title: Effects of Ecuador's national monetary incentive program on adherence to treatment for drug-resistant tuberculosis.
abstract: BACKGROUND
  Non-adherence to tuberculosis (TB) treatment jeopardizes patient health and promotes disease transmission. In July 2011, Ecuador's National Tuberculosis Program (NTP) enacted a monetary incentive program giving adherent drug-resistant TB (DR-TB) patients a US240 bonus each month.
  
  
  OBJECTIVE
  To describe patients' experiences with the program qualitatively, and to assess its effects on treatment adherence.
  
  
  METHODS
  We interviewed 92 current and five default patients about their treatment experience. NTP data on DR-TB patients receiving treatment were used to compare 12-month default rates among the incentive program group and non-program controls.
  
  
  RESULTS
  Our interviews found that patients are financially challenged and use the bonus for a variety of expenses, most commonly food. The most common complaint was that bonus payments were frequently delayed. The 1-year default rate among program patients (9.5%) was significantly lower than the rate among pre-program patients (26.7%).
  
  
  CONCLUSIONS
  Ecuador's monetary incentive program alleviates the economic burden placed by treatment on patients. The bonus does not, however, directly address other treatment barriers, including psychological distress and side effects. The program could benefit from timely delivery of payments. Further research is necessary to assess the program's effect on default rates.
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sripad
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: J
authors.initials: J
authors.lastname: Castedo
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA.
authors.forename: N
authors.initials: N
authors.lastname: Danford
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA.
authors.forename: R
authors.initials: R
authors.lastname: Zaha
authors.affiliation: National Tuberculosis Program of Ecuador, Quito, Ecuador.
authors.forename: C
authors.initials: C
authors.lastname: Freile
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D023801:Directly Observed Therapy / Q000191:economics; D024901:Drug Resistance, Multiple, Bacterial; D004484:Ecuador; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D009313:National Health Programs / Q000191:economics*; D017060:Patient Satisfaction; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D012959:Socioeconomic Factors; D013997:Time Factors; D014040:Token Economy; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents