A new study revealed that tuberculosis (TB) patients who receive cash payments for honouring doctors’ and treatment visits, as well as counselling sessions, have a 52% lower risk of an unsuccessful treatment outcome.

The study, a randomised controlled trial conducted across nine clinics in Johannesburg, evaluated the effects of a patient-centred intervention combining pre-test and post-test TB counselling with financial incentives on treatment adherence and outcomes.

Money transfers of roughly R150 were conditional upon participants attending their appointments within the prespecified window period, which included returning for their results, starting treatment, and completing monthly follow-up visits until the end of treatment.

Key findings:

• TB patients who received counselling and conditional cash transfers were significantly more likely to complete treatment successfully (82% vs. 65.6% in the control group).
• The intervention showed a substantial reduction in the relative risk (0.52) of unsuccessful patient outcomes, which included not starting treatment, not completing treatment, treatment failure, drug resistance development, or death.
• Pre-treatment loss to follow-up — that is, individuals who did not return and start treatment — was reduced from 15.8% to 3.9%, indicating improved engagement in care.

The findings are critical as they indicate economic and behavioural factors leading to poor treatment success in TB patients.

The study was conducted by the National Institute for Communicable Diseases (NICD), Wits University, the South African Human Sciences Research Council, and University College London and was led by Professor Nazir Ismail from Wits University (the former head of the NICD Centre for TB).

The study’s findings were published in The Lancet Infectious Diseases journal earlier in February.

The head of the TB Centre at the NICD, Dr Shaheed Vally Omar, also the study’s senior author, commended the researchers, adding that the findings showed counselling and incentives were critical in the fight against TB.

“This study’s findings reinforce the urgent need for patient-centred approaches that address both medical and socio-economic barriers to care.”

These sentiments were echoed by Prof Adrian Puren, the NICD executive director, who said: “Efforts have been intensified to manage the TB epidemic in South Africa. The incorporation of the study findings to ensure the success of these efforts is an important consideration.”

The study was funded by the South African Medical Research Council, the UK Medical Research Council, and the Newton Fund.

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