Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review

Abstract

BackgroundLatent tuberculosis infection (LTBI) control relies on high initiation and completion rates of preventive treatment to preclude progression to tuberculosis disease. Specific interventions may improve initiation and completion rates. The objective was to systematically review data on determinants of initiation, adherence and completion of LTBI treatment, and on interventions to improve initiation and completion.MethodsA systematic review of the literature (PubMed, Embase) published up to February 2014 was performed. Relevant prospective intervention studies were assessed using GRADE.ResultsSixty-two articles reporting on determinants of treatment initiation and completion were included and 23 articles on interventions. Determinants of LTBI treatment completion include shorter treatment regimen and directly observed treatment (DOT, positive association), adverse events and alcohol use (negative association), and specific populations with LTBI (both positive and negative associations). A positive effect on completion was noted in intervention studies that used short regimens and social interventions; mixed results were found for intervention studies that used DOT or incentives.ConclusionLTBI treatment completion can be improved by using shorter regimens and social interventions. Specific needs of the different populations with LTBI should be addressed taking into consideration the setting and condition in which the LTBI treatment programme is implemented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1549-4) contains supplementary material, which is available to authorized users.

Barriers to treatment adherence for individuals with latent tuberculosis infection: A systematic search and narrative synthesis of the literature

“…However, the 3‐ to 4‐month rifampicin regimen and the 3‐month weekly rifapentine‐plus‐isoniazid regimen had fewer hepatotoxicity events . Also, Stuurman et al found that shorter treatment regimens resulted in higher completion rates (OR = 1.92; 95% CI, 1.05‐3.52) in a meta‐analysis . These results, coupled with cost‐effectiveness data in each setting, should be used to support a stronger case for prioritizing the routine use of shorter treatment regimens for LTBI.…”

Use of a scoring strategy to determine clinical risk of progression and risk group-specific treatment adherence in subjects with latent tuberculosis infection

“…This, in turn, may affect the choice of regimen and the intensity of follow up provided to the patients when healthcare providers become aware of those at high cumulative risk of progression. Although lack of adequate healthcare as well as patient related factors have been reported to affect adherence to LTBI treatment [6, 14, 15], specific interventions like shorter duration of therapy using Rifamycin based regimens and directly observed treatment (DOT) are well recognized measures to improve treatment adherence [16–18]. This approach also minimizes the loss to follow up which was the major reason for incomplete treatment in our cohort.…”

“…This is especially important as more than 85% of subjects with HIV/AIDS were prescribed INH and only 30% were able to complete treatment in our study. Current US guidelines recommend use of 3HP only with efavirenz (EFV) - or raltegravir (RAL)-based regimens (in combination with either abacavir/lamivudine [ABC/3TC] or tenofovir disoproxil fumarate/emtricitabine [TDF/FTC]) for treatment of LTBI [18]. Allowing for drug resistance testing and patient adherence factors, a future strategy of temporarily switching HIV positive patients to the above mentioned regimens could allow better treatment completion rates with a 3HP based regimen.…”

Identifying components for programmatic latent tuberculosis infection control in the European Union

“…Since the development of the inventory, the assessment has continued and a series of systematic literature reviews has been performed [9-14]. The next step will be to conduct mathematical modelling and cost-effectiveness studies.…”