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Tuberculosis in Brazil and cash transfer programs: A longitudinal database study of the effect of cash transfer on cure rates

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Reis-Santos, Barbara, Shete, Priya, Bertolde, Adelmo, Sales, Carolina M., Sanchez, Mauro N., Arakaki-Sanchez, Denise, Andrade, Kleydson B., Gomes, Gabriela ORCID: https://orcid.org/0000-0002-1454-4979, Boccia, Delia, Lienhardt, Christian and Maciel, Ethel L. (2019) 'Tuberculosis in Brazil and cash transfer programs: A longitudinal database study of the effect of cash transfer on cure rates'. PLoS ONE, Vol 14, Issue 2, e0212617.

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Abstract

Introduction
Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates.
Methods
We conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching.
Results
In 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06–0.11) in subjects with pulmonary TB].
Conclusion
Our study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 310 Therapy
Faculty: Department: Biological Sciences > Vector Biology Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0212617
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 25 Feb 2019 09:48
Last Modified: 28 Feb 2019 12:19
URI: https://archive.lstmed.ac.uk/id/eprint/10209

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