Academic journal article Bulletin of the World Health Organization

A Randomized Controlled Study of Socioeconomic Support to Enhance Tuberculosis Prevention and Treatment, Peru/Une Etude Controlee Randomisee De L'accompagnement Socioeconomique Pour Ameliorer la Prevention et le Traitement De la Tuberculose Au Perou/Un Estudio Controlado Aleatorizado De Apoyo Socioeconomic Para Mejorar la Prevention Y El Tratamiento De la Tuberculosis En Peru

Academic journal article Bulletin of the World Health Organization

A Randomized Controlled Study of Socioeconomic Support to Enhance Tuberculosis Prevention and Treatment, Peru/Une Etude Controlee Randomisee De L'accompagnement Socioeconomique Pour Ameliorer la Prevention et le Traitement De la Tuberculose Au Perou/Un Estudio Controlado Aleatorizado De Apoyo Socioeconomic Para Mejorar la Prevention Y El Tratamiento De la Tuberculosis En Peru

Article excerpt

Introduction

An estimated one third of the world's population has latent tuberculosis infection and in 2015 10.4 million people developed tuberculosis disease. (1) Those at the highest risk of tuberculosis include the household contacts of patients with the disease and people living in poverty. (2) Trials have shown that preventive therapy decreases the risk of progression to tuberculosis disease by 60 to 90%. (2-4) Nevertheless, globally the impact of preventive therapy on tuberculosis control is limited because people with a latent tuberculosis infection are seldom identified (5) and, therefore, seldom take preventive therapy. (6-9) In addition, many people have difficulty adhering to treatment (7,8,10) and tuberculosis patients who do not take adequate treatment are more likely to experience adverse outcomes, such as treatment failure, tuberculosis recurrence and death. (11) They are also more likely to transmit the infection, especially to household contacts (12) and to develop multidrug-resistant tuberculosis, (13) an increasing global public health threat. (5)

The current, predominantly biomedical approach to tuberculosis control is not reducing disease incidence to the level required to eliminate tuberculosis envisioned in the World Health Organization's (WHO) End TB Strategy. (14,15) Increasing access to tuberculosis preventive therapy and treatment is likely to improve disease prevention and treatment success but requires strategies complementary to biomedical care, including socioeconomic support. Interventions such as conditional cash transfers can help improve people's capacity to manage social and financial risks. (16-23) Although socioeconomic interventions are common in the treatment of human immunodeficiency virus infection (HIV) and acquired immune deficiency syndrome (AIDS) and in maternal health, (24,25) little is known about their impact on tuberculosis care or prevention. (16,18,19,26)

Our research group in Peru, Innovation for Health and Development, has been funded to undertake the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project. The planning, design and economic impact of the intervention have been described previously. (27,28) Here we report the final results of the initial phase of CRESIPT, which involved a household-randomized, controlled study that evaluated the impact of tuberculosis-specific socioeconomic support on the initiation of tuberculosis preventive therapy and on tuberculosis treatment success. In addition, we describe the refinement of this intervention used in CRESIPT.

Methods

The study evaluated the impact of a socioeconomic support Intervention--described in Box 1--in 32 contiguous shanty towns in Callao, Peru, the northern, coastal extension of the capital Lima (Fig. 1). The Province of Callao has a population of 1 million, considerable poverty and zones with high levels of drug addiction and gun crime. The annual tuberculosis case notification rate in 2014 was 123 new cases per 100 000 population, the highest rate in the country. (34)

Box 1. Description of the socioeconomic support intervention for
tuberculosis prevention and treatment, Peru, 2014-2015

The socioeconomic support intervention comprised an integrated
package of social and economic support. (27) The intervention
targeted outcomes on the tuberculosis causal pathway and promoted
equitable access to tuberculosis programme activities, including:
(i) screening for tuberculosis in contacts of patients; (ii) the
initiation of tuberculosis preventive therapy and completion of
tuberculosis treatment; and (iii) engagement with social support
activities.

Social support comprised household visits and participatory
community meetings that aimed to provide information and mutual
support, empowerment and reduce the stigma of tuberculosis.
Household visits were made shortly after the patient commenced
treatment and involved providing education on tuberculosis
transmission, treatment and preventive therapy and on household
finances. … 
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