Abstract
Background Mitigating financial barriers to tuberculosis (TB) diagnosis and treatment is a core priority of the global TB agenda. We evaluated the impact of a cash transfer (CT) intervention on completion of TB testing and treatment initiation in Uganda.
Methods We conducted a pragmatic complete stepped-wedge randomized trial of a one-time unconditional CT at ten health centers between September 2019-March 2020. People referred for sputum-based TB testing were enrolled to receive 20 000 Uganda Shillings (∼US$5·39) upon sputum submission. The primary outcome was the number initiating treatment for micro-bacteriologically confirmed TB within two weeks of initial evaluation. The primary analysis included cluster-level intent-to-treat and per-protocol analyses using negative binomial regression.
Results 4288 people were eligible. The number diagnosed with TB initiating treatment was higher in the intervention period versus the pre-intervention period (adjusted Rate Ratio (aRR)=1·34) with a 95% confidence interval (CI) of 0·62–2·91 (p=0·46), indicating a wide range of plausible true intervention effects. More were referred for TB testing (aRR=2·60, 95%CI: 1·86–3·62; p<0·001) and completed TB testing (aRR=3·22, 95%CI: 1·37–7·60; p=0·007) per National Guidelines. Results were similar, but attenuated in per-protocol analyses. Surveys revealed that while the CT supported testing completion, it was insufficient to address long-term underlying social/economic barriers.
Interpretation While it is uncertain whether a single unconditional CT increased the number of people diagnosed and treated for TB, it did support higher completion of diagnostic evaluation in a programmatic setting. A one-time CT may offset some but not all of the social/economic barriers to improving TB diagnosis outcomes.
Footnotes
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Conflict of interest: The authors declare no competing interests.
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- Received February 16, 2023.
- Accepted April 12, 2023.
- Copyright ©The authors 2023
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