Closing the Evidence Gap of Cash Transfer for Tuberculosis-Affected Households : Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India"

Achieving the targets of eliminating tuberculosis (TB) requires a combination of biomedical, epidemiological, and social approaches. Having hitted by the coronavirus disease 2019 (COVID-19) pandemic which diminishes the financial capacity of TB-affected households, the importance of delivering socioeconomic support to TB-affected household emerges. However, the evidence of TB-related socioeconomic support is still scarce, and some questions are left unanswered. A sequential explanatory mixed-methods study by Dave and Rupani shows that the direct benefit transfer (DBT), a form of cash transfer, to TB-affected households improves TB treatment outcomes in India despite the challenges. Some critical issues remain to be discussed: trading-off between the amount of cash and its sustainability, choosing the most appropriate support packages, detecting, and reaching the target population, and arranging the most effective delivery strategy. Knowledge gap remains to be answered, and a global research agenda and political commitment are critical to encourage more evidence in delivering socioeconomic support for TB control.

Closing the Evidence Gap of Cash Transfer for Tuberculosis-Affected Households, Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India"

Achieving the targets of eliminating tuberculosis (TB) requires a combination of biomedical, epidemiological, and social approaches. Having hitted by the COVID-19 pandemic which diminishes the financial capacity of TB-affected households, the importance of delivering socioeconomic support to TB-affected household emerges. However, the evidence of TB-related socioeconomic support is still scarce, and some questions are left unanswered. A sequential explanatory mixed-methods study by Dave and Rupani (2022) shows that the direct benefit transfer, a form of cash transfer, to TB-affected households improves TB treatment outcomes in India despite the challenges. Some critical issues remain to be discussed: trading-off between the amount of cash and its sustainability, choosing the most appropriate support packages, detecting, and reaching the target population, and arranging the most effective delivery strategy. Knowledge gaps remains to be answered, and a global research agenda and political commitment are critical to encourage more evidence in delivering socioeconomic support for TB control.

Targeted Vaccine Allocation Could Increase the COVID-19 Vaccine Benefits Amidst Its Lack of Availability: A Mathematical Modeling Study in Indonesia.

With a limited number of vaccines and healthcare capacity shortages, particularly in low- and middle-income countries, vaccination programs should seek the most efficient strategy to reduce the negative impact of the COVID-19 pandemics. This study aims at assessing several scenarios of delivering the vaccine to people in Indonesia. We develop a model for several scenarios of delivering vaccines: without vaccination, fair distribution, and targeted distribution to five and eight districts with the highest COVID-19 incidence in West Java, one of the most COVID-19-affected regions in Indonesia. We calculate the needs of vaccines and healthcare staff for the program, then simulate the model for the initial 4-month and one-year scenarios. A one-year vaccination program would require 232,000 inoculations per day by 4833 vaccinators. Targeted vaccine allocation based on the burden of COVID-19 cases could benefit the COVID-19 vaccination program by lowering at least 5000 active cases. The benefits would increase by improving the number of vaccines and healthcare staff. Amidst lacking available vaccines, targeted vaccine allocation based on the burden of COVID-19 cases could increase the benefit of the COVID-19 vaccination program but still requires progressive efforts to improve healthcare capacity and vaccine availability for optimal protection for people.

COVID-19 and Tuberculosis-Related Catastrophic Costs.

The COVID-19 pandemic has created an unprecedented health crisis and a substantial socioeconomic impact. It also affects tuberculosis (TB) control severely worldwide. Interruptions of many TB control programs because of the COVID-19 pandemic could result in significant setbacks. One of the targets that can be affected is the WHO's End TB Strategy goal to eliminate catastrophic costs of TB-affected households by 2030. Disruptions to TB programs and healthcare services due to COVID-19 could potentially prolong diagnostic delays and worsen TB treatment adherence and outcomes. The economic recession caused by the pandemic could significantly impact household financial capacity because of the reduction of income and the rise in unemployment rates. All of these factors increase the risk of TB incidence and the gravity of economic impact on TB-affected households, and hamper efforts to eliminate catastrophic costs and control TB. Therefore, efforts to eliminate the incidence of TB-affected households facing catastrophic costs will be very challenging. Because financial constraint plays a significant role in TB control, the improvement of health and social protection systems is critical. Even before the pandemic, many TB-high-burden countries (HBCs) lacked robust health and social protection systems. These challenges highlight the substantial need for a more robust engagement of patients and civil society organizations and international support in addressing the consequences of COVID-19 on the control of TB.