Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial.



Rai, Bhola ORCID: 0000-0002-7421-4891, Dixit, Kritika ORCID: 0000-0002-7957-8109, Dhital, Raghu, Rishal, Poonam ORCID: 0000-0003-2758-757X, Gurung, Suman Chandra ORCID: 0000-0002-4012-7562, Paudel, Puskar Raj, Mishra, Gokul, Bonnett, Laura ORCID: 0000-0002-6981-9212, Siqueira-Filha, Noemia, Khanal, Mukti Nath
et al (show 4 more authors) (2022) Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial. Wellcome open research, 7. 141-.

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Abstract

<b>BACKGROUND: </b>The World Health Organization's End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal. <b>METHODS: </b>We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang. We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT's implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants. <b>CONCLUSIONS:</b> The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention's impact on catastrophic costs mitigation and TB outcomes. The trial is registered with the ISRCTN ( ISRCTN17025974).

Item Type: Article
Uncontrolled Keywords: Tuberculosis; poverty; social determinants; catastrophic costs; stigma; social protection; socioeconomic support; End TB Strategy; pilot trial; process evaluation; mixed-methods.
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 21 Apr 2023 13:57
Last Modified: 19 Mar 2024 18:46
DOI: 10.12688/wellcomeopenres.17669.3
Open Access URL: https://doi.org/10.12688/wellcomeopenres.17669.1
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3169859