Addressing the Social Determinants and Consequences of TB in Nepal (ASCOT) | Social medicine, infectious diseases and migration (SIM)

Between the year 2018-19, a Welcome Trust funded study was conducted in Nepal to understand the barriers and facilitators to accessing and engaging with TB diagnosis and care, and generate new evidence to develop a socioeconomic support intervention for TB-affected households.

Building on this formative research, the ASCOT project is a pilot trial that aims to evaluate the feasibility and acceptability of socioeconomic support for TB-affected households in Nepal. Participants are randomized to four study arms:

1) social support consisting of TB education, household visits, stigma reduction video, and mutual support groups;
2) economic support consisting of monthly unconditional cash transfers;
3) socioeconomic arm, combining social and economic support;
4) control consisting of standard of care plus a one-off food basket.

The process evaluation will help the team, in collaboration with the National TB Programme of Nepal, to refine the packages and inform design of a definitive, large-scale trial with the primary outcome of catastrophic costs prevalence among TB-affected households.