Effects of Ecuador's national monetary incentive program on adherence to treatment for drug-resistant tuberculosis

Int J Tuberc Lung Dis. 2014 Jan;18(1):44-8. doi: 10.5588/ijtld.13.0253.


Background: Non-adherence to tuberculosis (TB) treatment jeopardizes patient health and promotes disease transmission. In July 2011, Ecuador's National Tuberculosis Program (NTP) enacted a monetary incentive program giving adherent drug-resistant TB (DR-TB) patients a US240 bonus each month.

Objective: To describe patients' experiences with the program qualitatively, and to assess its effects on treatment adherence.

Methods: We interviewed 92 current and five default patients about their treatment experience. NTP data on DR-TB patients receiving treatment were used to compare 12-month default rates among the incentive program group and non-program controls.

Results: Our interviews found that patients are financially challenged and use the bonus for a variety of expenses, most commonly food. The most common complaint was that bonus payments were frequently delayed. The 1-year default rate among program patients (9.5%) was significantly lower than the rate among pre-program patients (26.7%).

Conclusion: Ecuador's monetary incentive program alleviates the economic burden placed by treatment on patients. The bonus does not, however, directly address other treatment barriers, including psychological distress and side effects. The program could benefit from timely delivery of payments. Further research is necessary to assess the program's effect on default rates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Directly Observed Therapy / economics
  • Drug Resistance, Multiple, Bacterial*
  • Ecuador
  • Female
  • Health Care Costs
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Income
  • Interviews as Topic
  • Male
  • Medication Adherence*
  • Middle Aged
  • Motivation*
  • National Health Programs / economics*
  • Patient Satisfaction
  • Program Development
  • Program Evaluation
  • Qualitative Research
  • Socioeconomic Factors
  • Time Factors
  • Token Economy*
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / diagnosis
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Tuberculosis, Multidrug-Resistant / economics
  • Tuberculosis, Multidrug-Resistant / microbiology
  • Young Adult


  • Antitubercular Agents