Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a c...Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy.This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland.Methods:This was a controlled study that compared treatment outcomes for patients with a treatment supporter who received or did not receive a financial incentive.Results:The intervention group had a higher chance of treatment success as compared with the control group:73%(95%confidence intervals[CIs]66–80%)versus 60%(95%CIs 57–64%),respectively,p=0.003.This improvement remained significant when treatment success rates were adjusted for differences in baseline characteristics,with the effect of incentivised treatment supporters on treatment outcomes having an odds ratio(OR)of 1.8.There was also a significant improvement in the death rate in the intervention group,as compared with the control group(10.6 versus 23.5%,p=<0.001).Conclusion:Incentives provided to TB treatment supporters appear to significantly improve TB treatment outcomes.Incentivising treatment support may be appropriate as an effective addition to support and supervision measures(199 words).展开更多
Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positiv...Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-specificity and design limitations.TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.展开更多
Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a...Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a focus on poor migrants in one district of Shanghai using treatment completion and default rates),the effect of financial incentives in terms of reducing the TB patient cost,and the incremental cost-effectiveness ratio of the intervention.Results:Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively.TB treatment completion rates significantly improved by 11%(from 78%to 89%)in the intervention district,compared with only a 3%increase(from 73%to 76%)in the control district(P=0.03).Default rates significantly decreased by 11%(from 22%to 11%)in the intervention district,compared with 1%(from 24%to 23%)in the control district(P=0.03).In the intervention district,the financial subsidy(RMB 1,080/US$170)accounted for 13%of the average patient direct cost(RMB 8,416/US$1,332).Each percent increase in treatment completion costs required an additional RMB 6,550(US$1,301)and each percent reduction in defaults costs required an additional RMB 5,240(US$825)in the intervention district.Conclusions:Overall,financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai.The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China,and this strategy may be applicable to similar international settings.展开更多
基金The Global Fund to Fight AIDS,Tuberculosis and Malaria,COMDIS HSD,Department for International Development(UK)provided funding for this study。
文摘Background:Swaziland has the highest national incidence of tuberculosis(TB)in the world,with treatment success rates well below the 85%international target.Treatment support as part of comprehensive TB services is a core component of the Stop TB Strategy.This study investigated the effects of financial incentives for treatment supporters on TB treatment outcomes in Swaziland.Methods:This was a controlled study that compared treatment outcomes for patients with a treatment supporter who received or did not receive a financial incentive.Results:The intervention group had a higher chance of treatment success as compared with the control group:73%(95%confidence intervals[CIs]66–80%)versus 60%(95%CIs 57–64%),respectively,p=0.003.This improvement remained significant when treatment success rates were adjusted for differences in baseline characteristics,with the effect of incentivised treatment supporters on treatment outcomes having an odds ratio(OR)of 1.8.There was also a significant improvement in the death rate in the intervention group,as compared with the control group(10.6 versus 23.5%,p=<0.001).Conclusion:Incentives provided to TB treatment supporters appear to significantly improve TB treatment outcomes.Incentivising treatment support may be appropriate as an effective addition to support and supervision measures(199 words).
文摘Background:The impact of the human immunodeficiency virus(HIV)on tuberculosis(TB),and the implications for TB and HIV control,is a public health challenge in Ghana-almost a quarter(23%)of all TB cases were HIV positive in 2010.The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV.The aim is to reduce fragmentation,improve access,enhance efficiency and improve quality of care.Ghana’s TB/HIV policy comprises three linked sets of activities:effective implementation of the Stop TB Strategy for TB control,improved HIV prevention and care,and the implementation of additional TB/HIV activities.Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care.The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.Methods:A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted.Anonymised patient data was collated from TB registers from each facility,and analysed to determine if TB treatment outcomes changed significantly after integration.Results:TB treatment success was 50%(95%CI 49-52)prior to,and 69%(95%CI 65-73)after,integration(Χ243.96,p<0.00).Treatment success increased from 43%to 53%at the one-stop shop(OSS),from 69%to 78%at the partially integrated site(PIS)and substantially from 46%to 78%at the referral site(RS)(Χ264.54;p<0.01).Defaults and cases transferred out reduced from 14.3%and 15.3%prior to integration,to 1.4%and 9.0%after integration,respectively,accounting for a significant increase in treatment success.Death rates remained high at 18%in all cases studied and 25%in HIV-associated cases after integration.Conclusion:TB/HIV integration may improve TB treatment success,but its exact impact is difficult to ascertain due to non-specificity and design limitations.TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.
基金This study was supported by the Communicable Disease Research Consortium(COMDIS)of the Department for International Development of the UK Government,however,the views expressed in this paper are those of the authors and do not necessarily reflect the opinions of the sponsor.
文摘Background:Financial issues are major barriers for rural-to-urban migrants accessing tuberculosis(TB)care in China.This paper discusses the effectiveness of providing financial incentives to migrant TB patients(with a focus on poor migrants in one district of Shanghai using treatment completion and default rates),the effect of financial incentives in terms of reducing the TB patient cost,and the incremental cost-effectiveness ratio of the intervention.Results:Ninety and ninety-three migrant TB patients were registered in the intervention and control districts respectively.TB treatment completion rates significantly improved by 11%(from 78%to 89%)in the intervention district,compared with only a 3%increase(from 73%to 76%)in the control district(P=0.03).Default rates significantly decreased by 11%(from 22%to 11%)in the intervention district,compared with 1%(from 24%to 23%)in the control district(P=0.03).In the intervention district,the financial subsidy(RMB 1,080/US$170)accounted for 13%of the average patient direct cost(RMB 8,416/US$1,332).Each percent increase in treatment completion costs required an additional RMB 6,550(US$1,301)and each percent reduction in defaults costs required an additional RMB 5,240(US$825)in the intervention district.Conclusions:Overall,financial incentives proved to be effective in improving treatment completion and reducing default rates among migrant TB patients in Shanghai.The results suggest that financial incentives can be effectively utilized as a strategy to enhance case management among migrant TB patients in large cities in China,and this strategy may be applicable to similar international settings.
