The impact of a governmental cash transfer programme on tuberculosis cure rate in Brazil: A quasi-experimental approach

Abstract

BackgroundSocial vulnerability is strongly associated with tuberculosis (TB) indicators like cure rate. By addressing key social determinants, social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in TB control. Evidence is consolidating around a positive effect of social protection on TB outcomes, however methodological limitations prevent strong conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB cure rate.Methods & FindingsThe data source was Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll. Propensity scores (PSs) were estimated from a complete-case logistic regression using covariates from this linked dataset, informed by a directed acyclic graph. Control patients were matched to exposed patients on the PS and the average effect of treatment on the treated (ATT) was estimated as the difference in TB cure rate between matched groups (n = 2167). The ATT was estimated as 10·58 (95% CIs: 4·39, 16·77). This suggests that 10·58% of the TB patients receiving BFP who were cured would not have been cured had they not received BFP. The direction of this effect was robust to sensitivity analyses performed and the PS matching broadly improved balance, although missing data limited the sample size.ConclusionsThis work is the first quasi-experimental evaluation of social protection in wide-scale practice on TB outcomes. It demonstrates a positive effect of conditional cash transfers on TB cure rate consistent with existing work, suggesting changes to policy and future research on increasing access to social protection for TB patients who remain uncovered by the programme.

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: A mixed methods study

“…In line with this study, studies conducted in Nigeria, Brazil and Argentina reported positive effects of social protection on treatment outcomes [29,30,32,33]. By contrast, studies from South Africa and Timor-Leste showed either weak or no effect of social protection on adherence and/or treatment outcomes [23,31].…”

Social protection interventions could improve tuberculosis treatment outcomes

“…A higher level of sensitivity could be achieved using a more inclusive, non-stigmatising, targeting strategy to identify and enrol patients with tuberculosis and other beneficiaries. 10 This study adds to the growing evidence for the expansion of social protection interventions for individuals with tuberculosis as a valid mechanism for improving tuberculosis outcomes beyond the traditional biomedical approach. 10 Kingsley N Ukwaja…”

“…10 This study adds to the growing evidence for the expansion of social protection interventions for individuals with tuberculosis as a valid mechanism for improving tuberculosis outcomes beyond the traditional biomedical approach. 10 Kingsley N Ukwaja…”

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: a mixed methods study

“…In line with this study, studies conducted in Nigeria, Brazil and Argentina reported positive effects of social protection on treatment outcomes. (29,30,32,33) By contrast, studies from South Africa and Timor-Leste showed either weak or no effect of social protection on adherence and/or treatment outcomes. (23,31) Possible explanations of these conflicting results could be heterogeneity in study designs, intervention packages and coverage of interventions.…”