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A Matter of Inclusion: A Cluster-Randomized Trial to Access the Effect of Food Vouchers Versus Traditional Treatment on Tuberculosis Outcomes in Brazil

Barbara Reis-SantosLaboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil;

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Rodrigo LocatelliLaboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil;

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Janaína OliosiLaboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil;

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Carolina M. SalesLaboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil;

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Thiago Nascimento do PradoLaboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil;

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Priya B. SheteDivision of Pulmonary and Critical Care Medicine and Center for Tuberculosis, San Francisco, California;
University of California, San Francisco, California;

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Lee W. RileyDivision of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California

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Ethel L. MacielLaboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil;

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ABSTRACT.

We assessed the effectiveness of food vouchers as a social protection strategy to enhance the adherence to tuberculosis treatment in health-care facilities in Brazil between 2014 and 2017. A cluster-randomized controlled trial was performed in four Brazilian capital cities. A total of 774 adults with newly diagnosed pulmonary tuberculosis were included in this study. Eligible participants initiated standard tuberculosis treatment per National Tuberculosis Program guidelines. Health clinics were assigned randomly to intervention groups (food voucher or standard treatment). The food voucher was provided by researchers, which could be used by subjects only for buying food. Most people with tuberculosis were poor, did receive benefits of the Bolsa Familia Program, and were unemployed. By Poisson regression analysis, with the total number of subjects included in the study, we found that individuals with tuberculosis who received food vouchers had a 1.13 greater risk of cure (95% CI, 1.03–1.21) compared with those who did not receive food vouchers. The provision of food vouchers improved outcomes of tuberculosis treatment and it should be enhanced even further as social protection for people with tuberculosis.

Author Notes

Address correspondence to Ethel L. Maciel, Laboratory of Epidemiology of Federal University of Espírito Santo, Ave. Marechal Campos, number 1468, Maruípe, Vitória, Espírito Santo 29043-900, Brazil. E-mail: ethel.maciel@gmail.com

Financial support: This work was supported by Brazilian National Council for Scientific and Technological Development (CNPq) and Brazilian Ministry of Health Department of Science and Technology (DECIT) (No. 404235/2012-3).

Authors’ addresses: Barbara Reis-Santos, Rodrigo Locatelli, Janaína Oliosi, Carolina M. Sales, Thiago Nascimento do Prado, and Ethel L. Maciel, Laboratory of Epidemiology of Federal University of Espírito Santo, Maruípe, Vitória, Espírito Santo, Brazil, E-mails: reissantos.barbara@gmail.com, rodrigolocatelli@hotmail.com, janaina_gn@hotmail.com, carolina.sales@outlook.com, thiagonorado@gmail.com, and ethel.maciel@gmail.com. Priya B. Shete, Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, San Francisco, CA, and University of California, San Francisco, CA, E-mail: priya.shete@ucsf.edu. Lee W. Riley, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, E-mail: lwriley@berkeley.edu.

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