Providing tuberculosis (TB) patients with advice and money can help them to finish their treatment and recover, finds a new study involving UCL researchers.
The research, published in The Lancet Infectious Diseases, demonstrated that patients who received counselling and cash incentives (around $10) for turning up to appointments on time, had a 52% lower relative risk of having an unsuccessful treatment outcome.
The interventions also reduced loss to follow-up (i.e. people who either do not start treatment or who stopped treatment during care) among TB patients in South Africa.
Cash transfers were conditional upon participants attending their appointments within the prespecified time period, which included returning for their results and starting treatment, as well as the monthly follow-up visits until the end of treatment.
Joint senior author of the paper, Professor Ibrahim Abubakar, Dean for the Faculty of Population Health Sciences, and Pro-Provost Health at UCL, conducted the research alongside study leads, Professor Nazir Ismail (University of the Witwatersrand, Johannesburg) and Dr Harry Moultrie (South Africa's Institute for Communicable Diseases).
Professor Abubakar, said: "We are delighted that this partnership with the University of Witwatersrand, Johannesburg, has resulted in this policy relevant evidence, with implications for South African and global tuberculosis control and elimination."
For the study, the researchers conducted a randomised controlled trial across nine clinics in Johannesburg, between October 2018 and March 2020.
The trial involved two groups of people (total 4,110 people) aged 18 years and older who were being checked for TB. One group received the usual care, and the other group received pre-test and post-test TB counselling and money if they came to their appointments on time.
The intervention resulted in halving unsuccessful TB outcomes compared to standard care.
Additionally, TB patients who received counselling and conditional cash transfers were significantly more likely to complete treatment successfully (82% vs. 65.6% in the control group).
Pretreatment loss to follow-up, that is, individuals who did not return and start treatment, was reduced from 15.8% to 3.9%, indicating improved engagement in care.
Professor Ismail said: "Our findings bring us closer to the 90-90-90 TB targets, which aim for 90% treatment success. By addressing financial and behavioural barriers, this approach can help reduce disease transmission and improve public health outcomes."
90-90-90 refers to 90% of people with TB are diagnosed, 90% of those diagnosed are put on treatment, and 90% of those on treatment are successfully treated.
The study was a collaboration between the University of the Witwatersrand, Johannesburg (Wits University), South Africa's National Institute for Communicable Diseases (NICD), the South African Human Sciences Research Council (HSRC), and UCL.
The South African Medical Research Council (SAMRC), the UK Medical Research Council, and the Newton Fund funded the study.
