The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil

BackgroundEvidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate.MethodsPropensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll.ResultsThe average effect of treatment on the treated was estimated as the difference in TB treatment success rate between matched groups (ie, the control and exposed patients, n=2167). Patients with TB receiving BFP showed a treatment success rate of 10.58 percentage points higher (95% CI 4.39 to 16.77) than patients with TB not receiving BFP. This association was robust to sensitivity analyses.ConclusionsThis study further confirms a positive relationship between the provision of conditional cash transfers and TB treatment success rate. Further research is needed to understand how to enhance access to social protection so to optimise public health impact.

Download Full-text

The impact of a governmental cash transfer programme on tuberculosis cure rate in Brazil: A quasi-experimental approach

10.1101/311589 ◽

2018 ◽

Author(s):

Daniel J. Carter ◽

Rhian Daniel ◽

Ana W. Torrens ◽

Mauro N. Sanchez ◽

Ethel L. N. Maciel ◽

...

Keyword(s):

Social Protection ◽

Experimental Approach ◽

Conditional Cash Transfer ◽

Cash Transfer ◽

Sensitivity Analyses ◽

Future Research ◽

Cure Rate ◽

Quasi Experimental ◽

The Impact ◽

Positive Effect

AbstractBackgroundSocial vulnerability is strongly associated with tuberculosis (TB) indicators like cure rate. By addressing key social determinants, social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in TB control. Evidence is consolidating around a positive effect of social protection on TB outcomes, however methodological limitations prevent strong conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB cure rate.Methods & FindingsThe data source was Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll. Propensity scores (PSs) were estimated from a complete-case logistic regression using covariates from this linked dataset, informed by a directed acyclic graph. Control patients were matched to exposed patients on the PS and the average effect of treatment on the treated (ATT) was estimated as the difference in TB cure rate between matched groups (n = 2167). The ATT was estimated as 10·58 (95% CIs: 4·39, 16·77). This suggests that 10·58% of the TB patients receiving BFP who were cured would not have been cured had they not received BFP. The direction of this effect was robust to sensitivity analyses performed and the PS matching broadly improved balance, although missing data limited the sample size.ConclusionsThis work is the first quasi-experimental evaluation of social protection in wide-scale practice on TB outcomes. It demonstrates a positive effect of conditional cash transfers on TB cure rate consistent with existing work, suggesting changes to policy and future research on increasing access to social protection for TB patients who remain uncovered by the programme.

Download Full-text

Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00818-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Ni Wang ◽

Lei Guo ◽

Hemant Deepak Shewade ◽

Pruthu Thekkur ◽

Hui Zhang ◽

...

Keyword(s):

Success Rate ◽

Treatment Outcomes ◽

Treatment Success ◽

Coverage Rate ◽

Treatment Success Rate ◽

County Level ◽

Time Data ◽

Tb Treatment ◽

Random Intercept ◽

Relative Change

Abstract Background In China, an indigenously developed electronic medication monitor (EMM) was designed and used in 138 counties from three provinces. Previous studies showed positive results on accuracy, effectiveness, acceptability, and feasibility, but also found some ineffective implementations. In this paper, we assessed the effect of implementation of EMMs on treatment outcomes. Methods The longitudinal ecological method was used at the county level with aggregate secondary programmatic data. All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019, and rifampicin-resistant cases were excluded. We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate, in which a mixed effects maximum likelihood regression using random intercept model was applied, by adjusting for seasonal trends, population size, sociodemographic and clinical characteristics, and clustering within counties. Results Among all 69 678 notified TB cases, the treatment success rate was slightly increased from 93.5% [95% confidence interval (CI): 93.0–94.0] in second quarter of 2018 to 94.9% (95% CI: 94.4–95.4) in second quarter of 2019 after implementing EMMs. There was a statistically significant effect between quarterly EMM coverage and treatment success rate after adjusting for potential confounders (P = 0.0036), increasing 10% of EMM coverage rate will lead to 0.2% treatment success rate augment. Besides, an increase of 10% of elderly or bacteriologically confirmed TB will lead to a decrease of 0.4% and 0.9% of the treatment success rate. Conclusions Under programmatic settings, we found a statistically significant effect between increasing coverage of EMM and treatment success rate at the county level. More prospective studies are needed to confirm the effect of using EMM on TB treatment outcomes. We suggest performing operational research on EMMs that provides real-time data under programmatic conditions in the future.

Download Full-text

Treatment outcome of tuberculosis at Dilla Referral Hospital, Gedeo Zone, southern Ethiopia: A retrospective study

PLoS ONE ◽

10.1371/journal.pone.0249369 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249369

Author(s):

Endrias Markos Woldesemayat ◽

Zewtir Azeze

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Success Rate ◽

Treatment Success ◽

Referral Hospital ◽

Treatment Success Rate ◽

Southern Ethiopia ◽

Hiv Status ◽

Hospital Data ◽

Tb Treatment

Background Tuberculosis (TB) is one of the major public health problems in Ethiopia. Determining treatment outcome of TB cases could help to understand the effectiveness of TB control efforts. The objective of this study was to assess TB treatment outcome and associated factors and determine the risk factors of death among TB cases who were on Directly Observed Treatment Short course (DOTS). Methodology We analyzed a retrospective data for TB cases who were on DOTS at Dilla Referral Hospital from July 2011- June 2016. The study population was TB cases with known HIV status and whose treatment outcome was evaluated at the Hospital. Data were entered, cleaned and analyzed using statistical package SPSS for windows, version 20. Result Out of 899 registered TB cases, 731 included in this analysis. Of these cases, 424 (58.0%) were male and 334 (45.7%) were in the age group of below 25 years. Treatment success rate of TB was 675 (92.3%) and death rate was 18 (2.5%). Treatment outcome showed statistically significant variation by HIV status (P < 0.001). HIV status of the TB cases and pretreatment weight were associated with TB treatment outcome. HIV status of the TB cases was associated with death of the TB cases (Adjusted Odds Ratio (AOR) 5.0; CI 95%: 1.8–13.5). Conclusion TB treatment success rate found in this study was high. Patient’s weight and HIV status were associated with treatment outcome. Moreover, HIV status predicted death of TB cases. Cautious treatment follow-up and defaulter tracing mechanisms for TB cases with these risk factors were suggested.

Download Full-text

Medication Event Monitoring System for Infectious Tuberculosis Treatment in Morocco: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030412 ◽

2019 ◽

Vol 16 (3) ◽

pp. 412 ◽

Cited By ~ 2

Author(s):

Seup Park ◽

Ilham Sentissi ◽

Seung Gil ◽

Won-Seok Park ◽

ByungKwon Oh ◽

...

Keyword(s):

Success Rate ◽

Monitoring System ◽

Treatment Success ◽

Treatment Success Rate ◽

Control Group ◽

Event Monitoring ◽

Tb Treatment ◽

The Mean ◽

Lost To Follow Up

Non-adherence to tuberculosis (TB) treatment is a barrier to effective TB control. We investigated the effectiveness of a Medication Event Monitoring System (MEMS) as a tailored adherence-promoting intervention in Morocco. We compared patients who received a MEMS (n = 206) with patients who received standard TB care (n = 141) among new active TB patients with sputum smear-positive. The mean total medication days were 141.87 ± 29.5 in the control group and 140.85 ± 17.9 in the MEMS group (p = 0.7147), and the mean age and sex were not different between the two groups (p > 0.05). The treatment success rate was significantly higher in the MEMS group than in the control group (odds ratio (OR): 4.33, 95% confidence interval (CI): 2.13–8.81, p < 0.001), and the lost to follow-up rate was significantly lower in the MEMS group than in the control group (OR: 0.03, 95% CI: 0.05–0.24, p < 0.001) after adjusting for sex, age, and health centers. The mean drug adherence rate in the first month was significantly higher in the MEMS group than in the control group (p = 0.023). MEMS increased TB treatment success rate and decreased the lost to follow-up rate overall for infectious TB patients in a Moroccan rural area.

Download Full-text

Treatment outcomes of patients with tuberculosis in war affected region of Khyber Pakhtunkhwa, Pakistan

10.21203/rs.2.9219/v3 ◽

2020 ◽

Author(s):

TAUSEEF AHMAD ◽

Muhammad Ayub Jadoon ◽

Muhammad Khan ◽

Haroon ◽

Muhammad Mumtaz Khan ◽

...

Keyword(s):

Treatment Outcome ◽

Success Rate ◽

Treatment Outcomes ◽

Successful Treatment ◽

Treatment Success ◽

Control Program ◽

Treatment Success Rate ◽

Khyber Pakhtunkhwa ◽

Tb Treatment ◽

Treatment Category

Abstract Background: Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an indicator for the effectiveness of a national TB control program. This study aimed to assess treatment outcomes of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. Methods: A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan, from January 2011 to December 2014. A binary logistic regression models were used to identify factors associated with successful TB treatment outcomes defined as the sum of cure and completed treatment. Results: A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of all patients, 234 (45.44%) were cured and 210 (40.77%) completed treatment. The overall treatment success rate was 444 (86.21%). Age 0-20 years (adjusted odds ratio, AOR= 3.47; 95% confidence interval, CI)= 1.54-7.81; P= 0.003), smear-positive pulmonary TB (AOR)= 3.58; 95% CI= 1.89-6.78; P= <0.001), treatment category (AOR= 4.71; 95% CI= 1.17-18.97; P= 0.029), and year of enrollment 2012 (AOR= 6.26; 95% CI= 2.52-15.59; P= <0.001) were significantly associated with successful treatment outcome. Conclusions: The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. Type of TB, age, treatment category, and year of enrollment were significantly associated with successful treatment outcomes.

Download Full-text

1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1206 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S485-S486

Author(s):

Subencha Pinsai

Keyword(s):

Cohort Study ◽

Treatment Outcome ◽

Hiv Infection ◽

Success Rate ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Treatment Success ◽

Treatment Success Rate ◽

Factors Associated ◽

The Impact

Abstract Background Tuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients. Methods We conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed. Results There were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02). Conclusion There is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients. Disclosures All authors: No reported disclosures.

Download Full-text

Evaluation of Borama tuberculosis control program in Somaliland, Somalia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.7676 ◽

2017 ◽

Vol 11 (02) ◽

pp. 115-122

Author(s):

Mohamed Gedi Qayad ◽

Gianfranco Tarsitani

Keyword(s):

Treatment Failure ◽

Success Rate ◽

Treatment Success ◽

Case Fatality ◽

Control Program ◽

Treatment Interruption ◽

Transfer Rates ◽

Monthly Average ◽

Tb Treatment ◽

The Impact

Introduction: The Borama TB program in Somalia lost resources for TB operations in 2003. We evaluated the impact of the loss on the program. Methodology: Pre-event (2002–2003) and post-event (2007) design were used. All TB patients registered in Borama and a sample of four months from Hargeisa (comparison) TB patients in both periods were abstracted. The following TB treatment outcomes were estimated: treatment success, treatment failure, case fatality, treatment interruption and transfer rates, along with percentage of patients with sputum specimen prior to treatment, percentage of patients from neighboring countries, and monthly average patients enrolled in treatment. The pre-event to post-event outcomes and measures were compared using descriptive and multivariate analyses. Results: In total, 3,367 TB cases were abstracted. In Borama, the TB treatment success rate increased 6% in the post-event. The treatment failure and interruption rates both declined 75%. Monthly average TB patients declined 55%. Percentage of patients smear tested prior to the initiation of the treatment declined 9%. Percentage of TB patients from neighboring countries and other parts of Somalia declined 51%. Treatment interruption/transfer rates declined significantly in the post-event, compared to the pre-event period. Treatment failure/death rate did not change in the post-event period. In Hargeisa, the treatment success, failure/death, and interruption/transfer rates were similar in both periods. The RR did not change in these measures after adjusting for age and gender. Conclusions: This study indicates a significant setback to the Borama TB control program in the majority of measures evaluated, except the TB success rate.

Download Full-text

Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v16i2.9293 ◽

2021 ◽

Author(s):

Tsegay Legesse ◽

Mohammed Hussein Elduma ◽

Nagi Masoud Awad ◽

Mousab Siddig Elhag ◽

Israa Abushama ◽

...

Keyword(s):

Treatment Outcome ◽

Success Rate ◽

Treatment Outcomes ◽

Treatment Success ◽

Treatment Success Rate ◽

Refugee Camps ◽

Historical Cohort ◽

Tb Treatment ◽

Unsuccessful Treatment ◽

Lost To Follow Up

Background: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017. Methods: This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment. Results: A total of 710 TB cases of which 53.4% were men, 22.1% children (<15 years), and 36.2% extrapulmonary TB (EPTB) were registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome. Conclusion: The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.

Download Full-text

The Factors associated with the unsuccessful tuberculosis treatment of hill tribe patients in Thailand

The Journal of Infection in Developing Countries ◽

10.3855/jidc.12029 ◽

2020 ◽

Vol 14 (01) ◽

pp. 42-47

Author(s):

Siriyaporn Khunthason ◽

Jaranit Kaewkungwal ◽

Wirichada Pan-Ngum ◽

Chusak Okascharoen ◽

Tawatchai Apidechkul ◽

...

Keyword(s):

Success Rate ◽

Treatment Success ◽

Public Health Problem ◽

Antiretroviral Drugs ◽

Tuberculosis Treatment ◽

Treatment Success Rate ◽

Factors Associated ◽

Tb Treatment ◽

Hill Tribe ◽

The Hill

Introduction: Tuberculosis (TB) remains a serious public-health problem worldwide. The successful tuberculosis treatment was in low rate among the hill tribes in Thailand. This study aimed to determine factors associated with the unsuccessful tuberculosis treatment among the hill tribe TB patients in northern Thailand. Methodology: A retrospective cohort study was conducted using secondary data from the national TB reporting system. Data of newly registered hill tribe patients with TB receiving treatment were obtained from 18 government hospitals in Chiang Rai province, during 2014–2017. TB treatment outcomes and factors associated with unsuccessful were determined. Results: A total of 770 hill tribe patients with TB registered during the study period. The majority were males aged 25–64 years. About 80% of the patients lived in rural areas and 53.9% worked in agriculture. The overall TB treatment success rate was 80.4%. Two factors were associated with unsuccessful TB treatment: ages 25–44 and ages 45–64 (aOR 3.14 (1.03–9.55) and 3.02 (1.01–9.03), respectively) and receiving antiretroviral drugs (proxy of HIV infection) (aOR 2.30 (1.02–5.15)). Conclusion: Although the TB treatment success rate among hill tribe patients did not reach the national goal, it was still higher than that of other Thai TB patients in the area. In Thailand, hill tribe people can access health services free-of-charge under the national health insurance. This could influence the successful treatment. However, some barriers need to be considered, such as the high default rate and high death rate among those with HIV coinfection.

Download Full-text

Analysis of Treatment Outcome in Patients with Tuberculosis in War Affected Region of Khyber Paktunkhwa, Pakistan

10.21203/rs.2.9219/v1 ◽

2019 ◽

Author(s):

TAUSEEF AHMAD ◽

Muhammad Ayub Jadoon ◽

Muhammad Khan ◽

Muhammad Mumtaz Khan ◽

Akbar Hussain ◽

...

Keyword(s):

Treatment Outcome ◽

Success Rate ◽

Successful Treatment ◽

Treatment Success ◽

Case Fatality ◽

Treatment Success Rate ◽

Control Programs ◽

Successful Treatment Outcome ◽

Tb Treatment ◽

Treatment Category

Abstract ABSTRACT Background Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an indicator for the effectiveness of a national TB control programs. This study aimed to assess treatment outcome of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. Methods A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan. Distribution of TB types, treatment outcome and associated factor with successful treatment was computed using SPSS version 20.0 software for windows. Results A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of the total, 234 (45.44%) were cured and 210 (40.77%) completed treatment with overall treatment success rate was 444 (86.21%). Age 0-20 years (AOR= 3.47; 95% CI= 1.54-7.81; P= 0.003), smear-positive pulmonary TB (SPPTB) (AOR= 3.58; 95% CI= 1.89-6.78; P= <0.001), treatment category (AOR= 4.71; 95% CI= 1.17-18.97; P= 0.029), and year of enrollment 2012 (AOR= 6.26; 95% CI= 2.52-15.59; P= <0.001) were significantly associated with successful treatment outcome. Conclusions The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. An increase was observed in overall case-fatality rate during the study duration which is an alarming signal for public health.

Download Full-text