Incentives and enablers to improve adherence in tuberculosis

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Incentives and enablers for improving patient adherence to tuberculosis diagnosis, prophylaxis, and treatment

Elizabeth E Lutge1, Charles Shey Wiysonge2,3, Stephen E Knight4, David Sinclair5, Jimmy Volmink3,6

1. KwaZulu-Natal Department of Health, Epidemiology, Pietermarizburg, South Africa
2. Stellenbosch University, Centre for Evidence-based Health Care, Cape Town, South Africa
3. South African Medical Research Council, South African Cochrane Centre, Cape Town, South Africa
4. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Department of Public Health Medicine, Congella, South Africa
5. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
6. Stellenbosch University, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape Town, South Africa

To read the full review please follow this link: DOI/10.1002/14651858.CD007952.pub3

Cochrane researchers conducted a review of the effects of material (economic) incentives or enablers on the adherence and outcomes of patients being tested or treated for latent or active tuberculosis (TB). After searching up to 5 June 2015 for relevant trials, they included 12 randomized controlled trials in this Cochrane review.

What are material incentives and enablers and how might they improve patient care?

Material incentives and enablers are economic interventions which may be given to patients to reward healthy behaviour (incentives) or remove economic barriers to accessing healthcare (enablers). Incentives and enablers may be given directly as cash or vouchers, or indirectly in the provision of a service for which the patient might otherwise have to pay (like transport to a health facility).

What the research says

Material incentives and enablers may have little or no effect in improving the outcomes of patients on treatment for active TB (low quality evidence), but further trials of alternative incentives and enablers are needed.

Material incentives and enablers may have some effects on completion of prophylaxis for latent TB in some circumstances but trial results were mixed, with one trial showing a large effect, and two trials showing no effect (low quality evidence).

One-off material incentives and enablers probably improve rates of return to a single clinic appointment for patients starting or continuing prophylaxis for TB (moderate quality evidence) and may improve the rate of return to the clinic for the reading of diagnostic tests for TB (low quality evidence).

Thus although material incentives and enablers may improve some patients' attendance at the clinic in the short term, more research is needed to determine if they have an important positive effect in patients on long term treatment for TB.