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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
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BMC Infectious Diseases

ISSN: 1471-2334

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