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Open Access Do incentives improve tuberculosis treatment outcomes in the Republic of Moldova?

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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.

Keywords: Eastern Europe; SORT IT; incentives; operational research; tuberculosis

Document Type: Research Article

Affiliations: 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

Publication date: 21 October 2014

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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