Cape Town | Findings from a Cochrane systematic review conducted by the South African Medical Research Council (SAMRC) suggest that financial incentives may be an effective tool in the fight against tuberculosis but more research is required to evaluate effects on long-term outcomes.
The review, conducted by Cochrane South Africa which is a research unit of the SAMRC, asked whether providing money, vouchers or food to people with tuberculosis increased the number of people who attended clinic appointments and completed treatment. Given the growth of antibiotic resistance tuberculosis over the last decade, ensuring effective treatment has become a public health priority.
Tuberculosis remains largely a disease of poverty, where overcrowding and undernutrition facilitate the spread of the disease from person-to-person. Indeed, tuberculosis can also exacerbate poverty by placing a substantial financial burden on patients even where drugs are given free. Patients are often required to attend multiple clinic appointments, incurring travel costs and time off from work. Patients are then left with difficult choices to make as they choose between providing for their families or completing their treatment. Consequently, there has been public health and research interest in the use of financial interventions to offset the costs of treatment and incentivize patients to attend their appointments.
“We found some evidence that cash incentives, in particular, improved once-off clinic re-attendance” says Principal Author of the Cochrane Review Dr Elizabeth Lutge. “But more research is urgently needed to look at the potential long-term effects”
“We only found two studies which had looked at the long-term effects of financial incentives, and the findings were interesting but inconclusive” she continued.
“In East Timor, a free daily hot-meal was used as an incentive but not well received by the population due to the inconvenience of attending the clinic at midday. In addition, conflict in the area affected clinic attendance and therefore participation in the trial. In the second trial, the nurses distributing the vouchers chose to "ration" their distribution among eligible patients and consequently decreased the power of this trial to detect a statistically significant result.
Cochrane South Africa conducts systematic reviews that aim to enhance evidence-informed health policy and practice for South Africa, the African region and internationally. Its current research focus areas include nutrition and food systems; infectious diseases; immunisation; and, clinical guideline development and implementation in South African primary care.
“Research focusing on adherence is crucial in a South African context where patients’ failure to adhere to treatment schedules plays a major role in the overall mismanagement of curable diseases such as TB,” Dr Lutge adds. “We have to find the most innovative mechanisms to manage treatment adherence.”
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