A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru
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Author(s)
Type
Journal Article
Abstract
Objective To evaluate the impact of socioeconomic support on tuberculosis preventive therapy initiation in household contacts of
tuberculosis patients and on treatment success in patients.
Methods A non-blinded, household-randomized, controlled study was performed between February 2014 and June 2015 in 32 shanty
towns in Peru. It included patients being treated for tuberculosis and their household contacts. Households were randomly assigned to either
the standard of care provided by Peru’s national tuberculosis programme (control arm) or the same standard of care plus socioeconomic
support (intervention arm). Socioeconomic support comprised conditional cash transfers up to 230 United States dollars per household,
community meetings and household visits. Rates of tuberculosis preventive therapy initiation and treatment success (i.e. cure or treatment
completion) were compared in intervention and control arms.
Findings Overall, 282 of 312 (90%) households agreed to participate: 135 in the intervention arm and 147 in the control arm. There were
410 contacts younger than 20 years: 43% in the intervention arm initiated tuberculosis preventive therapy versus 25% in the control arm
(adjusted odds ratio, aOR: 2.2; 95% confidence interval, CI: 1.1–4.1). An intention-to-treat analysis showed that treatment was successful
in 64% (87/135) of patients in the intervention arm versus 53% (78/147) in the control arm (unadjusted OR: 1.6; 95% CI: 1.0–2.6). These
improvements were equitable, being independent of household poverty.
Conclusion A tuberculosis-specific, socioeconomic support intervention increased uptake of tuberculosis preventive therapy and
tuberculosis treatment success and is being evaluated in the Community Randomized Evaluation of a Socioeconomic Intervention to
Prevent TB (CRESIPT) project.
tuberculosis patients and on treatment success in patients.
Methods A non-blinded, household-randomized, controlled study was performed between February 2014 and June 2015 in 32 shanty
towns in Peru. It included patients being treated for tuberculosis and their household contacts. Households were randomly assigned to either
the standard of care provided by Peru’s national tuberculosis programme (control arm) or the same standard of care plus socioeconomic
support (intervention arm). Socioeconomic support comprised conditional cash transfers up to 230 United States dollars per household,
community meetings and household visits. Rates of tuberculosis preventive therapy initiation and treatment success (i.e. cure or treatment
completion) were compared in intervention and control arms.
Findings Overall, 282 of 312 (90%) households agreed to participate: 135 in the intervention arm and 147 in the control arm. There were
410 contacts younger than 20 years: 43% in the intervention arm initiated tuberculosis preventive therapy versus 25% in the control arm
(adjusted odds ratio, aOR: 2.2; 95% confidence interval, CI: 1.1–4.1). An intention-to-treat analysis showed that treatment was successful
in 64% (87/135) of patients in the intervention arm versus 53% (78/147) in the control arm (unadjusted OR: 1.6; 95% CI: 1.0–2.6). These
improvements were equitable, being independent of household poverty.
Conclusion A tuberculosis-specific, socioeconomic support intervention increased uptake of tuberculosis preventive therapy and
tuberculosis treatment success and is being evaluated in the Community Randomized Evaluation of a Socioeconomic Intervention to
Prevent TB (CRESIPT) project.
Date Issued
2017-02-09
Date Acceptance
2017-01-05
Citation
BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2017, 95 (4), pp.270-280
ISSN
0042-9686
Publisher
WORLD HEALTH ORGANIZATION
Start Page
270
End Page
280
Journal / Book Title
BULLETIN OF THE WORLD HEALTH ORGANIZATION
Volume
95
Issue
4
Copyright Statement
Published by World Health Organization under a Creative Commons Attribution 3.0 License IGO (https://creativecommons.org/licenses/by/3.0/igo/)
Sponsor
Medical Research Council (MRC)
Wellcome Trust
Wellcome Trust
Imperial College London, Wellcome Trust
Wellcome Trust
Wellcome Trust
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000400631900014&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
MR/K007467/1
097816/Z/11/A
105788/Z/14/Z
Imperial College London ISSF fellowship
201251/Z/16/Z
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
CONTROLLED-TRIAL
INFECTION
ADHERENCE
THERAPY
Tropical Medicine
11 Medical And Health Sciences
Publication Status
Published