A Ciobanu1, L Domente1, V Soltan2, S Bivol2, L Severin3, V Plesca4, R Van den Bergh5, A M V Kumar6, P de Colombani7. 1. 'Chiril Draganiuc' Institute of Phthisiopneumology, Chisinau, Republic of Moldova. 2. Center for Health Policies and Studies, Chisinau, Republic of Moldova. 3. 'Act for Involvement' Health Development Center, Chisinau, Republic of Moldova. 4. National Centre of Health Management, Chisinau, Republic of Moldova. 5. Operational Centre Brussels, Operational Research Unit (LuxOR), Médecins Sans Frontières, Luxembourg, Luxembourg. 6. International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India. 7. World Health Organization Regional Office for Europe, Copenhagen, Denmark.
Abstract
SETTING: Tuberculosis (TB) health facilities in the Republic of Moldova, where various incentives were provided to TB patients to improve treatment outcomes. OBJECTIVE: To compare treatment outcomes among new drug-susceptible TB patients registered for treatment before (2008) and after (2011) introduction of incentives. DESIGN: Retrospective cohort study using data from the national electronic patient database and incentive registers. RESULTS: Of 2378 patients registered in 2011, 1895 (80%) received incentives (cash, food vouchers, travel reimbursement). Compared to 2008 (no incentives, n = 2492), the patients registered with incentives in 2011 had higher treatment success (88% vs. 79%, P < 0.001) and lower proportions of unsuccessful outcomes: loss to follow-up (5% vs. 10%, P < 0.001), death (5% vs. 6%, P = 0.03) and failure (2% vs. 5%, P < 0.001). In multivariate analysis (log-binomial regression) using the intention-to-treat approach, provision of incentives was independently associated with an overall reduction in unsuccessful outcomes of 50% (RR 0.5, 95%CI 0.45-0.62, P < 0.001), after adjusting for other confounders such as sex, age, education, occupation, residence, homelessness, type of TB and human immunodeficiency virus status. CONCLUSION: Provision of incentives to TB patients significantly improved treatment success rates and needs to continue. Treatment retention increased, thus potentially preventing drug resistance, a serious problem in the Republic of Moldova.
SETTING: Tuberculosis (TB) health facilities in the Republic of Moldova, where various incentives were provided to TB patients to improve treatment outcomes. OBJECTIVE: To compare treatment outcomes among new drug-susceptible TB patients registered for treatment before (2008) and after (2011) introduction of incentives. DESIGN: Retrospective cohort study using data from the national electronic patient database and incentive registers. RESULTS: Of 2378 patients registered in 2011, 1895 (80%) received incentives (cash, food vouchers, travel reimbursement). Compared to 2008 (no incentives, n = 2492), the patients registered with incentives in 2011 had higher treatment success (88% vs. 79%, P < 0.001) and lower proportions of unsuccessful outcomes: loss to follow-up (5% vs. 10%, P < 0.001), death (5% vs. 6%, P = 0.03) and failure (2% vs. 5%, P < 0.001). In multivariate analysis (log-binomial regression) using the intention-to-treat approach, provision of incentives was independently associated with an overall reduction in unsuccessful outcomes of 50% (RR 0.5, 95%CI 0.45-0.62, P < 0.001), after adjusting for other confounders such as sex, age, education, occupation, residence, homelessness, type of TB and human immunodeficiency virus status. CONCLUSION: Provision of incentives to TB patients significantly improved treatment success rates and needs to continue. Treatment retention increased, thus potentially preventing drug resistance, a serious problem in the Republic of Moldova.
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