Drug-resistant tuberculosis treatment

Material support for patients. The effects of material support were examined both with RCTs (178–
181) and observational studies (187, 220–227). The interventions included giving meals with DOT, 
monthly food vouchers, food baskets, food supplements and vitamins. Food support for patients and 
family members is an important incentive for TB patients and it also helps protect patients from the 
catastrophic costs associated with TB. Food may be an incentive, but it may also improve outcome 
biologically due to reduction in malnutrition and consequent improvement in immune function. Other 
material support could be financial support in the form of financial incentives, transport subsidies, 
living allowance, housing incentives or financial bonuses after reaching treatment targets. Based on 
an assessment of the certainty of the evidence, carried out using predefined criteria and documented 
in GRADEpro, the certainty of the evidence was rated as very low to high, depending on the outcome 
being assessed and type of study. There were higher rates of treatment success, completion and 
sputum conversion in patients who received material support, and lower rates of treatment failure 
and loss to follow-up in patients who did not receive material support. It is of note that all of these 
studies were in low- and middle-income countries, so presumably these incentives were of significant 
value to the patients in these settings. However, material support would be of significant value to 
TB patients even in higher-income countries, especially in countries that do not have a good social 
welfare system, as TB is a disease of poverty. The studies in this review found that material support was 
usually given to the most vulnerable groups, and therefore health equity was presumably improved 
by this intervention. However, if these incentives are not applied equitably, health disparities may be 
increased. The distribution of material support is likely to depend on the country context and may 
have different effects within and between
countries.