A household-randomized controlled evaluation of socioeconomic support to improve tuberculosis preventive therapy initiation and increase tuberculosis treatment success, Peru

Abstract

Objective. The End TB Strategy advocates socioeconomic support for TB-affected households but there is limited impact assessment. We evaluated the impact of socioeconomic support on TB: preventive therapy initiation in contacts; and treatment success in patients, and refined the support for the “Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB” (CRESIPT) project. Methods. Design: An un-blinded household-randomized controlled study. Setting: 32 shantytown communities, Peru. Participants: All consenting patients treated for TB disease by the Peruvian TB Program and their contacts aged <20 years. Randomisation: Patient households were randomly assigned to control (received Peruvian TB Program standard of care) or intervention (additionally received socioeconomic support) arms. Socioeconomic support: consisted of economic support (conditional cash transfers ≤230 United States dollars) integrated with social support (household visits and community meetings) throughout TB treatment. Outcomes: compared intervention versus control households using logistic regression adjusting for household-clustering. Findings. Between February 2014 and August 2014, 90% (282/312) of patients participated, 135 randomized to intervention and 147 to control arms. Primary outcome was TB preventive therapy initiation in contacts aged <20 years (n=410). This increased from 25% in controls to 43% in the intervention arm (adjusted odds ratio, aOR=2.2, 95% confidence interval, CI=1.1-4.2, p=0.02). Secondary outcome was an intention-to-treat analysis of patient TB treatment success (cure or completed treatment). This increased from 53% in controls to 64% in the intervention arm (OR=1.6, 95%CI=1.0-2.6, p=0.05). This increase was equitable, independent of poverty. Conclusion. A TB-specific socioeconomic support intervention improved TB preventive therapy initiation and TB treatment success