Evaluating the impact of cash transfers on TB

Tuberculosis (TB) continues to pose a significant global health challenge, particularly for the most vulnerable populations. In 2021 alone, 4 million of the estimated 10 million new TB cases went unaccounted for, while many who were diagnosed struggled to complete the evaluation process due to economic barriers. TB disproportionately affects low-income individuals and families, leading to severe financial strain—causing months of lost productivity, a significant portion of annual household earnings, and even impacting national economies. Addressing these socioeconomic challenges is crucial, as financial insecurity often forces patients to prioritize immediate survival over seeking and completing medical care.[2]

A study in Brazil estimated the impact of the Bolsa Família Program (BFP)—the world’s largest conditional cash transfer (CCT) initiative—on tuberculosis (TB) outcomes among 54.5 million low-income individuals between 2004 and 2015. Designed to alleviate poverty through financial support conditional on health and education compliance, BFP was associated with substantial reductions in TB incidence (adjusted rate ratio [aRR]: 0.59; 95% CI: 0.58–0.60) and TB mortality (aRR: 0.69; 95% CI: 0.65–0.73). The strongest effects were seen among individuals living in extreme poverty (incidence aRR: 0.49; mortality aRR: 0.60) and among Indigenous (incidence aRR: 0.37; mortality aRR: 0.35), Black, and Pardo populations. These findings highlight the potential of CCT programs like BFP to significantly reduce TB burden among socioeconomically and racially marginalized groups, supporting their role in achieving global End TB Strategy and Sustainable Development Goals.[3]

Person-centered approaches, such as cash transfers, have emerged as promising strategies to bridge these gaps in TB care. These financial supports help patients afford transportation costs, ensuring they can attend crucial diagnostic and treatment appointments. Even a modest, one-time cash transfer has been shown to significantly improve adherence to the TB diagnostic process, increasing the completion rate of each step by two to four times. While the intervention did not significantly impact treatment initiation, it successfully enabled more patients to complete their diagnostic evaluations—an essential step toward better TB control. These findings highlight the need for more sustained and comprehensive economic support to improve long-term health outcomes for TB-affected individuals, reinforcing the importance of integrating financial interventions into TB care strategies.[2] See also: https://tbreadingnotes.blogspot.com/2024/09/effects-of-diabetes-mellitus-on.html

The intervention program combining conditional cash transfers with comprehensive TB counseling proved to be a powerful approach in improving treatment adherence and success rates. Patients in the intervention group showed remarkable retention, with significantly lower rates of pretreatment and on-treatment loss to follow-up compared to the control group. More importantly, the intervention led to a notably higher treatment success rate of 82.0%, compared to only 66.9% in the control group. By reducing the risk of unsuccessful outcomes by nearly half, this approach demonstrated its effectiveness in ensuring that more patients complete their TB treatment and recover successfully.[1] See also: https://tbreadingnotes.blogspot.com/2024/09/tb-and-dm-increased-hospitalisations.html

Beyond clinical outcomes, the study highlighted the positive impact of socioeconomic stability on treatment success. Patients with full-time employment and food security had a significantly lower risk of unsuccessful outcomes, emphasizing the importance of social support in healthcare. The intervention itself was highly efficient, with 93.8% of eligible cash transfers successfully issued, despite minor logistical challenges. With a large sample size and real-world setting, the study provides robust evidence that integrating financial and behavioral support into TB programs can significantly improve patient retention and health outcomes. These findings offer valuable insights for policymakers aiming to enhance TB care, particularly in resource-limited settings.[1] See also: https://tbreadingnotes.blogspot.com/2024/09/nutritional-status-in-patients-with-tb.html

References:

1. Ismail, Nazir, Harry Moultrie, Judith Mwansa-Kambafwile, Andrew Copas, Alane Izu, Sizulu Moyo, Donald Skinner et al. "Effects of conditional cash transfers and pre-test and post-test tuberculosis counselling on patient outcomes and loss to follow-up across the continuum of care in South Africa: a randomised controlled trial." The Lancet Infectious Diseases (2025).

2. 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).

3. Jesus, G.S., Gestal, P.F., Silva, A.F., Cavalcanti, D.M., Lua, I., Ichihara, M.Y., Barreto, M.L., Boccia, D., Sanchez, M.N. and Rasella, D., 2025. Effects of conditional cash transfers on tuberculosis incidence and mortality according to race, ethnicity and socioeconomic factors in the 100 Million Brazilian Cohort. Nature Medicine, pp.1-10.