Linking Poor TB Patients to Government Welfare Schemes to Improve Treatment Adherence in West Bengal, India

Among new smear-positive TB patients in 2010, 7% in West Bengal did not complete treatment. Some patients may discontinue treatment because side-effects of the medicine prevented them from working in the context of financial strain. The objective of the study was to ascertain whether linking TB patients to government welfare schemes was associated with completing the full course of treatment and reducing death rate and default rate. In 2009, CARE India worked with the Ministry of Health and the national TB Control Program to link TB patients to already-existing welfare schemes. TB patients received cash, food and/or employment. The study area was in Murshidabad District in the state of West Bengal. The study period was July 2009 to December 2011. The intervention subjects are those TB patients who received aid through welfare schemes while undergoing DOTS treatment. The comparison subjects are those who received the same DOTS treatment, but did not receive any aid. Data was derived from India’s revised national TB Control Program. Data on the receipt of welfare benefit was ascertained directly by asking the patient. Effectiveness of the intervention was determined by comparing treatment success rate, default rate and death rate of both new and retreatment patients in the intervention and comparison groups. Treatment Success Rate among new patients was 92.2% for those who received welfare and 88.5% for non-recipients. Treatment Success Rate among retreatment patients was 83.4% in the intervention group and 72% in the comparison group. Among both new and retreatment patients, there is a statistically significant difference between the Treatment Success Rates of the comparison and intervention groups (p<0.01). Treatment Success Rate increased for both new and retreatment patients when linked to welfare. The effect is seen to be modest for new patients, largely due to the ‘ceiling effect’, but much more in retreatment cases.