title: The economic effects of supporting tuberculosis-affected households in Peru.
abstract: The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention.The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months.From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22-38%) versus 42% (95% CI 34-51%)). The mitigation impact was higher among poorer households.The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies.
authors.affiliation: Innovation for Health and Development (IFHAD), Section of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK tom.wingfield@ifhad.org.|Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.|The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK.|Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.|Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Wingfield
authors.affiliation: Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.|IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Tovar
authors.affiliation: Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.|Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Doug
authors.initials: D
authors.lastname: Huff
authors.affiliation: Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.|Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Delia
authors.initials: D
authors.lastname: Boccia
authors.affiliation: Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.
authors.forename: Rosario
authors.initials: R
authors.lastname: Montoya
authors.affiliation: IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Eric
authors.initials: E
authors.lastname: Ramos
authors.affiliation: Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.|Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: James J
authors.initials: JJ
authors.lastname: Lewis
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Innovation for Health and Development (IFHAD), Section of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK.|Innovación Por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú.|IFHAD, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Carlton A
authors.initials: CA
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003140:Communicable Disease Control; D005191:Family Characteristics; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D007182:Income; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018803:Models, Economic; D010568:Peru; D011203:Poverty; D011634:Public Health; D012944:Social Support; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D055815:Young Adult