​Research with University of Chicago, Johns Hopkins University and University of Maryland

This study will estimate the effect of financial incentives on leveraging social networks of existing tuberculosis (TB) patients to improve outreach and detection. Strategies to improve outreach and detection are vital, because while highly effective treatment is available, the disease infects about 9 million people worldwide and at least one third of those infected are not in treatment.

Our study will explore the use of financial incentives to encourage referrals, and will focus on a specific community group with unique potential to generate referrals: current patients under treatment for TB. Patients already in treatment for TB are uniquely suited to refer TB suspects both within the family and local community. Such patients are likely to know other people who are infected with TB (including family members), because they share risk factors. In particular, they may have connections to vulnerable people who are hard for health workers to identify and reach in a timely manner. Current patients are also able to provide personal testimonials that may be more compelling than information from health workers. Though patient-to-patient referrals have the potential to connect patients to beneficial treatment, they are very rare in practice. Financial incentives may overcome stigma and other costs that current patients face in referring others for testing and treatment. Combining incentives with patient-to-patient referrals represents both a scientific advance, and a contribution with the potential to change and enhance current practices in TB detection.

A collaboration between Operation ASHA, Johns Hopkins University, University of Maryland and University of Chicago is conducting a randomized controlled trial to compare the effectiveness of different types of incentives to current patients and prospective patients. The trial will focus on the importance of conditionality in reducing strategic behavior and/or inhibiting referrals, and on separating the effect of current patients’ networks from their ability to deliver information by varying whether outreach is led by patients or health workers.

If successful, incentivized patient-to-patient referrals could become part of the standard public health toolkit in the detection of TB and other communicable diseases (e.g. HIV/AIDS, STDs), much like community health workers or directly observed therapy have become standard tools, deployed when needed across a variety of treatment settings and in accordance with local norms and practices.