Background objective:
Tuberculosis (TB) is considered a disease related to poverty, in fact, a higher burden of TB is often observed in populations with low socioeconomic status. During the current COVID-19 pandemic, a substantial increase in the global TB burden, caused by disruption of TB health services and increased poverty, has been predicted. Therefore, social interventions such as conditional cash transfers (CCT) can be effective in mitigating the effect of the pandemic on TB. We estimated the effect of PBF on TB incidence, mortality, and case fatality rate using a national cohort of 53 million individuals.

Methods:
We analyzed individuals who entered the Cohort of 100 Million Brazilians between 2004-2015 and compared BFP beneficiaries and non-beneficiaries. We used multivariate Poisson regressions, adjusted for all relevant demographic and socioeconomic variables, and weighted with inverse probability of treatment weight (IPTW). We also perform a wide range of stratifications and sensitivity analyses.

Results:
Exposure to PBF was associated with lower rates of TB incidence (RR:0.59, 95% CI: 0.58-0.60) and mortality rates (RR:0.69, 95% CI:0.65 -0.73), was positively associated with a decrease in TB case fatality rates – although not statistically significant. Individuals living in extreme poverty had a greater impact of the PBF compared to less poor, (RR:0.49 versus RR:0.95 for incidence; RR:0.60 versus RR:1.00 for mortality and RR:0.80 versus RR:0.92 for fatality rate).

Conclusion:
CCT can significantly reduce tuberculosis incidence and mortality, especially in extremely poor populations, by decreasing the unequal distribution of the TB burden in the most vulnerable populations, essential at this time with the dramatic increase in global poverty due to the COVID-19 pandemic, therefore , such a strategy can help protect against increases in the incidence of TB worldwide and contribute to achieving the goals of the “End TB Strategy”.