‘PREVENT TB’-Improving determinants of TB cure, prevention & diagnosis
INCORPORATING: ‘CRESIPT’ Community Randomised Evaluation of a Socioeconomic Intervention to Prevent TB
BACKGROUND: Poverty is one of the greatest obstacles to tuberculosis (TB) control because poverty hampers TB care and increases TB risk factors.
RATIONALE: Socioeconomic support has become an important component of international TB control policy, but impact and operational evidence are needed.
STUDY: A community-randomised controlled study assessing socioeconomic support for TB patients and their household members.
SETTING: Communities in Callao, Peru that have frequent TB and poverty.
POPULATION: Patients commencing treatment for TB disease administered by the Peruvian TB control program, and those patients’ household members, are all invited to give informed written consent to participate.
SOCIOECONOMIC SUPPORT PACKAGE ACTIVITIES: (the study intervention activities or outputs): are led by recovering TB patients (who are termed peer mentors) and consist of integrated:
A) social support constituting household visits and TB clubs providing information and peer support; and
B) economic support constituting cash transfers as incentives & enablers, defraying household’s average TB-related costs.
OUTCOMES: aim to benefit patients, household members and their communities:
1.Empower TB patients and their household members.
1a. Social empowerment reducing TB-related knowledge gaps, stigma effects, depression and marginalisation; and facilitating community engagement in a TB advocacy civil society.
1b. Economic empowerment reducing impoverishing effects of TB-related household costs and preventing catastrophic costs.
1c. Empowering equitable access to and completion of TB program activities, tests and medicines.
1d. Reducing TB risk factors determined with reference to randomly selected community controls.
2a.Cure TB patients long-term whilst 2b. evaluating predictors of cure.
3a.Find TB in those at high risk whilst 3b. evaluating TB testing strategies.
4a.Prevent TB in patient’s households whilst 4b. evaluating predictors of TB risk.
5.Control TB, impacting community case notification rates.
RANDOMISATION: The socioeconomic support package is offered only in 16 randomly selected ‘supported’ communities for 2 years.
EVALUATION: compares outcomes in the 16 ‘supported’ communities and 16 randomly selected ‘comparison’ communities that do not receive the socioeconomic support package. Evaluation includes a final prevalence survey for all patients and their household members to check for TB recurrence and prevalent TB.
IMPACT: Strengthened policies and practices reducing TB, associated distress & impoverishment.
Further information is available from: Carlton.Evans@IFHAD.org