title: Do incentives improve tuberculosis treatment outcomes in the Republic of Moldova?
abstract: METHODS
  Tuberculosis (TB) health facilities in the Republic of Moldova, where various incentives were provided to TB patients to improve treatment outcomes.
  
  
  OBJECTIVE
  To compare treatment outcomes among new drug-susceptible TB patients registered for treatment before (2008) and after (2011) introduction of incentives.
  
  
  METHODS
  Retrospective cohort study using data from the national electronic patient database and incentive registers.
  
  
  RESULTS
  Of 2378 patients registered in 2011, 1895 (80%) received incentives (cash, food vouchers, travel reimbursement). Compared to 2008 (no incentives, n = 2492), the patients registered with incentives in 2011 had higher treatment success (88% vs. 79%, P < 0.001) and lower proportions of unsuccessful outcomes: loss to follow-up (5% vs. 10%, P < 0.001), death (5% vs. 6%, P = 0.03) and failure (2% vs. 5%, P < 0.001). In multivariate analysis (log-binomial regression) using the intention-to-treat approach, provision of incentives was independently associated with an overall reduction in unsuccessful outcomes of 50% (RR 0.5, 95%CI 0.45-0.62, P < 0.001), after adjusting for other confounders such as sex, age, education, occupation, residence, homelessness, type of TB and human immunodeficiency virus status.
  
  
  CONCLUSIONS
  Provision of incentives to TB patients significantly improved treatment success rates and needs to continue. Treatment retention increased, thus potentially preventing drug resistance, a serious problem in the Republic of Moldova.
authors.affiliation: 'Chiril Draganiuc' Institute of Phthisiopneumology, Chisinau, Republic of Moldova.
authors.forename: A
authors.initials: A
authors.lastname: Ciobanu
authors.affiliation: 'Chiril Draganiuc' Institute of Phthisiopneumology, Chisinau, Republic of Moldova.
authors.forename: L
authors.initials: L
authors.lastname: Domente
authors.affiliation: Center for Health Policies and Studies, Chisinau, Republic of Moldova.
authors.forename: V
authors.initials: V
authors.lastname: Soltan
authors.affiliation: Center for Health Policies and Studies, Chisinau, Republic of Moldova.
authors.forename: S
authors.initials: S
authors.lastname: Bivol
authors.affiliation: 'Act for Involvement' Health Development Center, Chisinau, Republic of Moldova.
authors.forename: L
authors.initials: L
authors.lastname: Severin
authors.affiliation: National Centre of Health Management, Chisinau, Republic of Moldova.
authors.forename: V
authors.initials: V
authors.lastname: Plesca
authors.affiliation: Operational Centre Brussels, Operational Research Unit (LuxOR), Médecins Sans Frontières, Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: de Colombani
keywords: Eastern Europe; SORT IT; incentives; operational research; tuberculosis