50th Union World Conference on Lung Health: Socioeconomic support improves TB prevention

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Science Speaks covered the 50th Union World Conference on Lung Health in Hyderabad, India from Oct. 30 to Nov. 2.

HYDERABAD, INDIA – Accelerating efforts to prevent tuberculosis wherever it is treated has been the rallying cry in Hyderabad during this conference. One study shows that providing financial incentives plus social support not only improves TB treatment completion but increases TB screening and preventative therapy uptake among household members of TB patients.

“TB is the archetypal disease of poverty,” Matthew Saunders of the Imperial College of London said, adding, “TB drives poverty and poverty drives TB.” And nowhere is that more apparent than in Peru, which has the highest incidence of TB per capita and the highest number of multidrug-resistant tuberculosis cases in the Americas, Saunders said.

To assess the impact of socioeconomic support programs on preventative therapy uptake, the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB – or CRESIPT – study provided households of TB patients in sixteen communities in Lima, Peru, with integrated socioeconomic support services, Saunders said, and compared prevention uptake with households that were offered the standard of care. This included offering $500 over six months to households of drug-sensitive TB patients and $800 over six months to households of drug-resistant TB patients to help defray TB care-related costs, including for transportation, nutritional support and compensation for time off from work.

As the average monthly income for residents in the communities enrolled in the study is between $400 and $500, Saunders said, offering participants roughly $83 a month made a significant impact in a household’s ability to cover the non-medical costs associated with TB treatment, Saunders said.

Researchers employed TB survivors to conduct household visits and lead “TB club” meetings with patients and their household members to educate participants on TB infection, care and support, and TB risk factors to reduce knowledge gaps and encourage TB screening, Saunders said. The clubs provided much-needed social support for both patients and their family members at highest risk of TB infection, Saunders said, and provided training to facilitators to identify and effectively respond to negative thoughts from TB patients.

Program implementors prioritized outreach to household members at highest risk of TB infection, including children under 15 those with additional — and often associated —  illnesses that include diabetes or HIV,  Saunders said.

The results were striking, he said. “Household members in the supported communities were significantly more likely to get a TB consultation at a health post,” he said, “and were more likely to provide at least one sputum sample for testing and get a chest x-ray.”

Household members who were older than 15 were 18 times more likely to start and finish TB preventative therapy while members under 15 were three times more likely, compared to participants in the control group, Saunders said.

While the financial incentive played a significant role in aiding patients to complete treatment, Saunders said. “giving money alone wasn’t the answer.”

“It’s clear from qualitative feedback that social support was key,” he said, a that has been made by TB survivors throughout the conference.

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