Interventions for promoting adherence to tuberculosis management.

Abstract

BACKGROUND: Up to half the people with tuberculosis do not complete their treatment. Strategies to improve adherence to treatment can be targeted at the person with the disease or at health workers. OBJECTIVES: The objective of this review was to assess the effects of promoting adherence to anti-tuberculosis treatment and completion of diagnostic protocols for TB. SEARCH STRATEGY: We searched the Cochrane Collaboration Trials, the Cochrane Effective Professional Practice Group trials register, the Cochrane Infectious Diseases Group trials register, Medline, Embase, Lilacs and reference lists of articles. We contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials of interventions to promote adherence with curative or preventive chemotherapy and diagnostic protocols for tuberculosis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Eleven trials were included. Reminder cards sent to defaulters, a combination package of a monetary incentive and health education and more supervision of tuberculosis clinic staff increased the number of people completing their tuberculosis treatment. Direct observation by clinic nurses of people swallowing their tuberculosis drugs did not increase the likelihood of treatment success. Return to the clinic for reading of a tuberculin skin test was enhanced by monetary incentives, assistance by lay health workers, contracts and telephone prompts but not by health education. REVIEWER'S CONCLUSIONS: We have found evidence of benefit for a number of specific interventions to improve adherence to anti-tuberculous therapy and completion of diagnostic protocols. These should be implemented by health care providers where appropriate to local circumstances. Future studies in low income countries are a priority and should measure adherence as well as clinical outcomes.