TB Outcomes: Professor Nazir Ismail from Wits University, Johannesburg, and Dr Harry Moultrie from SA’s National Institute for Communicable Diseases (NICD) led the study, which was  published in The Lancet Infectious Diseases journal on 6 February 2025.

The study demonstrated that a combination of conditional cash transfers and TB counselling significantly improves treatment success rates and reduces loss to follow-up among TB patients in South Africa.

Loss to follow-up refers to individuals diagnosed with TB who either do not start treatment or who stopped treatment during care.

Cash transfers were conditional upon participants attending their appointments within the prespecified window period, which included returning for their results and starting treatment, as well as the monthly follow-up visits until the end of treatment.

About the study

The study, a randomised controlled trial conducted across nine clinics in Johannesburg, evaluated the effects of a patient-centred intervention combining pre-test and post-test TB counselling with financial incentives on treatment adherence and outcomes.

The intervention resulted in halving unsuccessful TB outcomes compared to standard care.

“Our findings bring us closer to the 90–90–90 TB targets, which aim for 90% treatment success. By addressing financial and behavioural barriers, this approach can help reduce disease transmission and improve public health outcomes,” says lead author Professor Nazir Ismail, Department of Clinical Microbiology and Infectious Diseases at Wits University.

90-90-90 refers to 90% of people with TB are diagnosed, 90% of those diagnosed are put on treatment, and 90% of those on treatment are successfully treated.

Joint senior author of the paper, Professor Ibrahim Abubakar, Dean for the Faculty of Population Health Sciences, and Pro-Provost Health, at UCL, says, “We are delighted that this partnership with Wits has resulted in this policy relevant evidence, with implications for South African and global tuberculosis control and elimination.”

Key Findings

• TB patients who received counselling and conditional cash transfers were significantly more likely to complete treatment successfully (82.0% vs. 65.6% in the control group).

• The intervention showed a substantial reduction in the relative risk (0.52) of unsuccessful patient outcomes, which included not starting treatment, not completing treatment, treatment failure, drug-resistance development, or death.

• Pretreatment loss to follow-up, that is, individuals who did not return and start treatment, was reduced from 15.8% to 3.9%, indicating improved engagement in care.