Effectiveness of Providing Cash Incentives and Training To Community Health Workers on Active Case Finding for Tuberculosis In Nigeria: A Cluster-Randomized Control Trial

Abstract

Background Case detection for Tuberculosis remains low in high-burden communities. Community Health Workers (CHWs) are the first point of contact for many rural Nigerians and have been useful in active case finding. This study assessed the effectiveness of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods A cluster randomized control trial with three arms was conducted. Arm A received cash incentives and training, Arm B received only training, and the control arm (C) received neither. CHWs already working in the communities participated. TB case notification and number of community outreaches held were used to assess intervention effects. Data were analyzed using STATA (v.13) and GraphPad Prism (v.8). Effect sizes were calculated using odds ratios and 95% confidence intervals. Associations were tested using Chi-square (χ²) tests, with significance set at P=0.05. Results Arm A had a 14.4% increase in case notification, Arm B showed a 7.4% increase, and the control arm showed a 39.7% increase from the previous year. Arms A and B had lower odds of TB case notification post-intervention, compared to the control (OR = 0.819 and 0.769, respectively), with no significant difference between them. Arm A also saw a 144.8% increase in community outreaches, compared to 46.7% in Arm B and 22.7% in Control Arm C. Arms A and B had higher odds of carrying out community outreaches post-intervention compared to the control (OR = 1.995 and 1.195, respectively), but no significant differences were found between the groups regarding community outreach. Conclusion While the interventions resulted in an increased number of community outreaches compared to the control, case notification improved more in the control arm than in the intervention arms. Nevertheless, the findings highlight the potential of combining cash incentives with training to improve TB control efforts at the community level. Further exploration of the implementation process may shed light on the observed outcomes and guide future intervention strategies.