ASCOT pilot trial dissemination meeting

The dissemination meeting of “Addressing the Social Determinants and Consequences of TB in Nepal” (ASCOT) pilot trial, funded by the Medical Research Council, UK, and led by the principal investigator, Dr Tom Wingfield from Liverpool School of Tropical Medicine was organized in Kathmandu on 27^th March 2023, with the participation of government and non-government stakeholders from the ministry of health and population and project districts, civil society organizations and relevant BNMT project team. In the meeting, the overview and the foundation of the project in context to the goals of National TB Control Center (NTCC) was presented. Similarly, the qualitative and quantitative findings from the process evaluation of the pilot trial was shared among the audiences, along with the community reception of the socioeconomic support packages and the journey of fighting TB by a TB survivor, now a BNMT volunteer. This was followed by remarks from the stakeholders.

The ASCOT pilot trial recruited 128 participants from the study sites: Mahottari, Chitwan, Pyuthan and Morang; the participants were randomized to one of the four study arms, control standard of care plus single food basket, social support, economic support and socioeconomic support. We provided social support through TB Clubs to reduce stigma, home visits for TB education, and unconditional cash transfers to mitigate catastrophic costs of TB. The quantitative findings show that the rates of recruitment, follow-up, and fidelity to intervention activities were high across arms except for a slightly reduced attendance (78%) at TB Club in the social arm. Feedback from participants was highly positive about the TB Clubs, cash transfers, and home visits. Similarly, qualitative findings from the process evaluation of the pilot trial showed that key informants from the NTCC and others were supportive of socioeconomic interventions if suitably budgeted. People with TB reported using cash to buy food and cover travel costs to clinics. Across interviews and focus groups, there was a perception that cash supplemented with education and stigma reduction would be preferable to either cash or stigma reduction alone. Overall, the pilot trial has shown that a socioeconomic support package for TB affected households in Nepal is feasible, acceptable, and suitable for large-scale evaluation in an effectiveness-implementation trial.

The project was well received by the stakeholders; the open Q N A after the presentations focused on sampling, randomization process, queries on findings, implementation experiences from government stakeholders, with appreciation and suggestions for the full trial. The stakeholders appreciated the project as an important piece of work in social protection to inform the national TB program’s potential programs.

The ASCOT team is applying for funding to conduct a large-scale two-arm trial of integrated socioeconomic support for TB-affected households in Nepal, which will be vital to inform future evidence-based policy and practice.

For more readings:

• Socioeconomic barriers and facilitators to accessing TB care in Nepal
• ASCOT protocol
• ASCOT ISRCTN registration
• Participatory workshop to co-design socioeconomic support package
• SDG3 and Me SpringerNature Blog

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