Evaluating the impact of cash transfers on TB [TB0095]

In 2021, 4 million of the estimated 10 million new TB cases were not accounted for, and high rates of pre-treatment loss to follow-up hindered those identified. A major reason for this is the failure to address economic barriers faced by patients, which prevents them from completing the TB diagnostic evaluation process. 

TB disproportionately affects the poorest and most vulnerable populations, leading to significant losses in productivity—3 to 4 months of work for individuals, 30% of yearly household earnings for families, and 4 to 7% of GDP for countries. Accessing TB diagnostic services further threatens individuals' and households' socioeconomic status.

Person-centred approaches that address the underlying social determinants of TB are essential. Cash transfers, whether used as incentives or as part of a broader social protection strategy, represent a promising person-centred approach to improving TB outcomes. These transfers can play a crucial role in enhancing TB treatment completion and cure rates in programmatic settings. Cash transfers helped facilitate access to TB care by covering transportation costs, and receiving such support allowed people to prioritize returning to health centers. Even a modest, one-time unconditional cash transfer can be feasibly delivered to individuals undergoing TB evaluation in high-burden, low-income settings.

While the impact of this cash transfer on treatment initiation among those diagnosed with TB was not statistically significant, it did improve adherence to care. The intervention increased the rate of completion at each step of the TB diagnostic cascade, from referral for sputum testing to sputum submission and microbiological test results, by two to four times. This suggests that while cash transfers can effectively enable diagnostic evaluation, achieving better epidemiological outcomes, such as treatment initiation, may require more durable and comprehensive social and economic support to meet the needs of TB-affected individuals throughout the entire care cascade. There may also be differences in the effectiveness of cash transfers at different stages of TB care.

Source: Shete, P.B., Kadota, J.L., Nanyunja, G., Namale, C., Nalugwa, T., Oyuku, D., Turyahabwe, S., Kiwanuka, N., Cattamanchi, A. and Katamba, A., 2023. Evaluating the impact of cash transfers on tuberculosis (ExaCT TB): a stepped wedge cluster randomised controlled trial. ERJ open research, 9(3).

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