Does provision of cash incentive to HIV-infected tuberculosis patients improve the treatment success in programme settings? A cohort study from South India

Amuje Rohit; Ajay M V Kumar; Pruthu Thekkur; Suresh G Shastri; Ravi B N Kumar; Abhay S Nirgude; Mahendra M Reddy; Chinnappareddy Ravichandra; Narasimhaiah Somashekar; P S Balu

doi:10.4103/jfmpc.jfmpc_474_20

Does provision of cash incentive to HIV-infected tuberculosis patients improve the treatment success in programme settings? A cohort study from South India

J Family Med Prim Care. 2020 Aug 25;9(8):3955-3964. doi: 10.4103/jfmpc.jfmpc_474_20. eCollection 2020 Aug.

Authors

Amuje Rohit¹, Ajay M V Kumar^{2

3

4}, Pruthu Thekkur^{2

3}, Suresh G Shastri⁵, Ravi B N Kumar^{6

7}, Abhay S Nirgude⁴, Mahendra M Reddy⁸, Chinnappareddy Ravichandra⁹, Narasimhaiah Somashekar⁹, P S Balu¹

Affiliations

¹ Department of Community Medicine, JJM Medical College, Davanagere, Karnataka, India.
² Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
³ Centre for Operational Research, The Union South-East Asia Office, New Delhi, India.
⁴ Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed To Be University), Mangaluru, Karnataka, India.
⁵ Department of Health and Family Welfare Services, State Tuberculosis Cell, Bangalore, Karnataka, India.
⁶ Department of Health and Family Welfare Services, National AIDS Control Organization (NACO), New Delhi, India.
⁷ Department of Health and Family Welfare Services, Karnataka State AIDS Prevention Society (KSAPS), Bangalore, Karnataka, India.
⁸ Department of Community Medicine, Sri Devaraj Urs Medical College (SDUMC), Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar, Karnataka, India.
⁹ National Tuberculosis Institute, Bangalore, India.

Abstract

Background: In April 2018, the Government of India launched 'Nikshay Poshan Yojana' (NPY), a cash assistance scheme (500 Indian rupees [~8 USD] per month) intended to provide nutritional support and improve treatment outcomes among tuberculosis (TB) patients.

Objective: To compare the treatment outcomes of HIV-infected TB patients initiated on first-line anti-TB treatment in five selected districts of Karnataka, India before (April-September 2017) and after (April-September 2018) implementation of NPY.

Methods: This was a cohort study using secondary data routinely collected by the national TB and HIV programmes.

Results: A total of 630 patients were initiated on ATT before NPY and 591 patients after NPY implementation. Of the latter, 464 (78.5%, 95% CI: 75.0%-81.8%) received at least one installment of cash incentive. Among those received, the median (inter-quartile range) duration between treatment initiation and receipt of first installment was 74 days (41-165) and only 16% received within the first month of treatment. In 117 (25.2%) patients, the first installment was received after declaration of their treatment outcome. Treatment success (cured and treatment completed) in 'before NPY' cohort was 69.2% (95% CI: 65.6%-72.8%), while it was 65.0% (95% CI: 61.2%-68.8%) in 'after NPY' cohort. On adjusted analysis using modified Poisson regression we did not find a statistically significant association between NPY and unsuccessful treatment outcomes (adjusted relative risk-1.1, 95% CI: 0.9-1.3).

Conclusion: Contrary to our hypothesis and previous evidence from systematic reviews, we did not find an association between NPY and improved treatment outcomes.

Keywords: Cash incentives; Direct Benefit Transfer; Operational Research; SORT IT; conditional cash transfer; monetary incentives.