Delia Boccia

• London School of Hygiene and Tropical Medicine

Introduction: Tuberculosis (TB) is the leading cause of death due to infectious disease worldwide. Social protection interventions can benefit TB-affected households. We conducted a systematic review and meta-analysis to quantify the effectiveness of social protection on TB treatment and socioeconomic outcomes. Methods: We identified articles publi...

Conditional cash transfer (CCT) programs have been implemented globally to alleviate poverty. Although tuberculosis (TB) is closely linked to poverty, the effects of CCT on TB outcomes among populations facing social and economic vulnerabilities remain uncertain. Here we estimated the associations between participation in the world’s largest CCT pr...

Background. Conditional Cash Transfers (CCT) are the world’s most widely implemented interventions for poverty alleviation. Still, there is no solid evidence of the CCT effects on the reduction of the burden of Tuberculosis (TB) in marginalized and extremely vulnerable populations. We estimated the effect of the Bolsa Família Program (BFP), the lar...

Background: Tuberculosis (TB) is a leading cause of death due to infectious disease worldwide. People with TB and their households often suffer social and economic losses due to the cost of tuberculosis care. The World Health Organization 2015 End TB strategy called for socioeconomic support through social protection interventions. Social protectio...

Tuberculosis (TB) disproportionally affects impoverished members of society. The adverse socioeconomic impact of TB on households is mostly measured using money-centric approaches which have been criticised as one-dimensional and risk either overestimating or underestimating the true socioeconomic impacts of TB. We propose to use the sustainable li...

Background In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these inte...

Background: The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplin...

Background: Tuberculosis (TB) is a leading cause of death due to infectious disease worldwide. People with TB and their households often suffer social and economic losses due to the cost of tuberculosis care. The World Health Organization 2015 End TB strategy called for socioeconomic support through social protection interventions. Social protectio...

Background: It is well known that poverty is associated with ill health and that ill health can result in direct and indirect costs that can perpetuate poverty. Social protection, which includes policies and programmes intended to prevent and reduce poverty in times of ill health, could be one way to break this vicious cycle. Social protection, pa...

Tuberculosis (TB) and poverty are inextricably linked. Catastrophic costs of TB illness drive TB-affected households into worsening impoverishment and hamper treatment success. The WHO's End TB Strategy recommends social protection for TB-affected households to mitigate financial shock and improve TB outcomes. This scoping review maps the landscape...

Background Accelerating declines in tuberculosis (TB) incidence is paramount for achieving global goals set for 2030 by the Sustainable Development Goals and the End TB Strategy. The aim of this study was to identify key country-level social determinants of national TB incidence trends. Methods This longitudinal ecological study used country-level...

Background Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the r...

This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance‐related behaviors or prevent overweight/obesity in children from families experiencing socio‐economic disadvantage. We identified 24 interventions, from 33 articles, since 1990. Overall, despite their hetero...

Background: The global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods a...

Objectives Tuberculosis (TB) and mental illnesses are highly prevalent globally and often coexist. While poor mental health is known to modulate immune function, whether mental disorders play a causal role in TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and pub...

Background Tuberculosis (TB) and mental illnesses are highly prevalent globally and often co-exist. Whilst poor mental health is known to modulate immune function, whether mental disorders causally increase TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and publi...

Background The global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods app...

Tuberculosis is the leading cause of deaths from an infectious disease worldwide. WHO's End TB Strategy is falling short of several 2020 targets. Undernutrition is the leading population-level risk factor for tuberculosis. Studies have consistently found that undernutrition is associated with increased tuberculosis incidence, increased severity, wo...

Financial barriers are a key limitation to accessing health services, such as tuberculosis (TB) care in resource-poor settings. In Ghana, the National Health Insurance Scheme (NHIS), established in 2003, officially offers free TB care to those enrolled. Using data from the first Ghana’s national TB patient cost survey, we address two key questions...

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. The main aim of this review is to explore how conditional and unconditional cash transfers aimed at impacting on health behaviours are experienced and perceived by recipients. By health behaviours we mean health service use, health outcomes, or socio...

This review aims to provide a quantitative summary of the impact of cash transfers on poor households’ capacity to cope with idiosyncratic health shocks. For this, we will study the effect of cash transfers on household consumption and/or expenditure growth, and use of coping strategies in response to this type of shock.

Introduction Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculos...

Balance box from propensity score matching of subjects with completed data from the Brazilian Notifiable Disease Information System database (SINAN-2015). (TIFF)

Distribution of missing data among subjects from the Brazilian Notifiable Disease Information System database (SINAN), 2015. DOT: directly observed therapy; HIV/AIDS: human immunodeficiency virus/ acquired immunodeficiency syndrome; n: number of observations; TB: tuberculosis. (PDF)

Distribution of tuberculosis determinants of subjects with completed data on the Brazilian Notifiable Disease Information System database (SINAN), 2015. DOT: directly observed therapy; EPTB: extrapulmonary tuberculosis; HIV/AIDS: human immunodeficiency virus/ acquired immunodeficiency syndrome; n: number of observations; TB: tuberculosis. (PDF)

Adjusted* risk ratios of hierarchical Poisson regression models of the association of determinants of TB and treatment cure rates to subjects with completed data from the Brazilian Notifiable Disease Information System database (SINAN), 2015*. Adjusted for the determinants that belong to the hierarchical levels above, as well as for the determinant...

Distribution and estimates of the direct effect of being beneficiary of governmental cash transfer program on tuberculosis treatment outcomes among subjects with completed data from the Brazilian Notifiable Disease Information System database (SINAN), 2015. a: Model unadjusted. b: Model adjusted by schooling, skin color, healthcare worker, area of...

Background Evidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB trea...

Background: The World Health Organization prioritises a more holistic global response to end the tuberculosis (TB) epidemic by 2030. Based on experiences in the HIV response, social protection, and in particular cash transfers, show promise for contributing to this. Currently, individual-level evidence for the potential of cash transfers to preven...

Background: Pillar 3 of the End TB Strategy calls for the promotion of research and innovation at the country level to facilitate improved implementation of existing and novel interventions to end tuberculosis (TB). In an era of increasing cross-border migration, there is a specific need to integrate migration-related issues into national TB resea...

Background: Tackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy. However, evidence informing policies are still scarce. Mathematical modelling has the potential to contribute to fill this knowledge gap, but existing models are inadequate. The S-PROTECT consortium aimed t...

Objectives Tuberculosis (TB) is known as a disease of the poor. Despite TB diagnosis and care usually being offered for free, TB patients can still face substantial costs, especially in the context of multi‐drug resistance (MDR). The End TB Strategy calls for zero TB‐affected families incurring “catastrophic” costs due to TB by 2025. This paper exa...

Background: Social vulnerability is strongly associated with tuberculosis (TB) indicators like cure rate. By addressing key social determinants, social protection policies such as Brazil's Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in TB control. Evidence is consolidating around a positive effect of soc...

Figure S1. The distribution of household wealth index overall and by community in Zambia. Figure S2. The distribution of household wealth index overall and by community in South Africa. Figure S3. Household wealth score by educational attainment for individuals in Zambia. Figure S4. Household wealth score by educational attainment for individual...

The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in global tuberculos...

Background: The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in glob...

Objective: To present results of the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era, on socio-economic position. Methods: The main analyses used data on 34,446 individuals in Zambia and 30,017 individuals in South Africa with evaluable tuberculosis culture res...

Summary of countries’ household-level TB-related cost burden before, and after cash transfers. The “Before cash transfers” column represents countries’ mean TB-related cost burden without cash transfer data. The “After TB-specific cash transfers” column represents countries’ mean TB-related cost burden after cash transfers have been subtracted from...

Summary of countries’ household-level TB-related cost burden before and after cash transfers without imputation of missing costs components. The “Before cash transfers” column represents countries’ mean TB-related cost burden without cash transfer data. The “After TB-specific cash transfers” column represents countries’ mean TB-related cost burden...

Summary of countries’ household-level additional and total cash transfer, and country-level cash transfer budget needed to prevent catastrophic costs without imputation of missing costs components. The “additional cash transfer” column represents the additional value of cash transfer that countries’ average TB-affected household would need to preve...

Summary of countries’ household-level additional and total cash transfer, and country-level cash transfer budget needed to prevent catastrophic costs using a 10% threshold TB-related cost burden for measuring catastrophic costs. The “additional cash transfer” column represents the additional value of cash transfer that countries’ average TB-affecte...

Summary of cash transfer and household income data sources. PPP, purchasing power parity. (DOCX)

Summary of countries’ country-level cash transfer budget needed to prevent catastrophic costs. The “0.5% of country GDP” column represents the upper limit that governments in low- and middle-income countries spend on a poverty-reduction cash transfer programme [27]. The “poverty-reduction programme” column represents countries’ actual poverty-reduc...

Summary of countries’ household-level additional and total cash transfer, and country-level cash transfer budget needed to prevent catastrophic costs using a 30% threshold TB-related cost burden for measuring catastrophic costs. The “additional cash transfer” column represents the additional value of cash transfer that countries’ average TB-affecte...

Prospective analysis plan. (DOCX)

Background For the first time in the modern era of tuberculosis control, the WHO's End TB strategy specifically integrates socioeconomic support for people affected by tuberculosis with existing biomedical interventions. However, there is little evidence of the impact of this approach on tuberculosis outcomes. We designed and implemented one of the...

To evaluate the impact of socioeconomic support on tuberculosis preventive therapy initiation in household contacts of tuberculosis patients and on treatment success in patients. A non-blinded, household-randomized, controlled study was performed between February 2014 and June 2015 in 32 shanty towns in Peru. It included patients being treated for...

Even when tuberculosis (TB) care is free, impoverished patients and their households continue to incur unmanageable costs due to seeking and staying in care for the full duration of anti-TB treatment [1]. By aggravating household vulnerability, these costs can prevent or delay diagnosis, treatment and successful outcome, leading to increased TB tra...

Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strate...

The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention. The settin...

Cash transfer interventions are forms of social protection based on the provision of cash to vulnerable households with the aim of reduce risk, vulnerability, chronic poverty and improve human capital. Such interventions are already an integral part of the response to HIV/AIDS in some settings and have recently been identified as a core element of...

Cash transfers are key interventions in the World Health Organisation's post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource...

Background Even when tuberculosis (TB) treatment is free, hidden costs incurred by patients and their households (TB-affected households) may worsen poverty and health. Extreme TB-associated costs have been termed "catastrophic" but are poorly defined. We studied TB-affected households' hidden costs and their association with adverse TB outcome to...

To assess the robustness of socio-economic inequalities in tuberculosis (TB) prevalence surveys. Data were drawn from the TB prevalence survey conducted in Lusaka Province, Zambia, in 2005-2006. We compared TB socio-economic inequalities measured through an asset-based index (Index 0) using principal component analysis (PCA) with those observed usi...

Although historically tuberculosis (TB) has been associated with poverty, few analytical studies from developing countries have tried to: 1. assess the relative impact of poverty on TB after the emergence of HIV; 2. explore the causal mechanism underlying this association; and 3. estimate how many cases of TB could be prevented by improving househo...

To quantify the impact of cash transfer and microfinance interventions on a selected list of tuberculosis (TB) risk factors and assess their potential role in supporting TB control. Published and unpublished references identified from clinical and social electronic databases, grey literature and web sites. Eligible interventions had to be conducted...

Growing consensus indicates that progress in tuberculosis control in the low- and middle-income world will require not only investment in strengthening tuberculosis control programs, diagnostics, and treatment but also action on the social determinants of tuberculosis. However, practical ideas for action are scarcer than is notional support for thi...

This study aimed to assess the association between household socioeconomic position and tuberculosis (TB) infection in two communities of Zambia. For this purpose we implemented a cross-sectional investigation, nested within a larger case control study. Infection was assessed using Quantiferon-TB Gold. A socioeconomic position index was constructed...

To assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa. Systematic review of published peer-reviewed articles. Articles were identified that reported original data comparing individually measured educational attainment and HIV status among at least 300 individ...

Previous studies have estimated the prevalence of tuberculosis and HIV infection in population subgroups in the UK. This study was undertaken to describe recent trends in the proportion of individuals with HIV infection among reported cases of tuberculosis in England and Wales, and to review the implications for clinical and public health care. A p...

Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs). We c...

Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan. We re...

The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 Decem...

In order to estimate the incidence of invasive pneumococcal diseases (IPD) and the amount of vaccine preventable serious infections, a 1-year population-based surveillance was undertaken in two comparable Italian regions (Piemonte and Puglia, representing 14% of the Italian population) prospectively collecting data and strains from all the hospital...

Recent data indicated that the rate of vancomycin resistance in bloodstream-infecting enterococcal isolates in Italy is one of the highest in Europe. The aims of this study were to characterize bloodstream-infecting vancomycin-resistant enterococci (VRE) obtained from various Italian hospitals and to establish whether the isolates were clonally rel...

To evaluate the potential impact of antipneumococcal vaccination in Italy, Streptococcus pneumoniae isolates from invasive disease were collected from 65 laboratories in the years 1997-2000. Of the 503 isolates examined, 15% were from children <5 years and 34% from adults > or = 65 years. The most frequent serogroups were, in ranking order, 14, 19,...

In July 2000, an outbreak of gastroenteritis occurred at a tourist resort in the Gulf of Taranto in southern Italy. Illness in 344 people, 69 of whom were staff members, met the case definition. Norwalk-like virus (NLV) was found in 22 of 28 stool specimens tested. The source of illness was likely contaminated drinking water, as environmental inspe...

Necrotising enterocolitis (NEC) is one of the most serious gastrointestinal diseases among newborns and it mainly affects those in intensive care units. The aetiology of the disease has been reported to be multifactorial and both sporadic cases and nosocomial outbreaks have occurred. In this report, we review 17 epidemics of NEC reported in the lit...