Designing and implementing a socioeconomic intervention to enhance TB control: operational evidence from the CRESIPT project in Peru
Identifieur interne : 003261 ( Ncbi/Merge ); précédent : 003260; suivant : 003262Designing and implementing a socioeconomic intervention to enhance TB control: operational evidence from the CRESIPT project in Peru
Auteurs : Tom Wingfield [Pérou, Royaume-Uni] ; Delia Boccia [Pérou, Royaume-Uni] ; Marco A. Tovar [Pérou] ; Doug Huff [Pérou, États-Unis] ; Rosario Montoya [Pérou] ; James J. Lewis [Royaume-Uni] ; Robert H. Gilman [États-Unis] ; Carlton A. Evans [Pérou, Royaume-Uni]Source :
- BMC Public Health [ 1471-2458 ] ; 2015.
Abstract
Cash transfers are key interventions in the World Health Organisation’s post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource-constrained shantytowns in Lima, Peru for: the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project.
Newly-diagnosed TB patients from study-site healthposts were eligible to receive the intervention consisting of economic and social support
To evaluate project acceptability, quantitative and qualitative feedback was collected using a mixed-methods approach during formative activities. Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and stakeholders.
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.
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.
The online version of this article (doi:10.1186/s12889-015-2128-0) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12889-015-2128-0
PubMed: 26293238
PubMed Central: 4546087
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Cash transfers are key interventions in the World Health Organisation’s post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource-constrained shantytowns in Lima, Peru for: the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project.</p>
</sec>
<sec><title>Methods</title>
<p>Newly-diagnosed TB patients from study-site healthposts were eligible to receive the intervention consisting of economic and social support<italic>.</italic>
Economic support was provided to patient households through cash transfers on meeting the following conditions: screening for TB in household contacts and MDR TB in patients; adhering to TB treatment and chemoprophylaxis; and engaging with CRESIPT social support (household visits and community meetings).</p>
<p>To evaluate project acceptability, quantitative and qualitative feedback was collected using a mixed-methods approach during formative activities. Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and stakeholders.</p>
</sec>
<sec><title>Results</title>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
</sec>
<sec><title>Conclusions</title>
<p>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.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12889-015-2128-0) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id>
<journal-title-group><journal-title>BMC Public Health</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2458</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26293238</article-id>
<article-id pub-id-type="pmc">4546087</article-id>
<article-id pub-id-type="publisher-id">2128</article-id>
<article-id pub-id-type="doi">10.1186/s12889-015-2128-0</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Designing and implementing a socioeconomic intervention to enhance TB control: operational evidence from the CRESIPT project in Peru</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Wingfield</surname>
<given-names>Tom</given-names>
</name>
<address><phone>+44 (0)20 7589 5111</phone>
<email>tom.wingfield@ifhad.org</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff2"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Boccia</surname>
<given-names>Delia</given-names>
</name>
<address><email>delia.boccia@lshtm.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff4"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tovar</surname>
<given-names>Marco A.</given-names>
</name>
<address><email>marco.tovar@ifhad.org</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff5"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Huff</surname>
<given-names>Doug</given-names>
</name>
<address><email>dhuff@tulane.edu</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff6"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Montoya</surname>
<given-names>Rosario</given-names>
</name>
<address><email>Rosario.montoya@ifhad.org</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lewis</surname>
<given-names>James J.</given-names>
</name>
<address><email>James.Lewis@lshtm.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff4"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gilman</surname>
<given-names>Robert H.</given-names>
</name>
<address><email>gilmanbob@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff7"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Evans</surname>
<given-names>Carlton A.</given-names>
</name>
<address><email>carlton.evans@ifhad.org</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff2"></xref>
<xref ref-type="aff" rid="Aff5"></xref>
</contrib>
<aff id="Aff1"><label></label>
Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru</aff>
<aff id="Aff2"><label></label>
Innovation For Health And Development (IFHAD), Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, UK</aff>
<aff id="Aff3"><label></label>
The Monsall Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK</aff>
<aff id="Aff4"><label></label>
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK</aff>
<aff id="Aff5"><label></label>
Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru</aff>
<aff id="Aff6"><label></label>
Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA</aff>
<aff id="Aff7"><label></label>
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA</aff>
</contrib-group>
<pub-date pub-type="epub"><day>21</day>
<month>8</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>21</day>
<month>8</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>15</volume>
<elocation-id>810</elocation-id>
<history><date date-type="received"><day>29</day>
<month>12</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>7</day>
<month>8</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© Wingfield et al. 2015</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Cash transfers are key interventions in the World Health Organisation’s post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource-constrained shantytowns in Lima, Peru for: the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project.</p>
</sec>
<sec><title>Methods</title>
<p>Newly-diagnosed TB patients from study-site healthposts were eligible to receive the intervention consisting of economic and social support<italic>.</italic>
Economic support was provided to patient households through cash transfers on meeting the following conditions: screening for TB in household contacts and MDR TB in patients; adhering to TB treatment and chemoprophylaxis; and engaging with CRESIPT social support (household visits and community meetings).</p>
<p>To evaluate project acceptability, quantitative and qualitative feedback was collected using a mixed-methods approach during formative activities. Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and stakeholders.</p>
</sec>
<sec><title>Results</title>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
</sec>
<sec><title>Conclusions</title>
<p>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.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12889-015-2128-0) contains supplementary material, which is available to authorized users.</p>
</sec>
</abstract>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2015</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Pérou</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
<li>Grand Manchester</li>
<li>Louisiane</li>
<li>Maryland</li>
</region>
<settlement><li>Londres</li>
<li>Manchester</li>
</settlement>
</list>
<tree><country name="Pérou"><noRegion><name sortKey="Wingfield, Tom" sort="Wingfield, Tom" uniqKey="Wingfield T" first="Tom" last="Wingfield">Tom Wingfield</name>
</noRegion>
<name sortKey="Boccia, Delia" sort="Boccia, Delia" uniqKey="Boccia D" first="Delia" last="Boccia">Delia Boccia</name>
<name sortKey="Evans, Carlton A" sort="Evans, Carlton A" uniqKey="Evans C" first="Carlton A." last="Evans">Carlton A. Evans</name>
<name sortKey="Evans, Carlton A" sort="Evans, Carlton A" uniqKey="Evans C" first="Carlton A." last="Evans">Carlton A. Evans</name>
<name sortKey="Huff, Doug" sort="Huff, Doug" uniqKey="Huff D" first="Doug" last="Huff">Doug Huff</name>
<name sortKey="Montoya, Rosario" sort="Montoya, Rosario" uniqKey="Montoya R" first="Rosario" last="Montoya">Rosario Montoya</name>
<name sortKey="Tovar, Marco A" sort="Tovar, Marco A" uniqKey="Tovar M" first="Marco A." last="Tovar">Marco A. Tovar</name>
<name sortKey="Tovar, Marco A" sort="Tovar, Marco A" uniqKey="Tovar M" first="Marco A." last="Tovar">Marco A. Tovar</name>
</country>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Wingfield, Tom" sort="Wingfield, Tom" uniqKey="Wingfield T" first="Tom" last="Wingfield">Tom Wingfield</name>
</region>
<name sortKey="Boccia, Delia" sort="Boccia, Delia" uniqKey="Boccia D" first="Delia" last="Boccia">Delia Boccia</name>
<name sortKey="Evans, Carlton A" sort="Evans, Carlton A" uniqKey="Evans C" first="Carlton A." last="Evans">Carlton A. Evans</name>
<name sortKey="Lewis, James J" sort="Lewis, James J" uniqKey="Lewis J" first="James J." last="Lewis">James J. Lewis</name>
<name sortKey="Wingfield, Tom" sort="Wingfield, Tom" uniqKey="Wingfield T" first="Tom" last="Wingfield">Tom Wingfield</name>
</country>
<country name="États-Unis"><region name="Louisiane"><name sortKey="Huff, Doug" sort="Huff, Doug" uniqKey="Huff D" first="Doug" last="Huff">Doug Huff</name>
</region>
<name sortKey="Gilman, Robert H" sort="Gilman, Robert H" uniqKey="Gilman R" first="Robert H." last="Gilman">Robert H. Gilman</name>
</country>
</tree>
</affiliations>
</record>
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