The impact of social protection interventions on treatment and socioeconomic outcomes of tuberculosis-affected people and households in low income, high burden settings: A systematic review and meta-analysis

IntroductionTuberculosis (TB) is the leading cause of death due to infectious disease worldwide. Social protection interventions can benefit TB-affected households. We conducted a systematic review and meta-analysis to quantify the effectiveness of social protection on TB treatment and socioeconomic outcomes. MethodsWe identified articles published from January 2012 to July 2024 by searching PubMed (includes MEDLINE), Embase, and Web of Science. We included studies that described at least one social protection intervention and reported on either TB treatment or socioeconomic outcomes for people with TB or TB-affected households. Random-effects meta-analysis was used for our primary outcome of interest, TB treatment success (treatment completion or cure). We performed a meta-regression to evaluate the association of study characteristics with odds of TB treatment success. Risk of bias was assessed using the Newcastle Ottawa Scale and the Cochrane Risk of Bias tool. This review was registered prospectively in the PROSPERO database (registration number CRD42022382181). FindingsOur search generated 47,245 articles. Of the 50 which were eligible for inclusion, 36 reported TB treatment outcomes, 8 reported on socioeconomic, and two studies reported both TB treatment and socioeconomic outcomes. Random-effects meta-analysis of 24 articles found that people with TB who received social protection interventions during treatment had 2.23 times the odds of TB treatment success (95% CI 1.82, 2.74, I2 93.8%). ConclusionSocial protection interventions significantly improve odds of TB treatment success. Outcomes and definitions used in our study have the potential to guide further research and implementation of social protection for TB-affected populations. Summary BoxO_ST_ABSWhat is already known on this topicC_ST_ABSSeveral studies have found that social and financial interventions designed to mitigate socioeconomic risk and promote resiliency, termed social protection interventions, have the potential to improve treatment outcomes for tuberculosis (TB), including treatment completion and cure. Additionally, several studies have demonstrated that social protection interventions can improve socioeconomic outcomes among TB-affected households such as averting catastrophic costs and negative financial coping strategies. What this study addsThis is the first systematic review and meta-analysis that comprehensively evaluates the impact of TB specific and TB sensitive social protection interventions on both TB treatment and socioeconomic outcomes, thereby generating evidence on the ability of these interventions to curb the well-known cycle of TB disease and poverty. Through the use of an extensive list of search terms, expanded and systematic inclusion of outcomes of interest, and a focused definition of social protection interventions, our systematic review included the adequate number of high-quality studies needed to conduct a meta-analysis. Additionally, our systematic review evaluated implementation outcomes described in eligible studies which provides the basis for feasibility of these strategies in programmatic settings. How this study might affect research, practice or policyOur study provides evidence that social protection interventions, when used in conjunction with standard biomedical treatment, have the potential to significantly improve TB treatment outcomes. This study fills an essential gap in existing synthesized evidence of the impact of social protection interventions on TB, socioeconomic, and implementation outcomes. Our findings also highlight the need for standardized definitions of social protection, as well as uniform reporting procedures, to better help evaluate the impact of social protection interventions for TB-affected individuals and households. Addressing these gaps provides scientific basis for meeting the commitments articulated in the 2023 United Nations General Assembly high level meeting for TB which calls for social protection for all individuals with TB.