Conditional Cash Transfers to Incentivize Tuberculosis Screening: Description of a Novel Strategy for Contact Investigation in Rural South Africa.
Conditional Cash Transfers to Incentivize Tuberculosis Screening: Description of a Novel Strategy for Contact Investigation in Rural South Africa.
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有条件现金转移激励结核病筛查：南非农村地区接触者调查新策略的描述。
DOI：
10.1093/cid/ciab601
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Dowdy,DavidW
中科院分区：
文献类型：
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作者：
Baik,Yeonsoo;Hanrahan,ColleenF;Mmolawa,Lesego;Nonyane,BarengAS;Albaugh,NicholasW;Lebina,Limakatso;Siwelana,Tsundzukani;Martinson,Neil;Dowdy,DavidW
背景 为筛查密切接触者是否患有结核病提供激励措施是家庭接触者调查的替代方案。我们的目的是描述可能首选这种基于激励的策略的患者和环境。方法这是对 2016 年至 2020 年间在南非林波波区进行的结核病接触调查整群随机试验的二次分析。28 个诊所被随机分配到基于家庭的接触调查和基于激励的接触调查。在基于激励的部门中，指数参与者和接触者获得了交通报销以及接触者结核病筛查和微生物诊断的激励。我们通过基于家庭与基于激励的接触调查总体和指数参与者亚组内估计了每个指数参与者的平均联系人数量的差异。 结果 2501 名指数参与者转介了总共 3776 名联系人（基于激励的接触者 1903 名，基于家庭的接触者 1873 名）。基于激励的接触者比基于家庭的接触者中成年人（72% vs 59%）、报告有慢性结核病症状（25% vs 16%）或曾经吸烟（23% vs 11%）的比例更高。通过基于激励的调查，步行或骑自行车去诊所的指数参与者比基于家庭的调查多推荐了 1.03 个接触者（95% 置信区间 [CI]，0.48 至 1.57）。与 5 名以上家庭成员同住的指数参与者通过基于家庭的调查比基于激励的调查多推荐了 0.48 个接触者（95% CI，0.03 至 0.94）。结论相对于基于家庭的调查，基于激励的调查识别出可能处于活动性结核病高风险的接触者。基于激励的调查可能更适合那些可以轻松进入诊所的指数参与者，而基于家庭的调查则适合大家庭的患者。临床试验注册。 NCT02808507。
BackgroundProviding incentives to screen close contacts for tuberculosis (TB) is an alternative to household-based contact investigation. We aimed to characterize patients and contexts where this incentive-based strategy might be preferred.MethodsThis is a secondary analysis of a cluster randomized trial of TB contact investigation in Limpopo District, South Africa, conducted between 2016 and 2020. Twenty-eight clinics were randomly allocated to household-based vs incentive-based contact investigation. In the incentive-based arm, index participants and contacts received transport reimbursement and incentives for TB screening and microbiological diagnosis of contacts. We estimated differences in mean number of contacts per index participant with household-based vs incentive-based contact investigation overall and within subgroups of index participants.ResultsA total of 3776 contacts (1903 in the incentive-based and 1873 in the household-based arm) were referred by 2501 index participants. A higher proportion of contacts in the incentive-based than household-based arm were adults (72% vs 59%), reported chronic TB symptoms (25% vs 16%) or ever smoking (23% vs 11%). Index participants who walked or bicycled to a clinic referred 1.03 more contacts per index (95% confidence interval [CI], .48 to 1.57) through incentive-based than household-based investigation. Index participants living with >5 household members referred 0.48 more contacts per index (95% CI, .03 to .94) through household-based than incentive-based investigation.ConclusionsRelative to household-based investigation, incentive-based investigation identifies contacts likely at higher risk for active TB. Incentive-based investigation may be more appropriate for index participants who can easily access clinics, versus household-based investigation for patients with large households.Clinical Trials Registration. NCT02808507.