SPARKS Network – Health and Social Protection Action Research & Knowledge Sharing

The projects listed below are currently being conducted by researchers in the SPARKS network.

CHEST – Coordinating HEalth and Social care for TB patients in Mozambique

The aim of this project is to develop, implement and evaluate a bi-directional referral system for tuberculosis patients in Mozambique. Mozambique is among the countries with the highest TB burden in the world.

While TB is closely associated with poverty, it can also push TB-affected households into worsening impoverishment through costs associated with having TB disease and accessing treatment, including costs of medicines, food, and travel or indirect costs. Such costs can even become catastrophic, resulting in patients being lost to follow up, failing treatment, or in some cases dying.

Social protection, which can include poverty-reduction, insurance, and cash transfer schemes, could mitigate the costs incurred by patients and their households. Because of this, social protection is a critical element in the WHO’s End TB strategy. Though TB patients and their households need, and may be eligible for, social grants, referral systems between health and social services are often under-developed.

Improving the referral between social and health services for TB patients could have benefits for both TB patients and national TB programmes. When TB patients could be referred to potentially lifesaving grants that can support their treatment adherence, TB control can also be enhanced by using the social protection schemes as platform for TB case finding among the most vulnerable groups. CHEST will evaluate a multisectoral approach with a bi-direction referral system and coordinated patient support.

The project is funded with a grant from the Swedish Research Council.

Contact Person:
Salla Atkins
New Social Research
Global Health and Development/Health Sciences/ Faculty of Social Sciences
UNIVERSITY OF TAMPERE
salla.atkins@uta.fiELISIOS-TB Project (Longitudinal Study of Social Support Impacts on Tuberculosis Operational Indicators) is a project funded by Brazilian government in order to access the following objectives :

• To map existing social support schemes, explore opportunities for understanding and making existing schemes more TB-sensitive (qualitative study)
• To develop interventions to assess the impact of Social Support in TB patients, taking into account income (employment, governmental programs, catastrophic cost), healthy environment, coping and decision making and their social network and their contacts (by a randomized cluster study)
• To evaluate the impact of the identification of patients with risk of worst outcome in the incidence of tuberculosis infection and illness (by a cohort study)
• To propose an instrument that identifies the flow and differentiated intersectoralprocedures most appropriate for the cascade of TB taking into account the scenarios proposed by the Ministry of Health (disease burden, program performance, social aspects) and Minister of Social Development scenarios (by a Policy translation case study

Contact Person:
Professor Ethel Leonor Noia Maciel, PhD
Universidade Federal do Espirito Santo- UFES Vitoria, Brazil
ethel.maciel@gmail.com
http://impacttbproject.org

IMPACT TB will implement, evaluate and scale up proven active tuberculosis (TB) case finding and social support interventions in Nepal and Vietnam. The project will determine the effectiveness and cost-effectiveness of different implementation models and examine barriers and enablers for knowledge translation and scale up. In order for effective translation of research findings to policies on active TB case finding and social protection for people with TB, the project actively engages with Ministry of Health in each country, WHO, and the SPARKS network. The project started 2017, with EU funding (Horizon 2020).

Title: Developing a Locally-Appropriate Socioeconomic Support Package For TB-Affected Households In Nepal

Background: WHO’s 2015 End TB Strategy advocates social and economic (socioeconomic) support for TB-affected households to improve TB control.

Rationale: Evidence concerning the most appropriate and impactful socioeconomic support for TB-affected households remains limited, especially in low-income countries.

Study: Supported by Birat Nepal Medical Trust and within the larger IMPACT-TB study, this mixed-methods study in Nepal will:

• Project 1: evaluate the socioeconomic impact on TB-affected households of a household member being ill with TB disease and accessing TB care; and
• Project 2: create a shortlist of feasible and locally-appropriate interventions to mitigate this impact.

Setting: Four IMPACT-TB recruitment study sites of Nepal (Chitawari, Makawanpur, Mahotari), which have frequent TB and poverty.

Population:

• Project 1: up to 200 patients starting TB treatment with the Nepal National TB Program and recruited to the IMPACT-TB active case-finding study (EU Horizon 2020 project No 733174) and 100 randomly-selected healthy controls in the same sites; and
• Project 2: approximately 30 key stakeholders from Nepal including TB-affected people, civil-society representatives, community health workers, National TB Program (NTP) managers, and social protection and poverty-alleviation specialists.

Outputs: the results will strengthen understanding of the socioeconomic impact of TB and, through collaboration with diverse in-country stakeholders, generate a shortlist of feasible and locally-appropriate socioeconomic interventions for TB-affected households in Nepal.

Impact: this research will inform the design of “BEYOND TB”, a planned randomized-controlled trial of socioeconomic support for TB-affected households in multiple countries, including Nepal.

Contact Person: 
Dr Tom Wingfield
Institute of Infection and Global Health, University of Liverpool, UK
LIV-TB Collaboration, Liverpool School of Tropical Medicine, UK
United Kingdom
tom.wingfield@lstmed.ac.uk

Website: www.impacttbproject.org 

From Poverty to Cure: Addressing Socioeconomic Barriers to TB Diagnostic Evaluation in Uganda

Tuberculosis (TB) remains a significant threat to global public health with 10.4 million new cases and over 1.8 million deaths each year. There is increasing recognition that social and economic barriers that impede patient access to TB care are a key reason for poor global TB control. The objective of this proposal is to use implementation science together with behavioral economics and social epidemiology to identify social protection interventions that increase the proportion of patients undergoing TB evaluation who are diagnosed with and treated for TB in Uganda. Our approach consists of using mixed methods to identify modifiable social barriers to completing TB diagnostic evaluation and identify incentive-based strategies that overcome known economic barriers to completing TB diagnostic evaluation. With key local stakeholders, we will design an theory-informed social protection intervention that has the highest likelihood of success in overcoming socio-economic barriers to TB diagnostic care.

Contact person:
Priya Shete, MD.
Division of Pulmonary and Critical Care Medicine
Zuckerberg San Francisco General Hospital-UCSF, San Francisco, CA
Email: priya.shete@ucsf.edu
http://www.tbsequel.org

TB-Sequel is a multi-country cohort study designed to determine the short- and long-term medical, social and economic consequences of tuberculosis (TB). The study started in 2017 and is implemented in four African countries: The Gambia, Mozambique, South Africa, and Tanzania. Cohorts of TB patients will be followed from diagnosis to at least one year after treatment completion. KI/PHS is co-leading the socioeconomic work package of this study, which is collecting data on patients‘ socioeconomic situation, health expenditures, income loss, social consequences of disease and health-related quality of life.

The other project partners are: the Aurum Institute, South Africa; Department for Infectious Diseases and Tropical Medicine, University of Munich, Germany; Division of Wits Health Consortium, University Of The Witswatersrand, South Africa; National Institute For Medical Research – Mbeya Medical Research Centre, Tanzania, Instituto Nacional De Saúde, Mozambique; Medical Research Council, United Kingdom; and Research Center Borstel, Germany.