Is There a Need to Mitigate the Social and Financial Consequences of Tuberculosis at the Individual and Household Level?

Grede, Nils; Claros, Joan M.; Pee, Saskia de; Bloem, Martin W.

doi:10.1007/s10461-014-0732-0

Cited by 26 publications

(25 citation statements)

References 32 publications

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“…61 However, there was little operational evidence to guide implementation or evaluate the impact of TBrelated socio-economic support, including cash transfer interventions. 9,15,17,18 , 54-56 , 62-68 Building on the lessons learnt during the ISIAT project, 15 extensive expert and TB civil society consultation, 54 a systematic review of cash transfer interventions 55 and the phase 1 published research, 11 our IFHAD research group was funded by the Joint Global Health Trials (a consortium of Wellcome Trust, Medical Research Council and the UK Department for International Development) to undertake the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) project.…”

Section: S83mentioning

confidence: 99%

Beyond pills and tests: addressing the social determinants of tuberculosis

Wingfield¹,

Tovar²,

Huff³

et al. 2016

Clinical Medicine

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Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strategies is limited. The research described in this article, based on the 2016 Royal College of Physicians Linacre Lecture, aimed to address this knowledge gap. The research was divided into two phases: the first phase was an analysis of a cohort study identifying TB-related costs of TB-affected households and creating a clinically relevant threshold above which those costs became catastrophic; the second was the design, implementation and evaluation of a household randomised controlled evaluation of socio-economic support to improve access to preventive therapy, increase TB cure, and mitigate the effects of catastrophic costs. The first phase showed TB remains a disease of people living in poverty - 'free' TB care was unaffordable for impoverished TB-affected households and incurring catastrophic costs was associated with as many adverse TB treatment outcomes (including death, failure of treatment, lost to follow-up and TB recurrence) as multidrug resistant (MDR) TB. The second phase showed that, in TB-affected households receiving socio-economic support, household contacts were more likely to start and adhere to TB preventive therapy, TB patients were more likely to be cured and households were less likely to incur catastrophic costs. In impoverished Peruvian shantytowns, poverty remains inextricably linked with TB and incurring catastrophic costs predicted adverse TB treatment outcome. A novel socio-economic support intervention increased TB preventive therapy uptake, improved TB treatment success and reduced catastrophic costs. The impact of the intervention on TB control is currently being evaluated by the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) study.

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Section: S83mentioning

confidence: 99%

Beyond pills and tests: addressing the social determinants of tuberculosis

Wingfield¹,

Tovar²,

Huff³

et al. 2016

Clinical Medicine

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“…There is minimal operational research assessing the impact of socioeconomic interventions on mitigation of the effects of TB-related costs. Such interventions may be a cost-effective investment from a societal perspective [17] through their potential ability to enhance TB control as part of the post-2015 End TB Strategy.…”

Section: Introductionmentioning

confidence: 99%

The economic effects of supporting tuberculosis-affected households in Peru

et al. 2016

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The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention.The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months.From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22–38%) versus 42% (95% CI 34–51%)). The mitigation impact was higher among poorer households.The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies.

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“…Di bawah kos langsung, kos ekonomi yang ditanggung oleh pesakit tibi adalah seperti kos bayaran perubatan, dan kos bayaran bukan perubatan (contohnya kos tempat tinggal, dan pengangkutan). Tidak cukup dengan itu, pesakit tuberkulosis turut menanggung kos tidak langsung seperti kurang sumber pendapatan kerana kehilangan kerja, tidak mampu mendapatkan pekerjaan kerana penyakit yang dihidapi (Grede et al 2014). Di Malaysia, pesakit-pesakit tuberkulosis adalah lebih bernasib baik memandangkan rawatan dan ubatan anti tuberkulosis yang diberikan adalah percuma dan ditanggung sepenuhnya oleh kerajaan Malaysia.…”

Section: Perbincanganunclassified