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Social intervention in Brazil increases rate of TB cure by 7.6%

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January 21, 2019

The Bolsa Familia Programme — a conditional cash transfer program in Brazil — directly affects tuberculosis treatment outcomes, demonstrating a 7.6% higher rate of cure, according to findings published in The Lancet Global Health.

Created in 2006, the Bolsa Familia Programme (BFP) is one of the largest conditional cash transfer programs in the world, providing financial assistance to families with pregnant or lactating women or children and adolescents aged 17 years or younger, according to the study. Households must participate in pro-health and educational activities to receive income assistance from the program.

“Although the number of tuberculosis cases, and the associated incidence and mortality in Brazil has decreased in the past 15 years, important challenges remain for sustaining improvements in tuberculosis prevention and care,” Janaina Gomes Nascimento Oliosi, MSc, from the Federal University of Espirito Santo in Vitoria, Brazil, and colleagues wrote.

To evaluate the independent effect BFP may have on TB treatment outcomes, Oliosi and colleagues conducted a prospective cohort study at 42 health care centers in seven cities across Brazil. Treatment outcome, which included cure, dropout, death, treatment failure or development of drug-resistant TB, was recorded after 6 months of therapy.

infographic about TB social intervention 
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The study enrolled 1,239 patients aged 18 years or older who had initiated TB treatment between March 1, 2014, and April 30, 2017. BFP beneficiaries comprised 16% (n = 196) of the cohort and non-BFP individuals comprised the other 84% (n = 1,043). In the non-BFP group, 87% of patients were cured of TB, 10% dropped out and 3% died, after 6 months of treatment. In the BFP group, 88% of patients were cured of TB, 9% dropped out and 3% died, after 6 months of treatment. Additionally, less than 1% of patients in the non-BFP group developed drug-resistant TB, according to the study.

Although the proportions of patients achieving cure were similar between the BFP and non-BFP groups, Oliosi and colleagues observed a 7.6% (average effect = 0.076; 95% CI, 0.037-0.11) higher rate of cure among BFP beneficiaries after conducting propensity score matching. Moreover, they also found that the dropout rate was 7% (average effect = –0.07; 95% CI, 0.105-0.036) lower in the BFP group compared with that in the non-BFP group.

The researchers suggest that enrollment in the BFP directly affects the treatment outcome for TB.

“Our data highlight the social and economic disadvantages experienced by patients with tuberculosis (with or without BFP), supporting the rationale for interventions that address these potentially unmet social needs,” Oliosi and colleagues wrote. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

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