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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Economic support to improve tuberculosis treatment outcomes in South Africa: A pragmatic cluster-randomized controlled trial
Trials, Volume 14, No. 1, Article 154, Year 2013
Notification
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Description
Background: Poverty undermines adherence to tuberculosis treatment. Economic support may both encourage and enable patients to complete treatment. In South Africa, which carries a high burden of tuberculosis, such support may improve the currently poor outcomes of patients on tuberculosis treatment. The aim of this study was to test the feasibility and effectiveness of delivering economic support to patients with pulmonary tuberculosis in a high-burden province of South Africa.Methods: This was a pragmatic, unblinded, two-arm cluster-randomized controlled trial, where 20 public sector clinics acted as clusters. Patients with pulmonary tuberculosis in intervention clinics (n = 2,107) were offered a monthly voucher of ZAR120.00 (approximately US$15) until the completion of their treatment. Vouchers were redeemed at local shops for foodstuffs. Patients in control clinics (n = 1,984) received usual tuberculosis care.Results: Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (95% confidence interval: -1.2%, 12.3%), P = 0.107). Low fidelity to the intervention meant that 36.2% of eligible patients did not receive a voucher at all, 32.3% received a voucher for between one and three months and 31.5% received a voucher for four to eight months of treatment. There was a strong dose-response relationship between frequency of receipt of the voucher and treatment success (P <0.001).Conclusions: Our pragmatic trial has shown that, in the real world setting of public sector clinics in South Africa, economic support to patients with tuberculosis does not significantly improve outcomes on treatment. However, the low fidelity to the delivery of our voucher meant that a third of eligible patients did not receive it. Among patients in intervention clinics who received the voucher at least once, treatment success rates were significantly improved. Further operational research is needed to explore how best to ensure the consistent and appropriate delivery of such support to those eligible to receive it.Trial registration: Current Controlled Trials ISRCTN50689131. © 2013 Lutge et al.; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3680200/bin/1745-6215-14-154-S1.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC3680200/bin/1745-6215-14-154-S2.docx
Authors & Co-Authors
Lutge, Elizabeth Eleanor
South Africa, Cape Town
Stellenbosch University, Faculty of Medicine and Health Sciences
South Africa, Cape Town
Health Systems Trust
Lewin, Simon A.
South Africa, Tygerberg
South African Medical Research Council
Norway, Oslo
Nasjonalt Kunnskapssenter for Helsetjenesten
Volmink, Jimmy A.
South Africa, Cape Town
Stellenbosch University, Faculty of Medicine and Health Sciences
South Africa, Tygerberg
South African Medical Research Council
Friedman, Irwin B.
South Africa, Cape Town
Health Systems Trust
Lombard, Carl J.
South Africa, Tygerberg
South African Medical Research Council
Statistics
Citations: 51
Authors: 5
Affiliations: 4
Identifiers
Doi:
10.1186/1745-6215-14-154
e-ISSN:
17456215
Study Design
Randomised Control Trial
Study Approach
Quantitative
Study Locations
South Africa