Social services support improved adherence to tuberculosis treatment

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The following is a guest post by Siân L. Curtis of MEASURE Evaluation

People treated for tuberculosis in Ukraine are more likely to stay on their medication if they receive some social services, according to a study conducted by MEASURE Evaluation, funded by USAID.

Ukraine is among 20 countries that have the world’s highest burden of drug-resistant TB and so is an important locale for determining best-practice strategies in the fight against TB, especially multi-drug resistant tuberculosis. The evaluators consulted medical records from 2011 to 2012 for the study—just published by the PLOS Tuberculosis Channel — and showed that people being treated for MDR-TB are 10 percent more likely to complete their full course of treatment if social support is included. Read the full article here.

The study identified factors predictive of treatment default and used regression analyses to estimate the impact of the social support program on default. Typically, TB clients must go to a clinic that administers the medication — a practice termed directly observed therapy short-course, or DOTS. For the cohort receiving social services, a clinician delivered medication to their home and clients received food packages, psychological and career counseling, vouchers for transportation, or other necessities, based on their needs.

The authors recommend further research to quantify the costs and benefits for scaling up social support services and to evaluate program fidelity, identify which populations respond best to select services, and what barriers exist to achieve better adherence.

Additional information is available from a 2018 study: Helping People with Tuberculosis in Ukraine Stay in Treatment – Findings from a Qualitative Analysis of a Social Support Program. This qualitative study brief offers a patient perspective on the hardships of going to the clinic to receive medication and cope with side effects, understanding that feeling better does not indicate treatment should stop, and coping with psychological issues such as denial, depression, and the social stigma of having TB.

Siân L. Curtis, PhD is a Senior Evaluation Specialist at MEASURE Evaluation, and Associate Professor, UNC Gillings School of Global Public Health

Citation: Skiles, M.P., Curtis, S.L., Angeles, G, Mullen, S., Senik, T. (2018) Evaluating the impact of social support services on tuberculosis treatment default in Ukraine. PLOS One. August 9, 2018.

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