Choosing incentives to stimulate tuberculosis treatment compliance in a poorcounty in Rio de Janeiro state, Brazil.
Marcia Teresa Carreira Teixeira Belo, Marcia Teresa Carreira Teixeira Belo, Ronir Raggio Luiz, Christy Hanson, Ana Lucia Luna, Ana Lucia Luna, Anete Trajman
Med Sci Monit 2006; 12(5): PH1-5
Background: Tuberculosis (TB) treatment default is a major constraint ofTB control, resulting in continued disease transmission and possibly the emergence of multidrug resistance.Marginalized populations may abandon treatment before being cured. The objective of this study was toevaluate the socioeconomic status (SES) of TB patients and identify potential incentives for improvingtreatment compliance by SES. Material/Methods: A cross-sectional survey was conducted in a public healthunit in Duque de Caxias, a county with one of the lowest per capita incomes in Rio de Janeiro state.From November 2003 to March 2004, 305 TB patients answered an anonymous questionnaire on socio-demographicaspects, household items and family income, history of previous treatment default, and on incentivesfor improving treatment adherence. Incentives were classified as economic, administrative, health servicesupport, and habits, and scored as fundamental (3), important (2), desirable (1), or irrelevant (0).Results: Health service support incentives had the highest scores overall. The aggregate economic incentivescore correlated with SES (r=-0.191, p=0.001). Among the 20% poorest patients, 16.7% had a previous historyof default vs. 1.6% among the wealthiest (p=0.004). Patients with a history of treatment default weresignificantly more likely to choose health service support incentives than other patients (r=-0.263,p=0.039). Conclusions: Professional commitment will be needed to effect the necessary changes in healthservice support. Financial support for food and transportation subsidies may be required to improve treatmentcompliance among the poorest TB patients, i.e. those most likely to have previously defaulted from treatment.
Keywords: Humans, Tuberculosis - drug therapy, Questionnaires, Public Health, Poverty, Patient Compliance, Motivation, Middle Aged, Male, Aged, Female, Cross-Sectional Studies, Brazil, Antitubercular Agents - therapeutic use, Aged, 80 and over, Adolescent, Adult