Designing and Implementing a Socioeconomic Intervention to Enhance TB Control: Operational Evidence from the CRESIPT Project in Peru

Below:  Conceptual framework of the conditional cash transfer scheme within the CRESIPT project

Below:  Flow diagram of CRESIPT project activities during planning, implementation and refinement of the social protection intervention

Below:  Cash transfer received by participants in seven different potential scenarios during intervention implementation. Note: Typically in Peru, treatment of TB in people with non-MDR TB has a duration of 6 months, in people with HIV-TB co-infection treatment lasts 9 months, and in people with MDR TB treatment lasts 24 months. Key: ✓ = condition optimally achieved and double incentive cash transfer provided; X = condition not achieved thus no incentive cash transfer given/paid

Below:  a Proportion of patients optimally achieving (double incentive), adequately achieving (simple incentive) and not yet achieving project conditions. b Total amount provided to patients by conditional cash transfers in total and for each condition achieved

Over 7 months, 135 randomly-selected patients and their 647 household contacts were recruited from 32 impoverished shantytown communities. Of 1299 potential cash transfers, 964 (74 %) were achieved, 259 (19 %) were not achieved, and 76 (7 %) were yet to be achieved. Of those achieved, 885/964 (92 %) were achieved optimally and 79/964 (8 %) sub-optimally.

Key project successes were identified during 135 formative activities and included: strong multi-sectorial collaboration; generation of new evidence for TB-specific cash transfer; and the project being perceived as patient-centred and empowering.

Challenges included: participant confidence being eroded through cash transfer delays, hidden account-charges and stigma; access to the initial bank-provider being limited; and conditions requiring participation of all TB-affected household members (e.g. community meetings) being hard to achieve.

Refinements were made to improve project acceptability and future impact: the initial bank-provider was changed; conditional and unconditional cash transfers were combined; cash transfer sums were increased to a locally-appropriate, evidence-based amount; and cash transfer size varied according to patient household size to maximally reduce mitigation of TB-related costs and be more responsive to household needs.

Conclusions

A novel TB-specific socioeconomic intervention including conditional cash transfers has been designed, implemented, refined and is ready for impact assessment, including by the CRESIPT project. The lessons learnt during this research will inform policy-makers and decision-makers for future implementation of related interventions.

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