Impact of social protection programs on adults diagnosed with Tuberculosis: systematic review

Description	Abbreviation	Research components
Population	P	Adult patients diagnosed with Tuberculosis
Intervention or exposure	I	Exposure to social protection programs
Outcomes	O	Impact of social protection in the treatment of tuberculosis

Author, year	Country	Design	Study objectives	Funding source	Sample
Lutge, Elizabeth⁽⁹9 Lutge E, Lewin S, Volmink J, Friedman I, Lombard C. Economic support to improve tuberculosis treatment outcomes in South Africa: a pragmatic cluster-randomized controlled trial. BioMed Central [Internet]. 2013 [cited 2019 Apr 20];14(154):1-13. Available from: http://www.trialsjournal.com/content/14/1/154 http://www.trialsjournal.com/content/14/... ⁾, 2013	South Africa	Controlled, pragmatic, not blind, randomized by cluster	Test the feasibility and effectiveness of the provision of economic support for patients with pulmonary TB in a high-burden province in South Africa.	Public funding	4.091 people (exposure n = 2.107; control n =1.984)
Wingfield⁽¹⁰10 Wingfield T, Marco AT, Huff D, Boccia D, Montoya R, Ramos E, et al. A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru. Bull World Health Organ. 2017;95(1):270-80. https://doi.org/10.2471/BLT.16.170167 https://doi.org/10.2471/BLT.16.170167... ⁾, T, 2017	Peru	Controlled, randomized, not blind	Evaluate the impact of socioeconomic support in the initiation of TB preventive therapy in home contacts of patients with tuberculosis and in the success of treatment in patients.	Public funding	282 people (exposure n = 135; control n = 147).
Kundu⁽⁶6 Kundu D, Sharma N, Chadha S, Laokri S, Awungafac G, Jiang L. Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDRTB health insurance schemes, in Chhattisgarh state, India. Health Economics Review [Internet]. 2018 [cited 2019 Apr 20];8(3):1-12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29374822 https://www.ncbi.nlm.nih.gov/pubmed/2937... ⁾, D, 2018	India	Quantitative descriptive	Determine whether the implementation of MDR TB health insurance packages is effective or not.	Public funding	1159 people
Rudgard⁽¹¹11 Rudgard WE, Chagas NS, Gayoso R. Uptake of governmental social protection and financial hardship during drug-resistant tuberculosis treatment in Rio de Janeiro, Brazil. Eur Respir J. 2018;51(1):1800274. https://doi.org/10.1183/13993003.00274-2018 https://doi.org/10.1183/13993003.00274-2... ⁾, W.E, 2018	Brazil	Quantitative descriptive	Assess whether the adoption of social protection during treatment was associated with a reduced risk of financial difficulties.	Public funding	131 people
J Carter⁽¹²12 Carter DJ, Daniel R, Torrens AW. The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil. BMJ Glob Health. 2019;4:e001029. https://doi.org/10.1136/bmjgh-2018-001029 https://doi.org/10.1136/bmjgh-2018-00102... ⁾, D, 2019	Brazil	Quasi-experimental approach	Estimate the impact of a conditional cash transfer program on the success rates of TB treatment.	Public funding	13.029 people (exposure n =1269; control n = 898)
Reis-Santos⁽¹³13 Santos-Reis B, Shete P, Bertolde A, Sales CM, Mauro NS, Arakaki-Sanchez D, et al. Tuberculosis in Brazil and cash transfer programs: a longitudinal database study of the effect of cash transfer on cure rates. Plos One. 2019;14(2):e0212617. https://doi.org/10.1371/journal.pone.0212617 https://doi.org/10.1371/journal.pone.021... ⁾, B, 2019	Brazil	Longitudinal Study	Evaluate the effect of being a beneficiary of a Brazilian government cash transfer program, the Bolsa Família Program (PBF), on cure rates for TB treatment.	Public funding	5.993 people
Fuady⁽⁷7 Fuady A, Tanja A, Houweling M, Burhan E, Richardus H. Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios. Infect Dis Pov. 2019;8(10):1-14. https://doi.org/10.1186/s40249-019-0519-7 https://doi.org/10.1186/s40249-019-0519-... ⁾, A, 2019	Indonesai	Descriptive quantitative	Measure the socioeconomic impact of TB and MDR-TB (including the incidence of catastrophic costs) and assess the perceived needs of patients for social protection in Indonesia.	Public funding	282 people
Torrens⁽¹⁴14 Torrens AW, Rasellab D, Bocciac D, Ethel LNM, Nerye JS, Olsonf ZD, et al. Effectiveness of a conditional cash transfer programme on TB cure rate: a retrospec tive cohor t study in Brazil. Trans Rev Soc Trop Med Hyg. 2016;110(1):199-206. https://doi.org/10.1093/trstmh/trw01 https://doi.org/10.1093/trstmh/trw01... ⁾, Ana W, 2016	Brazil	Retrospective cohort	Inform the new policy, assessing the role of the PBF, one of the largest conditional cash transfer programs in the world, on TB cure rates in Brazil.	Public funding	7.255 people (exposure n = 5.788, control n = 1.467)
Klein⁽⁸8 Klein K, Bernachea MP, Iribarren S, Gibbons L, Chirico C, Rubinstein F. Correction evaluation of a social protection policy on tuberculosis treatment outcomes: a prospective cohort study. Plos Med. 2019; e1002788. https://doi.org/10.1371/journal.pmed.1002826 https://doi.org/10.1371/journal.pmed.100... ⁾, K, 2019	Argentina	Prospective cohort	Assess the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients.	Public funding	941 people

Author, year	Period of treatment for Tuberculosis	Social Program budget	Social Program Name	Objective of the social program	Results of the social protection program
Elizabeth Lutge⁽⁹9 Lutge E, Lewin S, Volmink J, Friedman I, Lombard C. Economic support to improve tuberculosis treatment outcomes in South Africa: a pragmatic cluster-randomized controlled trial. BioMed Central [Internet]. 2013 [cited 2019 Apr 20];14(154):1-13. Available from: http://www.trialsjournal.com/content/14/1/154 http://www.trialsjournal.com/content/14/... ⁾, 2013	2009 - 2010	Approximately US$ 15	Monthly voucher	Vouchers were redeemed at local stores for food.	It was associated with successful TB treatment (P <0.001), showing 5.6% less risk of failure in the treatment of tuberculosis.
Wingfield⁽¹⁰10 Wingfield T, Marco AT, Huff D, Boccia D, Montoya R, Ramos E, et al. A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru. Bull World Health Organ. 2017;95(1):270-80. https://doi.org/10.2471/BLT.16.170167 https://doi.org/10.2471/BLT.16.170167... ⁾, T, 2017	2014 - 2015	Up to US$ 230 per family	Peruvian National Tuberculosis Program	To access the complete treatment in clinics.	It was associated with 2.2 times more chances of obtaining TB preventive therapy (ORa: 2.2; 95%CI = 1.1-4.1) and 1,6 times more chances of success in treating TB (OR: 1.6; 95%CI = 1.0-2.6).
Kundu⁽⁶6 Kundu D, Sharma N, Chadha S, Laokri S, Awungafac G, Jiang L. Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDRTB health insurance schemes, in Chhattisgarh state, India. Health Economics Review [Internet]. 2018 [cited 2019 Apr 20];8(3):1-12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29374822 https://www.ncbi.nlm.nih.gov/pubmed/2937... ⁾, D, 2018	2013 - 2015	US$ 500 per family in one year (up to 5 members in a family).	Universal health insurance	To access treatment for multidrug-resistant tuberculosis (MDRTB) in India.	It was associated with 0.3 times more chances of using a single pre-treatment evaluation package with RSBY^* * RSBY- National Health Insurance Program, known as "Rashtriya Swasthya Bima Yojana". (ORa: 0.03; 95%CI = 0.01-0.05).
Rudgard⁽¹¹11 Rudgard WE, Chagas NS, Gayoso R. Uptake of governmental social protection and financial hardship during drug-resistant tuberculosis treatment in Rio de Janeiro, Brazil. Eur Respir J. 2018;51(1):1800274. https://doi.org/10.1183/13993003.00274-2018 https://doi.org/10.1183/13993003.00274-2... ⁾, W.E, 2018		USD 1970 ± 2897 (Annual).	Bolsa Família	It is a direct income transfer program, aimed at families in situations of poverty.	It was associated with 1.31 times less risk of poverty (RR: 1.31; 95%CI = 0.50-3.47).
J Carter⁽¹²12 Carter DJ, Daniel R, Torrens AW. The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil. BMJ Glob Health. 2019;4:e001029. https://doi.org/10.1136/bmjgh-2018-001029 https://doi.org/10.1136/bmjgh-2018-00102... ⁾, D, 2019	2010-2011	R$70 to R$140 per month.	Bolsa Família Program	It is a direct income transfer program, aimed at families in situations of poverty.	It was associated with a 10.58% higher success rate in treating TB.
Reis-Santos⁽¹³13 Santos-Reis B, Shete P, Bertolde A, Sales CM, Mauro NS, Arakaki-Sanchez D, et al. Tuberculosis in Brazil and cash transfer programs: a longitudinal database study of the effect of cash transfer on cure rates. Plos One. 2019;14(2):e0212617. https://doi.org/10.1371/journal.pone.0212617 https://doi.org/10.1371/journal.pone.021... ⁾, B, 2019	2015	R$70 to R$140 per month.	Bolsa Família Program	It is a direct income transfer program, aimed at families in situations of poverty.	It was associated with an 8% increase in the successful cure of pulmonary TB (Coefficient: 0.08; 95%CI = 0.06-0.11).
Fuady⁽⁷7 Fuady A, Tanja A, Houweling M, Burhan E, Richardus H. Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios. Infect Dis Pov. 2019;8(10):1-14. https://doi.org/10.1186/s40249-019-0519-7 https://doi.org/10.1186/s40249-019-0519-... ⁾, A, 2019	2016	US$ 4 to US$ 205 per month.	General Cash Transfer	Financial support to cover costs related to lost income, transportation and food supplements.	It was associated with a greater economic need in the income of patients with multidrug-resistant TB. (P <0.001).
Torrens⁽¹⁴14 Torrens AW, Rasellab D, Bocciac D, Ethel LNM, Nerye JS, Olsonf ZD, et al. Effectiveness of a conditional cash transfer programme on TB cure rate: a retrospec tive cohor t study in Brazil. Trans Rev Soc Trop Med Hyg. 2016;110(1):199-206. https://doi.org/10.1093/trstmh/trw01 https://doi.org/10.1093/trstmh/trw01... ⁾, Ana W, 2016	2010-2011	Average value US$55,60 monthly.	Bolsa Família	It is a direct income transfer program, aimed at families in situations of poverty.	It was associated with the 5.2% greater chance of curing pulmonary TB (RR: 1.07; 95% CI= 1.04-1.11).
Klein⁽⁸8 Klein K, Bernachea MP, Iribarren S, Gibbons L, Chirico C, Rubinstein F. Correction evaluation of a social protection policy on tuberculosis treatment outcomes: a prospective cohort study. Plos Med. 2019; e1002788. https://doi.org/10.1371/journal.pmed.1002826 https://doi.org/10.1371/journal.pmed.100... ⁾, K, 2019	2 years	The monthly family income was collected in categories: tertile 1 was less than 245 and tertile 2 was from 246 to 725.	CCT Program	Encourage complete treatment.	The program was associated with 2.9 times more chance of TB control in the global population (OR: 2.9; 95%CI = 2.0-4.3).

Study design	Evidence level of studies^* * Level of evidence according to the model suggested by Melnyk e Fineout-Overholt(19).
Randomized Controlled Clinical Trial
Lutge, Elizabeth 2013⁽⁹9 Lutge E, Lewin S, Volmink J, Friedman I, Lombard C. Economic support to improve tuberculosis treatment outcomes in South Africa: a pragmatic cluster-randomized controlled trial. BioMed Central [Internet]. 2013 [cited 2019 Apr 20];14(154):1-13. Available from: http://www.trialsjournal.com/content/14/1/154 http://www.trialsjournal.com/content/14/... ⁾	II
Wingfield, T, 2017⁽¹⁰10 Wingfield T, Marco AT, Huff D, Boccia D, Montoya R, Ramos E, et al. A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru. Bull World Health Organ. 2017;95(1):270-80. https://doi.org/10.2471/BLT.16.170167 https://doi.org/10.2471/BLT.16.170167... ⁾	II
Prospective cohort study
Klein, K, 2019⁽⁸8 Klein K, Bernachea MP, Iribarren S, Gibbons L, Chirico C, Rubinstein F. Correction evaluation of a social protection policy on tuberculosis treatment outcomes: a prospective cohort study. Plos Med. 2019; e1002788. https://doi.org/10.1371/journal.pmed.1002826 https://doi.org/10.1371/journal.pmed.100... ⁾	IV
Retrospective cohort study
Torrens⁽¹⁴14 Torrens AW, Rasellab D, Bocciac D, Ethel LNM, Nerye JS, Olsonf ZD, et al. Effectiveness of a conditional cash transfer programme on TB cure rate: a retrospec tive cohor t study in Brazil. Trans Rev Soc Trop Med Hyg. 2016;110(1):199-206. https://doi.org/10.1093/trstmh/trw01 https://doi.org/10.1093/trstmh/trw01... ⁾, Ana W, 2016	IV
Quantitative Descriptive
Kundu⁽⁶6 Kundu D, Sharma N, Chadha S, Laokri S, Awungafac G, Jiang L. Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDRTB health insurance schemes, in Chhattisgarh state, India. Health Economics Review [Internet]. 2018 [cited 2019 Apr 20];8(3):1-12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29374822 https://www.ncbi.nlm.nih.gov/pubmed/2937... ⁾, D, 2018	VI
Fuady⁽⁷7 Fuady A, Tanja A, Houweling M, Burhan E, Richardus H. Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios. Infect Dis Pov. 2019;8(10):1-14. https://doi.org/10.1186/s40249-019-0519-7 https://doi.org/10.1186/s40249-019-0519-... ⁾, A, 2019	VI
Rudgard, W.E, 2018⁽¹¹11 Rudgard WE, Chagas NS, Gayoso R. Uptake of governmental social protection and financial hardship during drug-resistant tuberculosis treatment in Rio de Janeiro, Brazil. Eur Respir J. 2018;51(1):1800274. https://doi.org/10.1183/13993003.00274-2018 https://doi.org/10.1183/13993003.00274-2... ⁾	VI
Quasi-Experimental Study
J Carter, D, 2019⁽¹²12 Carter DJ, Daniel R, Torrens AW. The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil. BMJ Glob Health. 2019;4:e001029. https://doi.org/10.1136/bmjgh-2018-001029 https://doi.org/10.1136/bmjgh-2018-00102... ⁾	VI
Longitudinal Study
Reis-Santos, B, 2019⁽¹³13 Santos-Reis B, Shete P, Bertolde A, Sales CM, Mauro NS, Arakaki-Sanchez D, et al. Tuberculosis in Brazil and cash transfer programs: a longitudinal database study of the effect of cash transfer on cure rates. Plos One. 2019;14(2):e0212617. https://doi.org/10.1371/journal.pone.0212617 https://doi.org/10.1371/journal.pone.021... ⁾	VI

Design and studies	Evaluation Criteria
Quantitative Randomized controlled trial (trials)	Randomization, sequence generation	Allocation Concealment	Results complete data (80% or more)	Low removal / withdrawal (below 20%)	Comments
Lutge, Elizabeth, 2013⁽⁹9 Lutge E, Lewin S, Volmink J, Friedman I, Lombard C. Economic support to improve tuberculosis treatment outcomes in South Africa: a pragmatic cluster-randomized controlled trial. BioMed Central [Internet]. 2013 [cited 2019 Apr 20];14(154):1-13. Available from: http://www.trialsjournal.com/content/14/1/154 http://www.trialsjournal.com/content/14/... ⁾	****	****	****	***	Moderate quality is suspected
Wingfield, T, 2017⁽¹⁰10 Wingfield T, Marco AT, Huff D, Boccia D, Montoya R, Ramos E, et al. A randomized controlled study of socioeconomic support to enhance tuberculosis prevention and treatment, Peru. Bull World Health Organ. 2017;95(1):270-80. https://doi.org/10.2471/BLT.16.170167 https://doi.org/10.2471/BLT.16.170167... ⁾	****	****	****	***	Moderate quality is suspected
Quantitative no randomized	Minimum selection biases	Appropriate measures	Comparable study groups or differences represented by these groups	Results data 80% or more, response rate 60% or more, or acceptable follow-up rate	Comments
Klein, K, 2019⁽⁸8 Klein K, Bernachea MP, Iribarren S, Gibbons L, Chirico C, Rubinstein F. Correction evaluation of a social protection policy on tuberculosis treatment outcomes: a prospective cohort study. Plos Med. 2019; e1002788. https://doi.org/10.1371/journal.pmed.1002826 https://doi.org/10.1371/journal.pmed.100... ⁾	****	****	****	***	Low quality is suspected
Torrens⁽¹⁴14 Torrens AW, Rasellab D, Bocciac D, Ethel LNM, Nerye JS, Olsonf ZD, et al. Effectiveness of a conditional cash transfer programme on TB cure rate: a retrospec tive cohor t study in Brazil. Trans Rev Soc Trop Med Hyg. 2016;110(1):199-206. https://doi.org/10.1093/trstmh/trw01 https://doi.org/10.1093/trstmh/trw01... ⁾, Ana W, 2016	****	****	***		Low quality is suspected
J Carter, D 2019⁽¹²12 Carter DJ, Daniel R, Torrens AW. The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil. BMJ Glob Health. 2019;4:e001029. https://doi.org/10.1136/bmjgh-2018-001029 https://doi.org/10.1136/bmjgh-2018-00102... ⁾,	****	****	****	****	High quality is suspected
Reis-Santos, B, 2019⁽¹³13 Santos-Reis B, Shete P, Bertolde A, Sales CM, Mauro NS, Arakaki-Sanchez D, et al. Tuberculosis in Brazil and cash transfer programs: a longitudinal database study of the effect of cash transfer on cure rates. Plos One. 2019;14(2):e0212617. https://doi.org/10.1371/journal.pone.0212617 https://doi.org/10.1371/journal.pone.021... ⁾	****	***	****	****	Low quality is suspected
Kundu⁽⁶6 Kundu D, Sharma N, Chadha S, Laokri S, Awungafac G, Jiang L. Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDRTB health insurance schemes, in Chhattisgarh state, India. Health Economics Review [Internet]. 2018 [cited 2019 Apr 20];8(3):1-12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29374822 https://www.ncbi.nlm.nih.gov/pubmed/2937... ⁾, D, 2018	***	****	****	****	Moderate quality is suspected
Rudgard, W.E, 2018⁽¹¹11 Rudgard WE, Chagas NS, Gayoso R. Uptake of governmental social protection and financial hardship during drug-resistant tuberculosis treatment in Rio de Janeiro, Brazil. Eur Respir J. 2018;51(1):1800274. https://doi.org/10.1183/13993003.00274-2018 https://doi.org/10.1183/13993003.00274-2... ⁾	**	**	**	***	Low quality is suspected
Fuady⁽⁷7 Fuady A, Tanja A, Houweling M, Burhan E, Richardus H. Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios. Infect Dis Pov. 2019;8(10):1-14. https://doi.org/10.1186/s40249-019-0519-7 https://doi.org/10.1186/s40249-019-0519-... ⁾, A, 2019	*	**	***	*	Low quality is suspected

[1] Corresponding author: Francisca Bruna Arruda Aragão. E-mail: aragao_bruna@usp.br

Brasil

Brasil

Impact of social protection programs on adults diagnosed with Tuberculosis: systematic review

Impacto de los programas de protección social en adultos diagnosticados con Tuberculosis: revisión sistemática

ABSTRACT

Objectives:

Methods:

Results:

Conclusions: