Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India

Background  A direct benefit transfer (DBT) program was launched to address the dual epidemic of under-nutrition and tuberculosis (TB) in India. We conducted this study to determine whether non-receipt of DBT was associated with unfavorable treatment outcomes among patients with TB and to explore the perspectives of patients and program functionaries regarding the program.Methods  We conducted a retrospective cohort study among ۴۲۶ patients with drug-sensitive pulmonary TB on treatment during January-September ۲۰۱۹ to determine the association between non-receipt of DBT and unfavorable treatment outcomes, which was followed by in-depth interviews of ۹ patients and ۸ program functionaries to explore their perspectives on challenges and suggestions regarding the DBT program. Multivariate logistic regression was applied to determine whether non-receipt of DBT was independently associated with unfavorable treatment outcomes, while the in-depth interviews were transcribed to describe them as codes and categories.Results  Among the ۴۲۶ patients, ۹% of the patients did not receive DBT and ۹۱% completed their treatment. Non-receipt of DBT was associated with a ۵ (۹۵% CI: ۲-۱۲) times higher odds of unfavorable treatment outcomes on multivariable analysis. Patients not owning a bank account was the primary challenge perceived by the program staff. The patients perceived the assistance under DBT to be insufficient to buy nutritious food throughout the course of treatment. The program functionaries as well as the patients suggested increasing the existing assistance under DBT along with the provision of a monthly nutritious food-kit.Conclusion  DBT improved the treatment completion rates among patients with TB in our setting. Provision of a monthly nutritious food-kit with an increase in the existing assistance under DBT might further improve the treatment outcomes. Future research should determine the long-term financial sustainability for ‘DBT plus food-kit’ vs. universal cash transfers in India.

Keywords:

Cash Transfer , Financial Protection , Treatment Outcomes , National Tuberculosis Program (NTP) , India , Tuberculosis Elimination