Conditional Cash Transfer to Improve TB Outcomes: Necessary but Not Sufficient; Comment on “Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India”

Document Type : Commentary

Authors

1 Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

2 Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK

Abstract

Tuberculosis (TB) still represents a major public health problem in many regions of the world. TB control can only be achieved through a comprehensive and inclusive response which takes into account both upstream and downstream coordinated interventions related to structural determinants such as poverty, nutrition, sanitation, housing and access to healthcare as well as timely diagnosis and support throughout the course of treatment. Several social and financial support strategies have been proposed to improve TB treatment adherence, including conditional cash transfers (CCTs). In this context, demonstrating that social protection directly improves a specific health outcome using routinely collected data, incomplete registries or surveillance reports brings about many methodological challenges. We briefly discuss this paper and some limitations, describe main findings from our own research in this area and make a call to expand social protection interventions to address structural conditions of those most affected.

Keywords


  1. Wingfield T. Mitigating the financial effects of tuberculosis requires more than expansion of services. Lancet Glob Health. 2017;5(11):e1056-e1057. doi:1016/s2214-109x(17)30368-6
  2. Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA. 2007;298(16):1900-1910. doi:1001/jama.298.16.1900
  3. 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(7):471-483. doi:2471/blt.18.208959
  4. Dave JD, Rupani MP. Does direct benefit transfer improve outcomes among people with tuberculosis? - A mixed-methods study on the need for a review of the cash transfer policy in India. Int J Health Policy Manag. 2022. doi:34172/ijhpm.2022.5784
  5. Wingfield T, Tovar MA, Huff D, et al. The economic effects of supporting tuberculosis-affected households in Peru. Eur Respir J. 2016;48(5):1396-1410. doi:1183/13993003.00066-2016
  6. Mansour O, Masini EO, Kim BJ, Kamene M, Githiomi MM, Hanson CL. Impact of a national nutritional support programme on loss to follow-up after tuberculosis diagnosis in Kenya. Int J Tuberc Lung Dis. 2018;22(6):649-654. doi:5588/ijtld.17.0537
  7. Samuel B, Volkmann T, Cornelius S, et al. Relationship between nutritional support and tuberculosis treatment outcomes in West Bengal, India. J Tuberc Res. 2016;4(4):213-219. doi:4236/jtr.2016.44023
  8. Si ZL, Kang LL, Shen XB, Zhou YZ. Adjuvant efficacy of nutrition support during pulmonary tuberculosis treating course: systematic review and meta-analysis. Chin Med J (Engl). 2015;128(23):3219-3230. doi:4103/0366-6999.170255
  9. Grobler L, Nagpal S, Sudarsanam TD, Sinclair D. Nutritional supplements for people being treated for active tuberculosis. Cochrane Database Syst Rev. 2016;2016(6):CD006086. doi:1002/14651858.CD006086.pub4
  10. Wingfield T, Tovar MA, Huff D, et al. Socioeconomic support to improve initiation of tuberculosis preventive therapy and increase tuberculosis treatment success in Peru: a household-randomised, controlled evaluation. Lancet. 2017;389(S16). doi:1016/s0140-6736(17)30412-9
  11. Shete PB, Dowdy DW. Measuring success: the challenge of social protection in helping eliminate tuberculosis. PLoS Med. 2017;14(11):e1002419. doi:1371/journal.pmed.1002419
  12. Boccia D, Rudgard W, Shrestha S, et al. Modelling the impact of social protection on tuberculosis: the S-PROTECT project. BMC Public Health. 2018;18(1):786. doi:1186/s12889-018-5539-x
  13. 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(4):e1002788. doi:1371/journal.pmed.1002788
  14. Boccia D, Pedrazzoli D, Wingfield T, et al. Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities. BMC Infect Dis. 2016;16:307. doi:1186/s12879-016-1529-8
  15. Myrdal G. Economic Theory and Underdeveloped Regions. London: University Paperbacks (Methuen); 1957.
  • Receive Date: 23 August 2022
  • Revise Date: 09 December 2022
  • Accept Date: 12 December 2022
  • First Publish Date: 13 December 2022