Strategies adopted to improve adherence to tuberculosis treatment
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2025.214684Keywords:
Tuberculosis, Pulmonary tuberculosis, Cooperation and treatment adherence, Medication adherenceAbstract
Objective: To identify, in the scientific literature, the strategies adopted to improve adherence to treatment for drug-susceptible pulmonary tuberculosis (TB). Methods: This is a systematic literature review conducted in accordance with PRISMA guidelines and registered in the PROSPERO platform under registration number CRD42022299152. Article retrieval was performed using the LILACS, MEDLINE, SciELO, and Web of Science databases with the following combination of keywords: Tuberculosis AND ("Medication Adherence" OR "Treatment Adherence and Compliance"). Article selection followed inclusion and exclusion criteria using the StArt 3.0.3 beta software. In addition, the quality and risk of bias in the studies were assessed using the Joanna Briggs Institute’s critical appraisal tools. Results: Sixteen articles were included in this review, of which seven were classified as high quality, seven as moderate, and two as low quality. The interventions were grouped into four categories: incentive-based, reminder-based, psychological, and those implemented through devices or systems. Conclusion: The studies showed heterogeneity in the results regarding the effectiveness of these strategies in improving adherence to TB treatment. This may be associated with the high efficacy of Directly Observed Therapy (DOT), which was used as a control in the interventions, as well as methodological discrepancies and limitations in the included studies. Limitations of this systematic review include the use of the same search strategy across all databases, the exclusion of other relevant databases, language restrictions, and the exclusion of participants diagnosed with drug-resistant or extrapulmonary TB.
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Ministério da Saúde (BR); Secretaria de Vigilância em Saúde; Departamento de Vigilância das Doenças Transmissíveis. Manual de recomendações para o controle da tuberculose no Brasil [Internet]. Brasília: Ministério da Saúde, 2019 [cited 2022 Dez 03]. 364 p. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf.
Veronesi R, Focaccia R. Tratado de infectologia. 5. ed. São Paulo: Editora Atheneu, 2015. 2600 p.
World Health Organization. Global tuberculosis report 2022. Geneva: WHO; 2022 [cited 2022 Dez 15]. 68 p. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022.
Ministério da Saúde (BR); Secretaria de Vigilância em Saúde e Ambiente. Boletim epidemiológico: tuberculose 2023. Brasília: Ministério da Saúde, 2023. [cited 2023 Mar 28]. 64 p. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2023/boletim-epidemiologico-de-tuberculose-numero-especial-mar.2023/view.
Alipanah N, et al. Adherence interventions and outcomes of tuberculosis treatment: a systematic review and meta-analysis of trials and observational studies. PloS med [Internet]. 2018 [cited 2022 Nov 28];15(7):1-44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029765/.
Chimeh RA, et al. Clinical and economic impact of medication non-adherence in drug-susceptible tuberculosis: a systematic review. Int. j. tuberc. lung. dis [Internet]. 2020 [cited 2022 Nov 17];24(8):811-19. Available from: https://pubmed.ncbi.nlm.nih.gov/32912386/.
Nezenega ZS, Lewis LP, Maeder AJ. Factors influencing patient adherence to tuberculosis treatment in Ethiopia: A literature review. Int. j. environ. res. public health [Internet]. 2020 [cited 2022 Nov 16];17(15):1-15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432798/#!po=1.51515. Acesso em: 17 Ago. 2022.
Du L, et al. Determinants of medication adherence for pulmonary tuberculosis patients during continuation phase in Dalian, Northeast China. Patient prefer. adherence [Internet]. 2020 [cited 2022 Nov 16];14:1119-28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354008/.
Choi H, Chung H, Muntaner C, Lee M, Kim Y, Barry CE, et. al. The impact of social conditions on patient adherence to pulmonary tuberculosis treatment. Int. j. tuberc. lung. dis. [Internet]. 2016 [cited 2022 Nov 17];20(7):948-54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013067/.
Herrero MB, Ramos S, Arrossi S. Determinants of non adherence to tuberculosis treatment in Argentina: barriers related to access to treatment. Rev. bras. epidemiol. [Internet]. 2015 [cited 17 Nov 2022];18(2):287-98. Available from: https://www.scielo.br/j/rbepid/a/HXM3VwLbFXz3qNFPLYrvBBw/?lang=en#.
United Nations; General Assembly. Resolution 70/1/2015. Transforming our world: the 2030 agenda for sustainable development [Internet]. New York: General Assembly; 2015 [cited 2022 Jan 09. Available from: https://documents-dds-ny.un.org/doc/UNDOC/GEN/N15/291/89/PDF/N1529189.pdf?OpenElement.
Ministério da Saúde (BR); Secretaria de Vigilância em Saúde; Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Brasil livre da tuberculose: plano nacional pelo fim da tuberculose como problema de saúde pública: estratégias para 2021-2025 [Internet]. Brasília: Ministério da Saúde; 2021 [cited 2023 Fev 28]. 68 p. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/tuberculose/plano-nacional-pelo-fim-da-tuberculose-como-problema-de-saude-publica_-estrategias-para-2021-2925.pdf/view. Available from: 28 Fev. 2023.
Galvão TF, Pansani TS; Harrad D. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol. serv. saúde [Internet]. 2015;24(2):335-42.
Joanna Briggs Institute. Critical appraisal tools. JBI; 2020 [cited 2023 Jan 20]. Available from: https://jbi.global/critical-appraisal-tools.
Martins N, Morris P, Kelly PM. Food incentives to improve completion of tuberculosis treatment: randomised controlled trial in Dili, Timor-Leste. BMJ [Internet]. 2009 [cited 2022 Fev 27],339:1-8. Available from: https://www.bmj.com/content/339/bmj.b4248. Acesso em: 27 Set. 2022.
Liu X, et al. Effectiveness of electronic reminders to improve medication adherence in tuberculosis patients: a cluster-randomised trial. Plos med. [Internet]. 2015 [cited 2023 Fev 24];12(9):1-18. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4570796/.
Prasetya H, Murti B, Anantanyu S, Syamsulhadi M. The effect of hypnosis on adherence to antituberculosis drugs using the health belief model. International journal of clinical and experimental hypnosis [Internet]. 2018 [cited 2023 Fev 26];66(2):211–27. chttps://www.tandfonline.com/doi/full/10.1080/00207144.2018.1421361?scroll=top&needAccess=true.
Fang HX, et al. Effect of short message service on management of pulmonary tuberculosis patients in Anhui Province, China: a prospective, randomized, controlled study. Med. sci. monit. [Internet]. 2017 [cited 2023 Mar 1];23:2465-69. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450853/.
Bediang G, Stoll B, Elia N, Abena JL, Geissbuhler, A. SMS reminders to improve adherence and cure of tuberculosis patients in Cameroon (TB-SMS Cameroon): a randomised controlled trial. BMC public health [Internet]. 2018 [cited 2023 Mar 2];18(583):1-14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932834/.
Browne SH, et al. Wirelessly observed therapy compared to directly observed therapy to confirm and support tuberculosis treatment adherence: A randomized controlled trial. PloS med. [Internet]. 2019 [cited 2023 Mar 5];16(10):1-19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777756/.
Parwati NM, Bakta IM, Januraga PP, Wirawan IM. A health belief model-based motivational interviewing for medication adherence and treatment success in pulmonary tuberculosis patients. Int. j. environ. res. public health [Internet]. 2021 [cited 2023 Mar 6];18(24):1-10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701142/.
Santra S, Garg S, Basu S, Sharma N, Singh MM, Khanna A. The effect of a mhealth intervention on anti-tuberculosis medication adherence in Delhi, India: A quasi-experimental study. Indian j. public health [Internet]. 2021 [cited 2023 Mar 7];65(1):34-8. Available from: https://www.ijph.in/article.asp?issn=0019-557X;year=2021;volume=65;issue=1;spage=34;epage=38;aulast=Santra.
Acosta J, Flores P, Alarcón M, Grande-Ortiz M; Moreno-Exebio L, Puyen ZM. A randomised controlled trial to evaluate a medication monitoring system for TB treatment. Int. j. tuberc. lung. dis. [Internet]. 2022 [cited 2023 Mar 8];26(1):1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734191/.
Saha, et al. Tuberculosis monitoring encouragement adherence drive (TMEAD): toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra. Front public health [Internet]. 2022 [cited 2023 Fev 9];10:1021427. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9812554/#!po=16.6667.
Manyazewal T, Woldeamanuel Y, Holanda DP, Fekadu A, Marconi VC. Effectiveness of a digital medication event reminder and monitor device for patients with tuberculosis (SELFTB): a multicenter randomized controlled trial. BMC med. [Internet]. 2022 [cited 2023 Fev 10];20(310):1-18. Available from: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02521-y#citeas.
World Health Organization. TB country, regional and global profiles [Internet]. c2022 [cited 2023 Jan 20]. Available from: https://worldhealthorg.shinyapps.io/tb_profiles/.
Pee S, Grede N, Mehra D, Bloem MW. The enabling effect of food assistance in improving adherence and/or treatment completion for antiretroviral therapy and tuberculosis treatment: a literature review. AIDS behav. [Internet]. 2014 [cited 2023 Fev 23];18 Suppl 5:531-41. Available from: https://link.springer.com/article/10.1007/s10461-014-0730-2#citeas.
Nglazi, MD, Bekker L, Wood R, Hussey GD, Wiysonge CS. Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review. BMC infect. dis. [Internet]. 2013 [cited 2023 Mar 18];13(566):1-16. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-566.
Ridho A, et al. Digital health technologies to improve medication adherence and treatment outcomes in patients with tuberculosis: systematic review of randomized controlled trials. J. med. internet res. [Internet]. 2022 [cited 2023 Mar 08];24(2):1-13. Available from: https://www.jmir.org/2022/2/e33062. Acesso em: 08 Mar. 2023.
Jones CJ, Smith H, Llewellyn C. Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review. Health psychol. rev. [Internet]. 2013 [cited 2023 Mar 09];8(3):253-9. Available from: https://www.tandfonline.com/doi/full/10.1080/17437199.2013.802623.
World Health Organization; Global Tuberculosis Programme. Implementing the end TB strategy: the essentials, 2022 update. Geneva: WHO; 2022 [cited 2023 Mar 02]. Available from: https://www.who.int/publications-detail-redirect/9789240065093.
World Health Organization; Global Tuberculosis Programme. The global plan to end TB: 2023-2030. Geneva: WHO; 2022 [cited 2023 Mar 01]. Available from: https://www.stoptb.org/global-plan-to-end-tb/global-plan-to-end-tb-2023-2030#:~:text=The%20Global%20Plan%20to,resources%20needed%20to%20end%20TB.
Volmink J; Garner P. Directly observed therapy for treating tuberculosis. Cochrane database syst. rev. [Internet]. 2006 [cited 2022 Dez 15];4:1-28. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003343.pub2/full.
Karumbi J; Garner P. Directly observed therapy for treating tuberculosis. Cochrane database syst. rev. [Internet]. 2015 [cited 2022 Dez 15];5:1-47. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003343.pub4/full/pt#0.
Mkopi A, et al. The economic costs of home-based directly observed treatment under patient centred tuberculosis treatment in Tanzania. Pan african medical journal one health [Internet]. 2022 [cited 2022 Dez 17];7(8):1-15. Available from: https://www.one-health.panafrican-med-journal.com/content/article/7/8/full/#ref11.
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Copyright (c) 2026 Hugo Barcelos de Matos, Catherine Marques Barros, Erica Toledo de Mendonça, Deise Moura de Oliveira, Tiago Ricardo Moreira
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Fundação de Amparo à Pesquisa do Estado de Minas Gerais
Grant numbers 9 bolsas de iniciação científica no valor de R$400 mensais.
