A total of 9317 publications were identified in the databases. Among them, 4280 were excluded due to duplication, and 4945 were eliminated after reviewing titles and abstracts. Out of the remaining 107 publications subjected to full-text review, four were excluded because their complete content could not be located. Consequently, 103 publications were considered eligible for full-text reading, and of these, 63 were included in the review (Fig. 1).

PRISMA flowchart of article searches and publications included in this scoping review. Adapted from [19]

Regarding the general characteristics of the included studies, five were published in 2015, 10 in 2016, eight in 2017, 13 in 2018, 11 in 2019, five in 2020, four in 2021, six in 2022, and one in 2023. Predominantly, the study locations were countries with a high TB incidence (n = 52), and a larger number of them were conducted in Brazil (n = 15), India (n = 11), China (n = 9), Peru (n = 5), and Nigeria (n = 4) (Fig. 2). Three studies encompassed a group of countries, providing a more global analysis of the implemented measures and strategies for social protection.

Countries* of the studies included in this scoping review. * Afghanistan (n = 1), South Africa (n = 1), Angola (n = 1), Argentina (n = 2), Australia (n = 1), Bangladesh (n = 1), Brazil (n = 15), China (n = 9), Singapore (n = 1), Republic of Korea (n = 1), Eswatini (n = 1), Ethiopia (n = 1), India (n = 11), Nigeria (n = 4), Peru (n = 5), Kenya (n = 1), United Kingdom (n = 1), Thailand (n = 1), Ukraine (n = 1), Uganda (n = 1), and group of countries (n = 3)

Regarding the study population, people affected by TB, healthcare professionals and managers, intradomestic contacts, community members, as well as various population groups in social vulnerability, such as migrants, refugees, homeless people, incarcerated people, indigenous people, quilombolas [descendants of Africans who were enslaved and who fled from slavery in Brazil during the colonial centuries and formed independent communities known as quilombos], and populations residing in rural and shantytown areas, were included. The publications encompassed all forms of TB, including sensitive forms of pulmonary TB, extrapulmonary TB, and mixed TB, as well as drug-resistant TB (DR-TB) and multidrug-resistant TB (MDR-TB).

More than half of the included studies presented specific measures and strategies focused on people affected by TB, another 16 articles explored TB-sensitive measures and strategies, and three studies listed the provision of both (TB-specific and TB-sensitive) for promoting social protection for individuals affected by the disease.

Regarding the objectives of the studies, the majority of publications were designed to analyze the influence of measures and strategies aimed at social protection on the diagnosis of TB, incidence, adherence, and, primarily, on the outcomes of treatment for both drug-sensitive TB and drug-resistant cases. Other publications focused on the impact of social protection measures on addressing risk factors for TB illness, alleviating catastrophic costs, ensuring food security, malnutrition and impoverishment during treatment, while some studies solely aimed to explore the quantity or proportion of people affected by TB who benefited from some form of social protection-oriented measure or strategy.

As for organizational aspects, some authors aimed to identify the coordination of healthcare, equity, and access to social protection, as well as the experiences, barriers, and facilitators of the implementation process of these measures or strategies.

There was a predominance of quantitative studies, including 17 cohort studies, five descriptive studies, five ecological studies, four randomized clinical trials, three intervention studies, two cross-sectional studies, one quasi-experimental study, one case–control study, and one evaluative study. In the seven qualitative studies, authors utilized phenomenological approaches, participatory action research, and grounded theory to discuss their findings. Additionally, 11 publications were included using a mixed-methods approach, employing various types of studies.

The measures and strategies identified in the included studies were organized into four dimensions related to social protection as a right of people affected by TB: the right to proper nutrition and nourishment, income, housing, and health insurance. A fifth dimension was created to describe expanded rights that were concurrently offered and included, in addition to the rights already mentioned, the right to social assistance, social security, and the right to transportation.

It is important to note that none of the studies included addressed the right to work; therefore, this dimension remained unexplored within the scope of this review. The dimensions were summarized in Table 1 and Fig. 3, outlining the organizational and operational aspects as well as the planning, execution, and potential effects on TB treatment and management.

Conceptual framework of the social protection as a right of people affected by tuberculosis. BFP Bolsa Família Program; BMI Body Mass Index; BPC Benefício de Prestação Continuada (Continuous Cash Benefit); DOT Directly Observed Treatment; DR-TB Drug-resistant tuberculosis; MDR-TB Multidrug-resistant tuberculosis; TB Tuberculosis

The right to proper nutrition and nourishment was established through specific measures and strategies for people affected by TB, characterized as governmental [20,21,22,23,24] and non-governmental [25,26,27,28] initiatives, and took place in two forms.

The first form involved the direct provision of monthly food vouchers [27, 29], weekly food baskets [28], or monetary values intended for the purchase of basic food baskets [20, 22, 25], with one of them being facilitated by the intervention of the World Food Programme (WFP) [20]. Additionally, food items were provided through the Afghanistan Food Assistance Program [24]. These measures were targeted at individuals with TB and low income who were undergoing directly observed treatment (DOT) [27] or conventional TB treatment [24], as well as the Australian Aboriginal population [28].

In Brazil, the provision of food vouchers improved TB treatment outcomes, with a 13% higher cure rate (RR = 1.13, 95% CI: 1.03–1.21) in the intervention group compared to the traditional treatment group [29], and a higher treatment completion rate (90.0% vs. 86.4%, P < 0.01) for those who received vouchers in Singapore [27]. The supply of basic food baskets also increased treatment success rates (88.0% vs. 60.5%, P = 0.001), reduced treatment failures (0.3% vs. 0.9%, P = 0.002), and decreased lost to follow-up rates (7.1% vs. 34.3%, P = 0.001) in Angola [20]. It also led to a significant increase in weight and body mass index (BMI) among individuals with active TB in India [25], as well as complemented TB treatment and provided immediate support to Aboriginal families affected by TB in Australia [28].

In the second form, this right was consolidated through nutritional support [21,22,23, 30], such as the monthly provision of rice and lentils to TB-affected people living below the poverty line [26], nutritional counseling, vitamin supplementation (vitamins A and B6), and fortified/therapeutic foods, especially for TB patients with varying degrees of malnutrition classified into four categories based on BMI [23].

Nutritional support contributed to the improvement of nutritional status and quality of life for people affected by TB in Ethiopia [21], although in some cases, the coverage and utilization of these measures were low and there were delays in receiving the benefits in India [22, 30]. Furthermore, they were associated with a 50% reduction in treatment failure (RR = 0.51, 95% CI: 0.30–0.86) in India [26], a decrease in the risk of lost to follow-up, with nutritional counseling leading to a 23% reduction and vitamins contributing to a 12% reduction in this risk in Kenya [23].

The right to income was established through specific or sensitive strategies, or both, aimed at people affected by TB and were divided into two forms: income transfer programs and financial support, funded either by the government or non-governmental sources.

Specific government income transfer programs were implemented conditionally for individuals with sensitive TB [31,32,33,34,35,36,37,38,39] and those with antimicrobial-resistant TB [35, 39, 40], ranging in amounts from USD 15 [31] to USD 230 [38]. Some of these programs also included home visits, community meetings for health education, empowerment, reduction of TB-related stigmas [38], psychological support, and DOT [40].

Conditional income transfers by the Nigerian government in partnership with the Nigerian National TB Program demonstrated high acceptance levels, utilized by people with TB to purchase food, supplements, medications, transportation, and other additional personal needs. This also increased their enthusiasm and adherence to treatment [31]. In India, not receiving this benefit was associated with a five-fold higher likelihood of unfavorable treatment outcomes (95% CI: 2–12) [32], however, individuals with TB waited an average of 84 days (ranging from 45 to 120 days) to receive this benefit [33]. In China, for individuals with MDR-TB, financial support had a direct positive effect (b = 0.769, P < 0.001) and a positive indirect effect on treatment success, mediated by a self-reported social support scale (b = 0.541, P = 0.008; b = 0.538, P = 0.001) [40].

In Argentina, through Regulatory Decree 170/91 of Law 10,436, which established a legal framework to ensure socioeconomic protection for people affected by TB, successful TB treatment rates of 83% were evidenced, with a 11% loss to follow-up in the registered program group, compared to 69% success and 20% loss to follow-up in the non-registered group [34]. For individuals with MDR-TB who received the benefit, statistically significant differences were identified in the positive treatment outcome of 81.5% compared to 58.9% for those who did not receive the benefit [35].

In Peru, the project titled “The Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT)”, funded by both government and non-governmental sources, took place based on the conditions of individuals with TB, wherein if they had MDR-TB, the person would receive more money [36]. This project reduced the probability of incurring catastrophic costs (95% CI: 22–38%) for families of TB patients by 30%, compared to 42% (95% CI: 34–51%) for families that were not part of the project [37, 39]. Regardless of family poverty, successful TB treatment rates were 64% in the intervention group and 53% in the control group (OR = 1.6, 95% CI: 1.0–2.6) [38].

Regarding sensitive income transfer programs for people affected by TB, all studies analyzed the Bolsa Família Program (BFP) [41,42,43,44,45,46,47,48,49,50], and two studies examined the BFP in conjunction with the Continuous Cash Benefit (BPC—Benefício de Prestação Continuada), both funded by the Brazilian government [42, 43]. It was evidenced that the BFP led to a 7.6% higher cure rate and a 7% lower loss to follow-up proportion in the BFP beneficiary group compared to the non-BFP group [41]. Other studies found that being a BFP beneficiary improved cure rates by 8% (95% CI: 0.05–0.10) [43] and 5.2% [50], when compared to the group of individuals without income transfer benefits and TB.

Furthermore, people with TB enrolled in the BFP were also 7–11% more likely to achieve successful treatment outcomes than the control group [44]. In Brazilian municipalities with high BFP coverage, the TB incidence rate (OR = 0.96, 95% CI: 0.93–0.99) [46] and TB mortality rate (RR = 0.88, 95% CI: 0.79–0.97) [45] were significantly reduced compared to those with low and medium coverage. Among the indigenous population, it was identified that the BFP had a protective effect against active TB [48].

In terms of specific financial support, various studies have introduced monthly incentives offered to individuals affected by drug-sensitive TB [51, 52], MDR-TB [53], as well as to family members of individuals with TB [54], and households with individuals suffering from TB-related poverty [55]. These incentives varied in monthly amounts from USD 15 [52] to USD 200 [53]. Two studies mentioned funding for these measures from the Global Fund [54, 56], others from TB Control Programs [51, 52], and one study through a specific consortium for MDR-TB patients [53].

Financial incentives have resulted in improved treatment outcomes among individuals with MDR-TB, achieving an 82.4% cure rate [53]. Moreover, higher rates of treatment success (97.7%) [51], as well as rates of 92% [54] and 86% [52], were observed within the intervention groups, in contrast to 63% [54] and 71.1% [52] in the control groups. Notably, there was a significant decrease in loss to follow-up during the intervention period (20.2% vs. 5.0%, P < 0.001) [