Summary
Introduction
Tuberculosis remains a global public health priority. It is predicted that there will be a 20% increase in TB deaths over the coming 5 years due to the impact of COVID-19.1 TB not only has devastating health implications but also severe socioeconomic impacts on those affected and their households. This socioeconomic burden falls mostly on poorer and vulnerable people and communities in low- and middle-income countries and perpetuates a cycle of poverty.2 An analysis by Silva et al. suggested that delays in achieving the World Health Organization’s 2015 End TB Strategy goals to reduce TB prevalence and mortality would have profound economic and health consequences, which would disproportionately affect sub-Saharan African countries.3 The major drivers of TB are undernutrition, poverty, diabetes, tobacco smoking, and household air pollution,4 which contribute to nearly half of the global TB burden. Such determinants need to be addressed urgently, including through social protection.5
When identified and treated early, TB is curable. However, there remain numerous challenges to completing treatment and achieving prolonged cure. The standard treatment regimen for drug-sensitive TB (DS-TB) lasts for 6 months. Drug-resistant TB (DR-TB) regimens are arduous, toxic, can involve injectable agents, can extend up to 24 months.6,7 The socioeconomic impacts of DS-TB and especially DR-TB are severe. Although all age groups are at risk, TB tends to affect adults in their most economically productive years. The economic devastation associated with loss of income and productivity, unemployment, and out-of-pocket medical costs (e.g., consultations, tests, pills) and nonmedical costs (e.g., food, travel) can make even “free” TB care expensive.8 Catastrophic costs (defined as total TB-related costs > 20% of a TB-affected household’s annual pre-TB income) can reduce the capacity of a household to cope with financial shocks and hamper access to and completion of TB treatment.8 According to the 2021 Global TB report, 45% and 87% of DS-TB and DR-TB-affected households incur catastrophic costs.9
The TB poverty cycle can be interrupted using social protection measures that alleviate poverty, reduce food insecurity and mitigate catastrophic costs of TB-affected households.10,11 Previous systematic reviews have examined the impact of social protection on the social determinants of TB.10–13 However, breadth and depth of exploration has been constrained by a limited evidence base and variable definitions or scope of what constitutes social protection. Moreover, since the introduction of the End TB strategy in 2015, which emphasized the importance of addressing the social determinants and consequences of TB and included a global Catastrophic Costs indicator, there has been a notable expansion of new evidence in the field.
This scoping review (ScR) will provide a much-needed assessment of the social protection interventions and programs available for people with TB and their households and evaluate the challenges and successes of their implementation including intervention design, recipients, and logistics of access, delivery, and receipt.
The aims of this ScR were to 1) establish what social protection interventions are available to people with TB and their households in low- and middle-income and/or TB high-burden countries, 2) describe the successes and challenges of implementation and delivery of available social protection interventions, and 3) inform the design of a systematic review and meta-analysis of the impact of social protection on TB and socioeconomic outcomes read more.
