Socioeconomic Support and Tuberculosis Preventive Therapy in Tanzania
Picture Credit: Jonathan Torgovnik
Study Context
Despite the wide use of antiretroviral therapy (ART), tuberculosis (TB) remains a public health challenge leading to increased morbidity and mortality among people living with HIV (PLHIV), especially in Sub-Saharan Africa. Preventive therapy reduces the risk of TB among PLHIV; however, socioeconomic barriers often inhibit patients from completing the full course of therapy. In Tanzania—where one in three TB patients are HIV-positive—recent coinciding policies have scaled up both the delivery of TB preventive therapy and the role of community health workers (CHWs) to support retention in care among HIV-positive patients.
Study Design
Building on a collaboration studying financial incentives for PLHIV in Western Tanzania, this study evaluated whether a socioeconomic intervention consisting of financial incentives plus optimized CHW engagement improved adherence to TB preventive therapy among PLHIV. Using a quasi-cluster randomized trial (CRT) design, the study included 19 HIV primary care facilities in Lake Zone district: 16 control sites from a larger CRT (Packel et al., 2020) and three randomly selected facilities meeting the same eligibility criteria allocated to this study’s intervention.
Eligible participants were adults who had recently started HIV treatment, had access to a mobile phone, and intend to continue treatment at the same facility. All study facilities used a tablet-based mobile health technology (mHealth) system to enroll participants and monitor attendance. Participants at control facilities received usual HIV care, while those at intervention facilities additionally received (1) automated mobile payments upon monthly clinic attendance of 22,500 TZS (US $10) for up to 6 months plus (2) early pairing with a CHW for participants at high risk of dropping out of care. From May to November, 2021, this study enrolled 1018 participants (intervention N=90, control N=928). Participants were 58% female with a mean age of 37 years.
Results and Policy Lessons
Dispensing data collected during the six month intervention showed that 67% of intervention participants completed a full course of isoniazid preventive therapy (IPT) compared to 51% in the control group—a 16 percentage point improvement. These findings suggest that modest, time-limited financial support combined with digital CHW engagement can significantly improve preventive treatment uptake among newly diagnosed HIV patients. These findings strengthen the case for integrating socioeconomic support and digitally enabled community health worker systems into national HIV programs, highlighting targeted assistance for high-risk patients as a potentially cost-effective strategy to improve health outcomes.