Do incentives improve tuberculosis treatment outcomes in the Republic of Moldova?

Setting: Tuberculosis (TB) health facilities in the Republic of Moldova, where various incentives were provided to TB patients to improve treatment outcomes. Objective: To compare treatment outcomes among new drug-susceptible TB patients registered for treatment before (2008) and after (2011) introduction of incentives. Design: Retrospective cohort study using data from the national electronic patient database and incentive registers. Results: Of 2378 patients registered in 2011, 1895 (80%) received incentives (cash, food vouchers, travel reimbursement). Compared to 2008 (no incentives, n = 2492), the patients registered with incentives in 2011 had higher treatment success (88% vs. 79%, P < 0.001) and lower proportions of unsuccessful outcomes: loss to follow-up (5% vs. 10%, P < 0.001), death (5% vs. 6%, P = 0.03) and failure (2% vs. 5%, P < 0.001). In multivariate analysis (log-binomial regression) using the intention-to-treat approach, provision of incentives was independently associated with an overall reduction in unsuccessful outcomes of 50% (RR 0.5, 95% CI 0.45-0.62, P < 0.001), after adjusting for other confounders such as sex, age, education, occupation, residence, homelessness, type of TB and human immunodeficiency virus status. Conclusion: Provision of incentives to TB patients significantly improved treatment success rates and needs to continue. Treatment retention increased, thus potentially preventing drug resistance, a serious problem in the Republic of Moldova.