However, no studies to date have provided a robust assessment of the impact of BFP or any CCTs on the burden of leprosy using individual-level data. Higher CCT coverage has been associated with reductions in leprosy risk at the population level ( 14, 15). Although leprosy in Brazil has been declining in the past decades, Brazil still registers over 20,000 new leprosy cases annually, accounting for over 14% of cases diagnosed globally ( 13). The Brazilian CCT, the Bolsa Familia Program (BFP), provides financial aid to low-income families, conditional on school attendance and preventive health checkups, and has been linked to improvements in children’s education, health-care access, and food security ( 8–12). However, there is limited evidence of their impact on neglected tropical diseases ( 7).
There is an increasing recognition that leprosy and other neglected tropical diseases are strongly linked to poverty, being both attributable to and responsible for unfavorable economic conditions in affected populations ( 3–5).Ĭonditional cash transfer programs (CCTs) have been proposed as a promising, cost-effective strategy for overcoming intergenerational poverty and ameliorating the social determinants of health ( 6). While the prevalence of leprosy has declined over the last 30 years, leprosy continues to be an important cause of disability and stigma among the over 200,000 individuals diagnosed annually worldwide ( 1, 2). Leprosy is a neglected tropical disease that can lead to blindness and permanent disabilities if left untreated. These findings provide policy-relevant evidence that social policies might contribute to ongoing leprosy control efforts in high-burden communities. In high-burden municipalities, the association was particularly pronounced for paucibacillary cases (IRR Poisson = 0.82, 95% CI: 0.68, 0.98) and cases with leprosy-associated disabilities (IRR Poisson = 0.79, 95% CI: 0.65, 0.97). After matching, BFP participation was not associated with leprosy incidence overall (incidence rate ratio (IRR) Poisson = 0.97, 95% CI: 0.90, 1.04) but was associated with lower leprosy incidence when restricted to families living in high-burden municipalities (IRR Poisson = 0.86, 95% CI: 0.77, 0.96). Overall, cumulative leprosy incidence was 17.4/100,000 person-years at risk (95% CI: 17.1, 17.7) and markedly higher in “priority” (high-burden) versus “nonpriority” (low-burden) municipalities (22.8/100,000 person-years at risk, 95% confidence interval (CI): 22.2, 23.3, compared with 14.3/100,000 person-years at risk, 95% CI: 14.0, 14.7). After propensity score matching BFP beneficiary to nonbeneficiary families, we used Mantel-Haenszel tests and Poisson regressions to estimate incidence rate ratios for new leprosy case detection and secondary endpoints related to operational classification and leprosy-associated disabilities at diagnosis. To test the hypothesis that poverty-alleviating policies might be associated with reduced leprosy incidence, we evaluated the association between the Brazilian Bolsa Familia (BFP) conditional cash transfer program and new leprosy case detection using linked records from 12,949,730 families in the 100 Million Brazilian Cohort (2007–2014). Leprosy is a neglected tropical disease predominately affecting poor and marginalized populations.
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