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Leveraging Patients' Social Networks to Overcome Tuberculosis

Jessica Goldberg tests the effectiveness of new methods of enrolling patients in tuberculosis treatment by providing financial incentives for recruitment

The World Health Organization (WHO) estimates that only one third of the 8.7 million people infected with tuberculosis are in treatment. Strategies to improve outreach and detection of TB are vital, especially among vulnerable, hard-to-reach populations. Personal referrals from current patients who are already in treatment to others in their social networks have the potential to increase the total fraction of infected persons who are treated for TB, and to extend treatment to those who are the most marginalized.

This project will determine whether using financial incentives to encourage referrals can leverage the social networks of existing patients to provide broader outreach and deeper penetration into marginalized populations. The effectiveness of financial incentives will be measured through a randomized controlled trial conducted with patients at Operation ASHA, an NGO that operates 185 community-based Directly Observed Therapy--Short Course (DOTS) centers in 17 cities in India. Patients will be randomly assigned to one of three outreach schemes: encouragement only, encouragement and financial incentive for any new suspect, and encouragement and financial incentives for new suspects who test positive for TB. New patients will similarly be eligible for either no financial incentive, an incentive for getting tested, or an incentive for getting tested conditional on having a positive test result. The effect of each type of incentive will be measured through administrative data on the total number of new patients and the number of new patients who test positive for TB referred under each scheme.

The study will measure the cost effectiveness of incentives to current patients and new suspects, and compare the costs of detection under these schemes to alternatives such as relying on salaried or incentivized health workers. By using baseline and follow up survey data for current patients and new suspects, the study will also determine whether incentivized referrals reach patients with different characteristics than other outreach schemes.