BACKGROUND. TB kills 1.5 million people each year, more than any other single infection. There is an urgent need to evaluate the impact of new interventions to strengthen TB control. Poverty is increasing globally in cities and urban areas, and is associated with factors that increase TB risk including crowding and malnutrition. Conversely, TB worsens poverty by increasing expenses and reducing income. In addition, those with TB and their families may experience stigma. Poor people have more TB and greater TB-related needs but they tend to have least access to TB care. This mismatch between need for and access to TB care undermines TB control and worsens poverty. OBJECTIVE. We will evaluate the impact of socioeconomic interventions for reducing poverty, improving access to TB care and consequently reducing the risk of future TB. SETTING. 24 peri-urban shantytowns in Northern Lima, Peru near the site of our TB control research since 2001. Peru has an acclaimed TB control programme but its levels of TB disease remain high and its rates of multidrug-resistant TB (MDR-TB) have doubled over the last decade to the highest levels in the Americas. The high TB and increasing MDR-TB rates are concentrated in "hotspots" such as poor peri-urban shantytowns surrounding Lima. It is these "hotspots" where we will work. RELATED WORK. Since 2007, our on going pilot project has been "Innovative Socio-economic Interventions Against TB (ISIAT)" which involves developing and implementing socioeconomic interventions to fight poverty and increase equitable access to TB care. Early analysis of the pilot ISIAT project showed promising results with the interventions described below increasing the number of people to a) complete TB treatment b) complete preventive therapy to prevent them getting TB c) be tested for TB and d) be tested for HIV. These results were published in 2011. The improvement in awareness, prevention and treatment of TB that our work and subsequent article showed has attracted the attention of funding bodies, like the World Bank and The Bill and Melinda Gates Foundation, and policymakers such as the World Health Organisation (WHO) and its Stop-TB department. Our on going relationship and involvement of these organizations and the published results of the pilot ISIAT project are encouraging for future work. The proposed project will rigorously assess the impact of these interventions not just on poverty and access to TB care but also on actual TB control. INTERVENTIONS AND STUDY DESIGN. The interventions will be inexpensive, involving a team of experts from different fields working with all TB-affected families. They will utilize household visit and fortnightly community meetings to implement an integrated program of social support for enhancing equitable access to TB-related healthcare and economic support to help people to afford TB care and to help them to become less poor. We will include in the study all members of a household with a new diagnosis of TB, as assessed by the Peruvian national TB program, without age limit, who provides informed written consent. TB-affected households in 12 intervention communities will be offered the socioeconomic intervention for 6-months whilst the TB patient is receiving TB treatment. TB-affected households in 12 other control communities will be offered no intervention (standard of TB care). We will then re-visit those households 2 years after recruitment to assess what happened to the people with TB and those people in the household exposed to TB, and if our interventions prevented TB and reduced poverty. BENEFITS: These socio-economic 'structural' interventions will be assessed for their capacity to reduce poverty-related TB risk factors, improve access to TB care and for reducing TB treatment failure, recurrence and transmission. This has potential importance for focusing poverty reduction on those in greatest need and who have the most to benefit and preventing TB.