach. The total proportion of households encountering catastrophic costs varied from 0% to 36%, depending on the estimation method. Self-reported mean annual income was significantly lower than permanent income estimated using an asset linking approach, or income estimated using the national average. A disproportionate number of participants adopting certain coping strategies, including selling assets and taking loans, were unable to provide self-reported income data. We conclude that the rapid methods for estimating income among patients attending a health facility are currently inconsistent. Further research on methods for measuring income, comparing the current recommended methods to 'gold standard' methods in different settings, should be done to identify the most appropriate measurement method.
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Affiliation(s)
- Sedona Sweeney
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Sophie Candfield
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Lorna Guinness
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK; Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Vassall
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
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Carrasco MA, Grund JM, Davis SM, Ridzon R, Mattingly M, Wilkinson J, Kasdan B, Kiggundu V, Njeuhmeli E. Systematic review of the effect of economic compensation and incentives on uptake of voluntary medical male circumcision among men in sub-Saharan Africa. AIDS Care 2018; 30:1071-1082. [PMID: 29566546 PMCID: PMC6800131 DOI: 10.1080/09540121.2018.1453921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Voluntary medical male circumcision (VMMC) prevalence in priority countries in sub-Saharan Africa, particularly among men aged ≥20 years, has not yet reached the goal of 80% coverage recommended by the World Health Organization. Determining novel strategies to increase VMMC uptake among men ≥20 years is critical to reach HIV epidemic control. We conducted a systematic review to analyze the effectiveness of economic compensation and incentives to increase VMMC uptake among older men in order to inform VMMC demand creation programs. The review included five qualitative, quantitative, and mixed methods studies published in peer reviewed journals. Data was extracted into a study summary table, and tables synthesizing study characteristics and results. Results indicate that cash reimbursements for transportation and food vouchers of small nominal amounts to partially compensate for wage loss were effective, while enrollment into lotteries offering prizes were not. Economic compensation provided a final push toward VMMC uptake for men who had already been considering undergoing circumcision. This was in settings with high circumcision prevalence brought by various VMMC demand creation strategies. Lottery prizes offered in the studies did not appear to help overcome barriers to access VMMC and qualitative evidence suggests this may partially explain why they were not effective. Economic compensation may help to increase VMMC uptake in priority countries with high circumcision prevalence when it addresses barriers to uptake. Ethical considerations, sustainability, and possible externalities should be carefully analyzed in countries considering economic compensation as an additional strategy to increase VMMC uptake.
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Affiliation(s)
- Maria A. Carrasco
- U.S. Agency for International Development (USAID), Washington DC, USA
| | | | | | | | - Meghan Mattingly
- U.S. Agency for International Development (USAID), Washington DC, USA
| | - Jessica Wilkinson
- U.S. Agency for International Development (USAID), Washington DC, USA
| | - Benjamin Kasdan
- U.S. Agency for International Development (USAID), Washington DC, USA
| | - Valerian Kiggundu
- U.S. Agency for International Development (USAID), Washington DC, USA
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Rudgard WE, Carter DJ, Scuffell J, Cluver LD, Fraser-Hurt N, Boccia D. Cash transfers to enhance TB control: lessons from the HIV response. BMC Public Health 2018; 18:1052. [PMID: 30134870 PMCID: PMC6106939 DOI: 10.1186/s12889-018-5962-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/14/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The World Health Organization prioritises a more holistic global response to end the tuberculosis (TB) epidemic by 2030. Based on experiences in the HIV response, social protection, and in particular cash transfers, show promise for contributing to this. Currently, individual-level evidence for the potential of cash transfers to prevent TB by addressing the structural social determinants of disease is lacking. To identify priority actions for the TB research agenda, we appraised efforts by the HIV response to establish the role of cash transfers in preventing HIV infection. MAIN BODY The HIV response has evaluated the effects of cash transfers on risky sexual behaviours and HIV incidence. Work has also evaluated the added effects of supplementing cash transfers with psychosocial support. The HIV response has focused research on populations with disproportionate HIV risk, and used a mix of explanatory evaluations, which use ideal conditions, and pragmatic evaluations, which use operational conditions, to generate evidence that is both causally valid and applicable to the real world. It has always collaborated with multiple stakeholders in funding and evaluating projects. Learning from the HIV response, priority actions for the TB response should be to investigate the effect of cash transfers on intermediary social determinants of active TB disease, and TB incidence, as well as the added effects of supplementing cash transfers with psychosocial support. Work should be focused on key groups in high burden settings, and look to build a combination of explanatory and pragmatic evidence to inform policy decisions in this field. To achieve this, there is an urgent need to facilitate collaborations between groups interested in evaluating the impact of cash transfers on TB risk. CONCLUSIONS The HIV response highlights several priority actions necessary for the TB response to establish the potential of cash transfers to prevent TB by addresing the structural social determinants of disease.
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Affiliation(s)
- William E. Rudgard
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Daniel J. Carter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - James Scuffell
- Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Lucie D. Cluver
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Richterman A, Steer-Massaro J, Jarolimova J, Luong Nguyen LB, Werdenberg J, Ivers LC. Cash interventions to improve clinical outcomes for pulmonary tuberculosis: systematic review and meta-analysis. Bull World Health Organ 2018; 96:471-483. [PMID: 29962550 PMCID: PMC6022611 DOI: 10.2471/blt.18.208959] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess cash transfer interventions for improving treatment outcomes of active pulmonary tuberculosis in low- and middle-income countries. METHODS We 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$). We calculated odds ratio (OR) for the primary outcome using a random effects meta-analysis. FINDINGS Eight studies met eligibility criteria for review inclusion. Seven studies assessed a tuberculosis-specific intervention, with average amount of cash ranging from Int$ 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). CONCLUSION The 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.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, United States of America (USA)
| | - Jonathan Steer-Massaro
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, USA
| | - Jana Jarolimova
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Liem Binh Luong Nguyen
- Infection, Antimicrobials, Modelling and Evolution, Unité Mixte de Recherche 1137, INSERM, Paris, France
| | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, USA
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Boccia D, Rudgard W, Shrestha S, Lönnroth K, Eckhoff P, Golub J, Sanchez M, Maciel E, Rasella D, Shete P, Pedrazzoli D, Houben R, Chang S, Dowdy D. Modelling the impact of social protection on tuberculosis: the S-PROTECT project. BMC Public Health 2018; 18:786. [PMID: 29940906 PMCID: PMC6020219 DOI: 10.1186/s12889-018-5539-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/03/2018] [Indexed: 11/21/2022] Open
Abstract
Background Tackling 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. Methods S-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. Results Assessing 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. Conclusions Results 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. Electronic supplementary material The online version of this article (10.1186/s12889-018-5539-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Boccia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - W Rudgard
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - S Shrestha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - K Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - P Eckhoff
- Institute for Disease Modeling, Bellevue, USA
| | - J Golub
- Department of Medicine, Epidemiology & International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - M Sanchez
- Federal University of Brasilia, Brasilia, Brazil
| | - E Maciel
- Federal University of Espírito Santo, Maruipe, Vitória, Brazil
| | - D Rasella
- Oswaldo Cruz Foundation (FIOCRUZ), Brasília, DF, Brazil
| | - P Shete
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.,Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, USA
| | - D Pedrazzoli
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Houben
- TB Modelling Group, TB Centre and CMMID, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - S Chang
- Institute for Disease Modeling, Bellevue, USA
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Owusu-Addo E, Renzaho AMN, Smith BJ. The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review. Health Policy Plan 2018; 33:675-696. [PMID: 29762708 PMCID: PMC5951115 DOI: 10.1093/heapol/czy020] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 11/14/2022] Open
Abstract
Cash transfers (CTs) are now high on the agenda of most governments in low- and middle-income countries. Within the field of health promotion, CTs constitute a healthy public policy initiative as they have the potential to address the social determinants of health (SDoH) and health inequalities. A systematic review was conducted to synthesise the evidence on CTs' impacts on SDoH and health inequalities in sub-Saharan Africa, and to identify the barriers and facilitators of effective CTs. Twenty-one electronic databases and the websites of 14 key organizations were searched in addition to grey literature and hand searching of selected journals for quantitative and qualitative studies on CTs' impacts on SDoH and health outcomes. Out of 182 full texts screened for eligibility, 79 reports that reported findings from 53 studies were included in the final review. The studies were undertaken within 24 CTs comprising 11 unconditional CTs (UCTs), 8 conditional CTs (CCTs) and 5 combined UCTs and CCTs. The review found that CTs can be effective in tackling structural determinants of health such as financial poverty, education, household resilience, child labour, social capital and social cohesion, civic participation, and birth registration. The review further found that CTs modify intermediate determinants such as nutrition, dietary diversity, child deprivation, sexual risk behaviours, teen pregnancy and early marriage. In conjunction with their influence on SDoH, there is moderate evidence from the review that CTs impact on health and quality of life outcomes. The review also found many factors relating to intervention design features, macro-economic stability, household dynamics and community acceptance of programs that could influence the effectiveness of CTs. The external validity of the review findings is strong as the findings are largely consistent with those from Latin America. The findings thus provide useful insights to policy makers and managers and can be used to optimise CTs to reduce health inequalities.
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Affiliation(s)
- Ebenezer Owusu-Addo
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, KNUST- Kumasi, Ghana
| | - Andre M N Renzaho
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW, Australia and
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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The impact of social protection and poverty elimination on global tuberculosis incidence: a statistical modelling analysis of Sustainable Development Goal 1. LANCET GLOBAL HEALTH 2018; 6:e514-e522. [PMID: 29580761 PMCID: PMC5968370 DOI: 10.1016/s2214-109x(18)30195-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/13/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
Background The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in global tuberculosis incidence that could be obtained by reaching SDG 1. Methods We developed a conceptual framework linking key indicators of SDG 1 progress to tuberculosis incidence via well described risk factor pathways and populated it with data from the SDG data repository and the WHO tuberculosis database for 192 countries. Correlations and mediation analyses informed the strength of the association between the SDG 1 subtargets and tuberculosis incidence, resulting in a simplified framework for modelling. The simplified framework linked key indicators for SDG 1 directly to tuberculosis incidence. We applied an exponential decay model based on linear associations between SDG 1 indicators and tuberculosis incidence to estimate tuberculosis incidence in 2035. Findings Ending extreme poverty resulted in a reduction in global incidence of tuberculosis of 33·4% (95% credible interval 15·5–44·5) by 2035 and expanding social protection coverage resulted in a reduction in incidence of 76·1% (45·2–89·9) by 2035; both pathways together resulted in a reduction in incidence of 84·3% (54·7–94·9). Interpretation Full achievement of SDG 1 could have a substantial effect on the global burden of tuberculosis. Cross-sectoral approaches that promote poverty reduction and social protection expansion will be crucial complements to health interventions, accelerating progress towards the End TB targets. Funding World Health Organization.
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Andrade KVFD, Nery JS, Souza RAD, Pereira SM. Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis. CAD SAUDE PUBLICA 2018; 34:e00153116. [DOI: 10.1590/0102-311x00153116] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/09/2017] [Indexed: 11/22/2022] Open
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.
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Treloar C, Hopwood M, Cama E, Saunders V, Jackson LC, Walker M, Ooi C, Ubrihien A, Ward J. Evaluation of the Deadly Liver Mob program: insights for roll-out and scale-up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care. Harm Reduct J 2018; 15:5. [PMID: 29391019 PMCID: PMC5796347 DOI: 10.1186/s12954-018-0209-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Deadly Liver Mob (DLM) is a peer-driven, incentivised health promotion program aimed at increasing understanding of hepatitis C, promoting harm reduction in relation to injecting drug use, and linking participants to screening for hepatitis C, other blood borne viruses and sexually transmissible infections among Aboriginal people in Western Sydney, NSW. This paper presents the evaluation of a pilot study examining the acceptability of the program as a first step of a scalability assessment. Methods Deadly Liver Mob operated in co-located needle and syringe programs and sexual health clinics in two sites: (Site 1: two and a half years for 2 days/week; Site 2: 1 year for 1 day per week). Comparisons were made of the proportion of Aboriginal clients (Site 1) and occasions of service provided to Aboriginal clients (Site 2) in the 12 months prior and post-introduction of DLM. Interviews were conducted with 13 staff involved in delivery of DLM and with 19 clients. Results A total of 655 and 55 Aboriginal clients, respectively, attended Site 1 and Site 2 for health education. The proportion of Aboriginal clients attending both sites was significantly higher during the DLM compared with prior to its implementation. Of those attending for health education, 79 and 73%, respectively, attended screening following education. DLM clients strongly endorsed the program. Some staff were concerned about workforce capacity to effectively engage Aboriginal clients with multiple and complex needs, managing the differing aims of the participating services involved, and about offering of incentives for attendance at health services. Conclusion While acceptability was high among staff and clients and preliminary results show high engagement with Aboriginal communities, this evaluation of a pilot program raises some issues to consider in scale up of DLM to other sites. The initiation of additional DLM sites should address issues of alignment with governing strategies and workforce capacity.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Veronica Saunders
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - L Clair Jackson
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Melinda Walker
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
| | - Ashley Ubrihien
- Western Sydney HIV and Related Programs Unit, Western Sydney Local Health District, Sydney, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
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Fuady A, Houweling TAJ, Mansyur M, Richardus JH. Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia's implementation of universal health coverage. Infect Dis Poverty 2018; 7:3. [PMID: 29325589 PMCID: PMC5765643 DOI: 10.1186/s40249-017-0382-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background As well as imposing an economic burden on affected households, the high costs related to tuberculosis (TB) can create access and adherence barriers. This highlights the particular urgency of achieving one of the End TB Strategy’s targets: that no TB-affected households have to face catastrophic costs by 2020. In Indonesia, as elsewhere, there is also an emerging need to provide social protection by implementing universal health coverage (UHC). We therefore assessed the incidence of catastrophic total costs due to TB, and their determinants since the implementation of UHC. Methods We interviewed adult TB and multidrug-resistant TB (MDR-TB) patients in urban, suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier. Following the WHO recommendation, we assessed the incidence of catastrophic total costs due to TB. We also analyzed the sensitivity of incidence relative to several thresholds, and measured differences between poor and non-poor households in the incidence of catastrophic costs. Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs. Results We analyzed 282 TB and 64 MDR-TB patients. For TB-related services, the median (interquartile range) of total costs incurred by households was 133 USD (55–576); for MDR-TB-related services, it was 2804 USD (1008–4325). The incidence of catastrophic total costs in all TB-affected households was 36% (43% in poor households and 25% in non-poor households). For MDR-TB-affected households, the incidence was 83% (83% and 83%). In TB-affected households, the determinants of catastrophic total costs were poor households (adjusted odds ratio [aOR] = 3.7, 95% confidence interval [CI]: 1.7–7.8); being a breadwinner (aOR = 2.9, 95% CI: 1.3–6.6); job loss (aOR = 21.2; 95% CI: 8.3–53.9); and previous TB treatment (aOR = 2.9; 95% CI: 1.4–6.1). In MDR-TB-affected households, having an income-earning job before diagnosis was the only determinant of catastrophic total costs (aOR = 8.7; 95% CI: 1.8–41.7). Conclusions Despite the implementation of UHC, TB-affected households still risk catastrophic total costs and further impoverishment. As well as ensuring access to healthcare, a cost-mitigation policy and additional financial protection should be provided to protect the poor and relieve income losses. Electronic supplementary material The online version of this article (10.1186/s40249-017-0382-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands. .,Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
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George PE, Bazo-Alvarez JC, Bayer AM. The Earning and Spending Habits of Male Sex Workers in Lima, Peru. SAGE OPEN 2018; 8:10.1177/2158244017753046. [PMID: 30221033 PMCID: PMC6138051 DOI: 10.1177/2158244017753046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Over the past decade, data have identified male sex work as a potentially viable economic decision; despite this, male sex workers (MSWs) continue to be perceived as group with access to few assets and resources. Using data from a pilot skills- building intervention for MSWs in Lima, Peru, an analysis of the economic characteristics of 209 MSWs is presented. The majority reported livable incomes with median earnings of US$250 per month, 83% earning above the urban poverty line. Interestingly, non-sex work was also an important source of income, especially for the high-earning MSWs. Spending data revealed that a large portion of income went to necessities (55%), luxuries (11%), and gifts (11%), with less toward savings (5%) and studies (1%). Such data on MSWs' earnings and spending, which suggest that a lack of overall income is not the MSW's main impediment to escaping poverty, could direct future poverty alleviation and health improvement programs in this key population.
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Affiliation(s)
- Paul E. George
- University of California, Los Angeles, USA
- Texas Children’s Hospital, Houston, USA
| | - Juan Carlos Bazo-Alvarez
- Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Perú
- Peruvian Research Institute of Educational and Social Psychology (PSYCOPERU), Lima, Peru
| | - Angela M. Bayer
- University of California, Los Angeles, USA
- Universidad Peruana Cayetano Heredia, Lima, Peru
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Pega F, Liu SY, Walter S, Pabayo R, Saith R, Lhachimi SK. Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries. Cochrane Database Syst Rev 2017; 11:CD011135. [PMID: 29139110 PMCID: PMC6486161 DOI: 10.1002/14651858.cd011135.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age or HIV infection) are a type of social protection intervention that addresses a key social determinant of health (income) in low- and middle-income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided so long as the recipient engages in prescribed behaviours such as using a health service or attending school) is unknown. OBJECTIVES To assess the effects of UCTs for improving health services use and health outcomes in vulnerable children and adults in LMICs. Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure and to compare to effects of UCTs versus CCTs. SEARCH METHODS We searched 17 electronic academic databases, including the Cochrane Public Health Group Specialised Register, the Cochrane Database of Systematic Reviews (the Cochrane Library 2017, Issue 5), MEDLINE and Embase, in May 2017. We also searched six electronic grey literature databases and websites of key organisations, handsearched key journals and included records, and sought expert advice. SELECTION CRITERIA We included both parallel group and cluster-randomised controlled trials (RCTs), quasi-RCTs, cohort and controlled before-and-after (CBAs) studies, and interrupted time series studies of UCT interventions in children (0 to 17 years) and adults (18 years or older) in LMICs. Comparison groups received either no UCT or a smaller UCT. Our primary outcomes were any health services use or health outcome. DATA COLLECTION AND ANALYSIS Two reviewers independently screened potentially relevant records for inclusion criteria, extracted data and assessed the risk of bias. We tried to obtain missing data from study authors if feasible. For cluster-RCTs, we generally calculated risk ratios for dichotomous outcomes from crude frequency measures in approximately correct analyses. Meta-analyses applied the inverse variance or Mantel-Haenszel method with random effects. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included 21 studies (16 cluster-RCTs, 4 CBAs and 1 cohort study) involving 1,092,877 participants (36,068 children and 1,056,809 adults) and 31,865 households in Africa, the Americas and South-East Asia in our meta-analyses and narrative synthesis. The 17 types of UCTs we identified, including one basic universal income intervention, were pilot or established government programmes or research experiments. The cash value was equivalent to 1.3% to 53.9% of the annualised gross domestic product per capita. All studies compared a UCT with no UCT, and three studies also compared a UCT with a CCT. Most studies carried an overall high risk of bias (i.e. often selection and/or performance bias). Most studies were funded by national governments and/or international organisations.Throughout the review, we use the words 'probably' to indicate moderate-quality evidence, 'may/maybe' for low-quality evidence, and 'uncertain' for very low-quality evidence. UCTs may not have impacted the likelihood of having used any health service in the previous 1 to 12 months, when participants were followed up between 12 and 24 months into the intervention (risk ratio (RR) 1.04, 95% confidence interval (CI) 1.00 to 1.09, P = 0.07, 5 cluster-RCTs, N = 4972, I² = 2%, low-quality evidence). At one to two years, UCTs probably led to a clinically meaningful, very large reduction in the likelihood of having had any illness in the previous two weeks to three months (odds ratio (OR) 0.73, 95% CI 0.57 to 0.93, 5 cluster-RCTs, N = 8446, I² = 57%, moderate-quality evidence). Evidence from five cluster-RCTs on food security was too inconsistent to be combined in a meta-analysis, but it suggested that at 13 to 24 months' follow-up, UCTs could increase the likelihood of having been food secure over the previous month (low-quality evidence). UCTs may have increased participants' level of dietary diversity over the previous week, when assessed with the Household Dietary Diversity Score and followed up 24 months into the intervention (mean difference (MD) 0.59 food categories, 95% CI 0.18 to 1.01, 4 cluster-RCTs, N = 9347, I² = 79%, low-quality evidence). Despite several studies providing relevant evidence, the effects of UCTs on the likelihood of being moderately stunted and on the level of depression remain uncertain. No evidence was available on the effect of a UCT on the likelihood of having died. UCTs probably led to a clinically meaningful, moderate increase in the likelihood of currently attending school, when assessed at 12 to 24 months into the intervention (RR 1.06, 95% CI 1.03 to 1.09, 6 cluster-RCTs, N = 4800, I² = 0%, moderate-quality evidence). The evidence was uncertain for whether UCTs impacted livestock ownership, extreme poverty, participation in child labour, adult employment or parenting quality. Evidence from six cluster-RCTs on healthcare expenditure was too inconsistent to be combined in a meta-analysis, but it suggested that UCTs may have increased the amount of money spent on health care at 7 to 24 months into the intervention (low-quality evidence). The effects of UCTs on health equity (or unfair and remedial health inequalities) were very uncertain. We did not identify any harms from UCTs. Three cluster-RCTs compared UCTs versus CCTs with regard to the likelihood of having used any health services, the likelihood of having had any illness or the level of dietary diversity, but evidence was limited to one study per outcome and was very uncertain for all three. AUTHORS' CONCLUSIONS This body of evidence suggests that unconditional cash transfers (UCTs) may not impact a summary measure of health service use in children and adults in LMICs. However, UCTs probably or may improve some health outcomes (i.e. the likelihood of having had any illness, the likelihood of having been food secure, and the level of dietary diversity), one social determinant of health (i.e. the likelihood of attending school), and healthcare expenditure. The evidence on the relative effectiveness of UCTs and CCTs remains very uncertain.
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Affiliation(s)
- Frank Pega
- University of OtagoPublic Health23A Mein Street, NewtownWellingtonNew Zealand6242
| | - Sze Yan Liu
- Harvard UniversityHarvard Center for Population and Development StudiesCambridgeMAUSA
- Weill Cornell Medical College, Cornell UniversityHealthcare Policy and ResearchNew YorkNYUSA
| | - Stefan Walter
- University of California, San FranciscoEpidemiology and Biostatistics185 Berry StSan FranciscoCAUSA94107
| | - Roman Pabayo
- Harvard TH Chan School of Public HealthSocial and Behavioral Sciences677 Huntington AvenueBostonMAUSA02215
- University of AlbertaSchool of Public HealthEdmontonAlbertaCanada
| | - Ruhi Saith
- New DelhiOxford Policy ManagementNew DelhiIndia
| | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence‐Based Public HealthAchterstr. 30BremenGermany28359
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