Strategies to Promote Adherence to Treatment by Pulmonary Tuberculosis Patients: A systematic review
Bibliographic record
Abstract
Background Successful tuberculosis control depends upon effective treatment of patients which requires adherence throughout the full course of medical treatment. Poor adherence to treatment is a major obstacle in the global fight against tuberculosis. Therefore, interventions that promote adherence to the tuberculosis treatment regimen should be implemented. Objective To review and synthesise the best available research evidence that investigates the effectiveness of strategies to promote adherence to treatment by patients with pulmonary tuberculosis. Inclusion Criteria Types of participants: This review considered all studies that included adults aged ≥ 15 years diagnosed with smear positive and smear negative pulmonary tuberculosis (regardless of HIV infection) in community settings who had never received anti-tuberculosis drugs, or had taken them for less than one month. Types of interventions: Intervention included strategies to promote adherence to tuberculosis treatment by patients with pulmonary tuberculosis. Types of outcomes: Outcomes included measures for treatment completion rate, cure rate, and success rate. Types of studies: The review primarily considered any randomised controlled trials that explored different strategies to promote adherence to tuberculosis treatment of patients with pulmonary tuberculosis but also included quasi-experimental studies. Search strategy The search sought to find published and unpublished studies. The time period of the search covered articles published from 1990 to 2010 in English and Thai language. The database searches included: CINAHL, EMBASE, Cochrane Library, PubMed, Science Direct, Current Content Connect, Thai Nursing Research Database, Thai thesis database, Digital Library of Thailand Research Fund, Research of National Research Council of Thailand, and Database of Office of Higher Education Commission. Studies were additionally identified from reference lists of all studies retrieved. Methodological quality Studies selected for retrieval were assessed by two independent reviewers for methodological quality using a standardised critical appraisal tool from the Joanna Briggs Institute. Data Collection Data extraction was performed using a standardised data extraction form from the Joanna Briggs Institute. Data Synthesis The quantitative study results were pooled in statistical meta-analysis using the Review Manager software (RevMan 5.0) and summarised in narrative form where statistical pooling was not appropriate or possible. Results This systematic review included ten randomised controlled trials and eight quasi-experimental studies that report on the effectiveness of a number of specific interventions to improve adherence to tuberculosis treatment among newly diagnosed pulmonary tuberculosis patients. These interventions included Directly Observed Treatment coupled with alternative patient supervision options, case management with Directly Observed Treatment, Short-course, the intensive triad-model program, and an intervention package consisting of improving patients' counselling and communication, decentralisation of treatment, patient choice of Directly Observed Treatment supporter, and reinforcement of supervision activities. Conclusion The interventions that had the best outcomes for treatment adherence among newly diagnosed pulmonary tuberculosis patients were Directly Observed Treatment and Directly Observed Treatment, Short-course combined with case management, improving counselling and communication and decentralisation of treatment. These interventions should be implemented by health care providers and tailored to local contexts and circumstances, where appropriate. Implications for practice It would be beneficial to shift the treatment of all pulmonary tuberculosis patients to facilities within the primary health care structure. Directly Observed Treatment coupled with alternative patient supervision options, formalised educational programs and a tuberculosis case management team should be used to improve adherence to tuberculosis treatment among newly diagnosed pulmonary tuberculosis patients. Implications for research Our review shows the need for further large-scale on adherence to treatment by newly diagnosed pulmonary tuberculosis patients. Factors that determine the usefulness of Directly Observed Treatment in various settings require further study. Further strategies, especially those that are feasible in developing countries or countries with limited resources, should be evaluated in randomised controlled trials before being introduced into routine practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.040 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".