A quasi-experimental study employing propensity score matching found that free drug availability for tuberculosis improves patient follow-ups and successful treatment results in the Indian private sector.

 A quasi-experimental study employing propensity score matching found that free drug availability for tuberculosis improves patient follow-ups and successful treatment results in the Indian private sector : 

Background

An essential but insufficiently regulated part of India's TB treatment infrastructure is the private sector. The Joint Effort for Tuberculosis Elimination (Project JEET) aims to connect private sector TB care with the array of social support mechanisms made available by the Indian National TB Elimination Programme (NTEP), including giving patients free fixed-dose combination (FDCs) medications. In order to establish how free medications affected patient follow-ups and treatment outcomes, a quasi-experimental study analysed data that was routinely collected.

Methods

We analysed data for Project JEET participants in the private sector who received a diagnosis of pulmonary or extrapulmonary TB between January 2019 and March 2020 and finished their treatment by December 31, 2021. To assess the number of follow-ups and percentage of successful treatment outcomes between patients receiving free medications and a control group who paid out-of-pocket, propensity score matching was used to construct a dataset. The analysis includes 11,621 matched pairs. In order to calculate the effect of free medications on the quantity of follow-ups and treatment success—the latter of which is defined as successful treatment or cure—logistic regression and ordinary least squares regression models were utilised.

Results

After adjusting for potential confounders, patients who received free medications had an average of 2.522 (95% C.I. : 2.325 to 2.719) more follow-ups than those who had to pay for them. For patients receiving free medications, this translates to a 25% mean and 32% median increase in follow-ups. Patients who received free medications had 45% better likelihood of a successful therapy (likelihood Ratio: 1.452, 95% C.I.: 1.288 to 1.637) than those who did not.

Conclusions

In comparison to patients who were paying out of pocket, it was discovered that patients getting free drugs followed up with their treatment coordinator more frequently, possibly in part to permit drug refills. These additional interactions would have provided chances to address worries about side effects, offer more information about the treatment, and establish connections with social support agencies, all of which ultimately helped patients remain actively engaged in their care. This may be an example of the unmeasured impact of free medication on ongoing social support, which increases the likelihood that patients will successfully complete their treatment.