Programmatic nutritional support and tuberculosis treatment outcomes: a natural experiment in West Africa
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BACKGROUND
Undernutrition is the leading risk factor for tuberculosis (TB), yet evidence on programmatic nutritional support during treatment is limited. Benin and Togo are neighboring West African counties. Benin provides in-kind food support to all people with drug-susceptible TB; neighbouring Togo does not. This created the opportunity for a natural experiment.
METHODS
We conducted a prospective cohort study at 13 sites in Benin and Togo (September 2023-June 2024). We compared recipients of nutritional support with non-recipients, using Beninese non-recipients as an internal comparison. Primary outcomes were ≥5% weight gain at month 2, change in 6-minute walk test (6MWT) distance, and pill-count adherence. We used multivariable regression adjusted for pre-specified covariates.
RESULTS
Of 769 participants, 450 received nutritional support and 319 did not. Recipients had higher odds of ≥5% weight gain at month 2 (adjusted odds ratio [aOR] 1.57, 95% CI 1.13–2.19) and ≥10% at month 6 (aOR 1.92, 1.35–2.74), greater 6MWT improvement (adjusted β 40.6 m, 26.5–54.6), and higher adherence (aOR 3.43, 1.81– 6.51). Mortality was lower among recipients (aOR 0.32, 0.11–0.93). Sputum conversion and treatment success did not differ. Beninese non-recipients resembled Togolese participants across outcomes.
CONCLUSION
Programmatic nutritional support was associated with improved weight gain, functional recovery, adherence, and lower mortality during TB treatment, supporting its integration into national TB programmes.
