Cash and social support boost tuberculosis treatment success

Tuberculosis (TB) remains the leading cause of death from an infectious disease worldwide, and the disease is tightly linked to poverty and social hardship. Researchers led by Mollie Hudson asked whether social protection—programs that provide financial or social support to reduce socioeconomic risk—helps people with TB complete treatment and protects households from the economic damage that TB can cause. To answer this, the team carried out a systematic review and meta-analysis, searching PubMed (includes MEDLINE), Embase, and Web of Science for studies published between January 2012 and July 2024. They included studies that described at least one social protection intervention and reported either TB treatment outcomes (such as cure or treatment completion) or socioeconomic outcomes for people with TB or TB-affected households. From an initial 47,245 articles identified by the search, 50 studies met the review’s eligibility criteria. The review was registered in advance in the PROSPERO database (CRD42022382181). By assembling this set of studies, the authors aimed to quantify the overall effect of social protection on both clinical and economic outcomes for people and households affected by TB.

The research team used a random-effects meta-analysis to focus on the primary outcome of TB treatment success—defined as treatment completion or cure. Of the 50 eligible studies, 36 reported TB treatment outcomes, eight reported socioeconomic outcomes, and two reported both. Twenty-four studies provided results suitable for inclusion in the pooled meta-analysis. The combined analysis found that people with TB who received social protection interventions during treatment had 2.23 times the odds of treatment success compared with those who did not receive such support (95% confidence interval 1.82 to 2.74). Statistical heterogeneity among studies was high (I2 = 93.8%), and the authors performed a meta-regression to explore how study characteristics related to the odds of treatment success. To assess study quality and potential bias, they used the Newcastle Ottawa Scale and the Cochrane Risk of Bias tool. The review also examined implementation outcomes reported in the eligible studies to inform feasibility in program settings.

The findings suggest that social protection interventions meaningfully improve the chances that people with TB will complete treatment and be cured when these supports are provided alongside standard biomedical care. Because the review included both TB-specific and TB-sensitive social protection measures and looked at socioeconomic outcomes as well as treatment outcomes, it offers evidence that these programs can help break the cycle between TB disease and poverty. The high pooled effect size supports broader use of social protection in TB programs, but the large heterogeneity across studies points to the need for clearer, standardized definitions of what counts as social protection and for uniform outcome reporting. By filling an important evidence gap, the study supports the commitments from the 2023 United Nations General Assembly high-level meeting on TB, which called for social protection for all individuals with TB, and it provides a basis for policymakers and program managers to consider implementing or expanding cash and social support linked to TB care.