Skip to main content

Advertisement

Table 4 Grading of the body of evidence for the effectiveness of (monetary) incentives. Question: Does treatment supported by (monetary) incentives result in higher initiation, adherence, or completion rates than treatment not supported by incentives in individuals eligible for LTBI treatment?

From: Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review

    Quality assessment n/N = % Effect Quality Importance
No of studies (No of participants) Design Population - treatment-intervention Risk of bias Inconsistency Indirectness Imprecision Other considerations Incentives OR (95 % CI) Absolutea (per 1000 (95 % CI))
No incentives
Initiation
0 (0) No evidence available Critical
Adherence
0 (0) No evidence available Critical
Completion
1 (111) [16] RCT PWID - long Hb Very seriousc Not serious Not serious Seriousd None 49/72 = 68 % 14.5 (5.0-42) 552 (296-732) OOO Very low Critical
Methadone treatment + DOT vs. no incentive + SATe 5/39 = 13 %
1 (108) [55] RCT PWID - long Hb Not seriousf Not serious Not serious Seriousd None 29/53 = 53 % 32.0 (7.1–145)g 511 (174–809) O Moderate Critical
Monetary incentive vs. no incentive 2/55 = 3.6 %
1 (216) [15] RCT Inmatesh - long H Not seriousi Not serious Not serious Seriousd None 14/113 = 12 % 1.1 (0.5–2.4)j 7 (−58–124) O Moderate Critical
Non-cashk incentive vs. no incentive 12/103 = 12 %
1 (119) [56] RCT Homeless - long H or short HR Seriousl Not serious Not serious Seriousd None 58/68 = 85 % 1.7 (0.7–4.3) 80 (−69–164)  OO Low Critical
Cash vs. non-cash incentivem 44/57 = 77 %
  1. Bibliography: Tulsky et al. 2004 [56]; Batki et al. 2002 [16]; Malotte et al. 2001 [55]; White et al. 2002 [15]
  2. n/N: No of individuals with LTBI who initiated, or adhered to or completed treatment/total number of subjects; CI: confidence interval; DOT: directly observed therapy; H: isoniazid; HR: isoniazid and rifampicin; OR: odds ratio; PWID: people who inject drugs; RCT: randomised controlled trial
  3. aCalculated via GradePro
  4. bBoth studies with PWID population are presented separately, since one of the studies applies incentive + DOT as intervention
  5. cMalotte et al. 2001 [55]: unclear sequence generation; partly blinded
  6. dBatki et al. 2002 [16]: no blinding; use of unvalidated patient-reported outcomes in SAT arm (monthly medication pick-up); dissimilarities between treatment arms (age, Addiction Severity Index psychiatric and Beck depression inventory); exposure bias (DOT in incentive arm)
  7. eApproximately half of the intervention group (37/72) also received substance abuse counselling
  8. fWhite et al. 2002 [15]: partly blinded
  9. gAdjusted OR, adjusted for: treatment condition, recruitment status, binge drinking
  10. hInmates who started treatment in jail and were released before treatment completion
  11. iTulsky et al. 2004 [56]: partly blinded; dissimilarities between treatment arms (primary housing in last year shelter/street; not found to be an independent predictor of completion in this study)this study presents data for incentive vs. another incentive (rather than vs. no incentive)
  12. jAdjusted OR, not reported which factors this OR was adjusted for
  13. k$25 equivalent in food or transportation vouchers
  14. lTotal number of events <125
  15. mPatients with normal chest X-rays prescribed H, while those with evidence of old TB on chest X-ray were prescribed HR. Participants randomly assigned to the cash or non-cash incentive. Non-cash incentives consisted of a choice of $5 equivalent in fast-food or grocery store coupons, phone cards or bus tokens