title: Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities.
abstract: Cash transfer interventions are forms of social protection based on the provision of cash to vulnerable households with the aim of reduce risk, vulnerability, chronic poverty and improve human capital. Such interventions are already an integral part of the response to HIV/AIDS in some settings and have recently been identified as a core element of World Health Organization's End TB Strategy. However, limited impact evaluations and operational evidence are currently available to inform this policy transition.
  
  
  
  This paper aims to assist national tuberculosis (TB) programs with this new policy direction by providing them with an overview of concepts and definitions used in the social protection sector and by reviewing some of the most critical operational aspects associated with the implementation of cash transfer interventions. These include: 1) the various implementation models that can be used depending on the context and the public health goal of the intervention; 2) the main challenges associated with the use of conditionalities and how they influence the impact of cash transfer interventions on health-related outcomes; 3) the implication of targeting diseases-affected households and or individuals versus the general population; and 4) the financial sustainability of including health-related objectives within existing cash transfer programmes. We aimed to appraise these issues in the light of TB epidemiology, care and prevention. For our appraisal we draw extensively from the literature on cash transfers and build upon the lessons learnt so far from other health outcomes and mainly HIV/AIDS.
  
  
  
  The implementation of cash transfer interventions in the context of TB is still hampered by important knowledge gaps. Initial directions can be certainly derived from the literature on cash transfers schemes and other public health challenges such as HIV/AIDS. However, the development of a solid research agenda to address persisting unknowns on the impact of cash transfers on TB epidemiology and control is vital to inform and support the adoption of the post-2015 End TB strategy.
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, WC1E 7HT, London, UK. Delia.Boccia@lshtm.ac.uk.
authors.forename: Delia
authors.initials: D
authors.lastname: Boccia
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, WC1E 7HT, London, UK.
authors.forename: Debora
authors.initials: D
authors.lastname: Pedrazzoli
authors.affiliation: Infectious Disease & Immunity and Wellcome Trust Centre for Global Health Research, Imperial College, London, UK.|The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Wingfield
authors.affiliation: World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Jaramillo
authors.affiliation: World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Knut
authors.initials: K
authors.lastname: Lönnroth
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, WC1E 7HT, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Lewis
authors.affiliation: London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Hargreaves
authors.affiliation: Infectious Disease & Immunity and Wellcome Trust Centre for Global Health Research, Imperial College, London, UK.|Innovation For Health And Development (IFHAD), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Carlton A
authors.initials: CA
authors.lastname: Evans
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005191:Family Characteristics; D005378:Financial Support; D006291:Health Policy; D006801:Humans; D011203:Poverty; D011634:Public Health; D064890:Social Determinants of Health; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D035862:Vulnerable Populations; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents
keywords: Cash transfer; Co-financing; Conditionality; Implementation; Social protection; Targeting; Tuberculosis