title: Designing and implementing a socioeconomic intervention to enhance TB control: operational evidence from the CRESIPT project in Peru.
abstract: BACKGROUND
  Cash transfers are key interventions in the World Health Organisation's post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource-constrained shantytowns in Lima, Peru for: the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project.
  
  
  METHODS
  Newly-diagnosed TB patients from study-site healthposts were eligible to receive the intervention consisting of economic and social support. Economic support was provided to patient households through cash transfers on meeting the following conditions: screening for TB in household contacts and MDR TB in patients; adhering to TB treatment and chemoprophylaxis; and engaging with CRESIPT social support (household visits and community meetings). To evaluate project acceptability, quantitative and qualitative feedback was collected using a mixed-methods approach during formative activities. Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and stakeholders.
  
  
  RESULTS
  Over 7 months, 135 randomly-selected patients and their 647 household contacts were recruited from 32 impoverished shantytown communities. Of 1299 potential cash transfers, 964 (74 %) were achieved, 259 (19 %) were not achieved, and 76 (7 %) were yet to be achieved. Of those achieved, 885/964 (92 %) were achieved optimally and 79/964 (8 %) sub-optimally. Key project successes were identified during 135 formative activities and included: strong multi-sectorial collaboration; generation of new evidence for TB-specific cash transfer; and the project being perceived as patient-centred and empowering. Challenges included: participant confidence being eroded through cash transfer delays, hidden account-charges and stigma; access to the initial bank-provider being limited; and conditions requiring participation of all TB-affected household members (e.g. community meetings) being hard to achieve. Refinements were made to improve project acceptability and future impact: the initial bank-provider was changed; conditional and unconditional cash transfers were combined; cash transfer sums were increased to a locally-appropriate, evidence-based amount; and cash transfer size varied according to patient household size to maximally reduce mitigation of TB-related costs and be more responsive to household needs.
  
  
  CONCLUSIONS
  A novel TB-specific socioeconomic intervention including conditional cash transfers has been designed, implemented, refined and is ready for impact assessment, including by the CRESIPT project. The lessons learnt during this research will inform policy-makers and decision-makers for future implementation of related interventions.
authors: Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru. tom.wingfield@ifhad.org.|Innovation For Health And Development (IFHAD), Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK. tom.wingfield@ifhad.org.|The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK. tom.wingfield@ifhad.org.
authors: Tom
authors: T
authors: Wingfield
authors: Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru. delia.boccia@lshtm.ac.uk.|Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. delia.boccia@lshtm.ac.uk.
authors: Delia
authors: D
authors: Boccia
authors: Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru. marco.tovar@ifhad.org.|Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru. marco.tovar@ifhad.org.
authors: Marco A
authors: MA
authors: Tovar
authors: Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru. dhuff@tulane.edu.|Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. dhuff@tulane.edu.
authors: Doug
authors: D
authors: Huff
authors: Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru. Rosario.montoya@ifhad.org.
authors: Rosario
authors: R
authors: Montoya
authors: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. James.Lewis@lshtm.ac.uk.
authors: James J
authors: JJ
authors: Lewis
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. gilmanbob@gmail.com.
authors: Robert H
authors: RH
authors: Gilman
authors: Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru. carlton.evans@ifhad.org.|Innovation For Health And Development (IFHAD), Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK. carlton.evans@ifhad.org.|Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru. carlton.evans@ifhad.org.
authors: Carlton A
authors: CA
authors: Evans
mesh_terms: D003140:Communicable Disease Control / Q000191:economics / Q000458:organization & administration*; D005191:Family Characteristics; D006284:Health Plan Implementation; D006801:Humans; D018803:Models, Economic; D009042:Motivation; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010568:Peru; D016730:Program Development; D014397:Tuberculosis, Pulmonary / Q000191:economics / Q000517:prevention & control*; D014944:World Health Organization