Effects of Incentives and Subsidies on Tuberculosis Testing Rates in Rural Philippines

Background
International Care Ministries (ICM) is a Philippines-based non-governmental organization with a mission to reduce the burden of extreme poverty in the Philippines. Between February 2018 and January 2019, ICM conducted the first randomized controlled trial (RCT) to investigate whether providing food and transportation costs increases the rate of attendance to the rural health unit (RHU) for tuberculosis (TB) testing.

 Methods
Study participants were assigned to one of four RCT groups based on incentives or subsidies that they were given: A) no incentives or subsidies (i.e., control group); B) food; C) transportation costs to the RHU; and D) food and transportation costs to the RHU. Between February 2019 and January 2020, ICM conducted the second RCT with three RCT groups: A) food and transportation costs to the RHU (i.e., control group); B) food, transportation costs to the RHU, and subsidies for chest x-ray; and C) food, transportation costs to the RHU, subsidies for chest x-ray, and accompaniment of a counsellor (i.e., a trusted community member) to the RHU. To elucidate the effect of incentives and subsidies in increasing the rate of RHU attendance for TB testing, a logistic regression model was developed using RHU attendance for TB testing as the outcome, and RCT group, age, and sex as the predictors.

 Results & Key Messages

The first RCT has shown that providing both food and transportation costs was associated with the highest odds of attending the RHU for TB testing (Odds Ratio (OR) = 7.06, 95% Confidence Interval (CI) [4.79, 10.38], p < 0.05), compared to providing no incentives or subsidies. Males had significantly lower odds of attending the RHU for TB testing (OR = 0.63, 95% CI [0.47, 0.83], p < 0.05), compared to females. In the second RCT, chest x-ray subsidies and counsellor accompaniment did not significantly increase the odds of attending the RHU for TB testing (p > 0.05). Overall, providing food and transportation costs was shown to be a promising strategy for encouraging TB testing in rural Philippines.