Targeted Behavioral Incentives for Improving Tuberculosis (TB) Diagnostic Evaluation Outcomes
Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV), responsible for over one-third of all HIV deaths worldwide. Eliminating TB in this setting is a necessary step in improving overall morbidity and mortality for PLHIV. The new End TB Strategy put forward by the World Health Organization (WHO) outlines key targets required for achieving global TB control including increasing detection of TB cases in Africa by 50%. However, the process of TB diagnosis can be burdensome on patients due to the potentially catastrophic costs associated with accessing TB care. Indeed, despite free provision of TB diagnostic testing, patients in Uganda spend 28% of median monthly household income during the process of TB diagnosis because of transportation, lost wages, and childcare. These costs make already vulnerable patients more susceptible to poverty and less likely to complete the continuum of TB care. In light of this, the End TB strategy now calls for development of interventions and programs designed to maximize social protection and relieve the economic burden associated with TB. Growing evidence suggests that behavioral incentives may address these issues. However, there is limited data on how to structure incentives, particularly in the context of improving TB diagnostic evaluation outcomes in high HIV/TB burden settings. We propose a novel mixed methods approach combining implementation science and behavioral economics to develop and test the feasibility of targeted behavioral incentives in TB diagnostic evaluation.