Bridging the Gap: How Financial Incentives and Counselling Improve TB Treatment Outcomes
- FHS Communications
Tuberculosis (TB) remains a serious health challenge, particularly in low-resource settings.
Despite having access to excellent diagnostics and treatment, outcomes are still suboptimal, especially in communities facing financial and social pressures. This study examined the effectiveness of combining conditional financial incentives with supportive counselling to help patients adhere to their treatment regimen.
Study overview
A randomised controlled trial was implemented across nine clinics in Johannesburg, targeting participants aged 18 years and older undergoing investigation for pulmonary TB. The trial assessed whether providing pre- and post-test counselling and R150 per clinic visit at the initiation and monthly until treatment completion would motivate participants to complete their treatment.
The study titled ‘Effects of conditional cash transfers and pre-test and post-test tuberculosis counselling on patient outcomes and loss to follow-up across the continuum of care in South Africa: a randomised controlled trial’ was published in The Lancet.
Key findings
93% of eligible payments were successfully made. The proportion of dropouts and unsuccessful patient outcomes was reduced by approximately half among those who received financial support and counselling. These results were corroborated by a study finding that factors such as full-time employment and food security were associated with better outcomes.
The Wits study lead and Head of the Department of Clinical Microbiology and Infectious Diseases, Professor Nazir Ismail, says that the impact was greater than expected, “highlighting the importance of financial and educational factors influencing patient outcomes in our context”. He says that the study was deliberately designed not to separate the impact of the financial incentive from that of counselling, as both elements are essential to quality care.
“Early work has shown the intervention to be cost-effective, and the relative cost of such an intervention compared with overall health system costs is small, making it sustainable,” says Professor Ismail.