Economic support intervention improves tuberculosis treatment outcomes in rural Nigeria

• Published in: The international journal of tuberculosis and lung disease Vol. 21; no. 5; pp. 564 - 570
• Main Authors: Ukwaja, K. N., Alobu, I., Gidado, M., Onazi, O., Oshi, D. C.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.05.2017; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Adherence; Adult; Antitubercular Agents - administration & dosage; Antitubercular Agents - economics; Cash Transfer; Clinical outcomes; Demographics; Drug-Susceptible Tb; Failure rates; Feasibility Studies; Female; HIV; Human immunodeficiency virus; Humans; Incentives; Incentives And Enablers; Intervention; Lost to Follow-Up; Male; Medication Adherence; Monetary incentives; Motivation; Nigeria; Patient compliance; Patients; Poverty; Prospective Studies; Rural Population - statistics & numerical data; Sex Factors; Sex ratio; Smear; Sputum; Sputum - microbiology; Success; Treatment Outcome; Treatment Success; Tuberculosis; Tuberculosis - drug therapy; Viruses; Nigeria
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.16.0741

SETTING: A secondary care hospital in rural Nigeria.OBJECTIVE: To investigate the feasibility of providing financial incentives to tuberculosis (TB) patients under routine conditions, and to determine their impact on TB treatment outcomes in a low-resource setting.DESIGN: A prospective, non-randomised intervention study.RESULTS: A total of 294 TB patients (respectively 173 and 121 in the control and intervention periods of 3 months' duration each) were registered in the study. The patients did not differ in terms of their demographic or clinical characteristics (P not significant). The treatment success rate was 104/121 (86.0%) during the intervention, and 123/173 (71.1%) during the control period (P = 0.003). The proportion of patients who were lost to follow-up significantly decreased during the intervention period (20.2% vs. 5.0%, P <0.001). There were no differences in deaths (P = 0.8) or treatment failure rates (P = 0.5) in the intervention and control periods. There was also no difference in the rate of sputum smear conversion after the intensive phase of treatment (88.1% vs. 91.5%, P = 0.5). Independent determinants of treatment success were female sex (adjusted odds ratio [aOR] 1.9), human immunodeficiency virus negativity (aOR 2.5) and receiving financial incentives (aOR 2.3).CONCLUSIONS: Financial incentives proved to be effective in improving treatment success and reducing loss to follow-up among poor TB patients in Nigeria.