Interventions to improve medication adherence in tuberculosis patients: a systematic review of randomized controlled studies

Pradipta, Ivan Surya; Houtsma, Daphne; Boven, Job F M van; Alffenaar, Jan‐Willem C.; Hak, Eelko

doi:10.1038/s41533-020-0179-x

Cited by 62 publications

(35 citation statements)

References 29 publications

(66 reference statements)

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“…Our study revealed that nearly 98 and 91%, respectively, succinctly understood TB to be curable, as well as being a disease transmittable from one person to another. Previous studies had reported between 76 and 95% of TB patients who knew about the curable nature of TB [36][37][38][39][40][41]. Higher values of 96.3 and 97.6% about patients' awareness of the curability of TB had also been reported in other studies [42,43].…”

Section: Discussionmentioning

confidence: 59%

Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria

2021

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Background Tuberculosis (TB) remains one of the most common infectious diseases worldwide. Although TB is curable provided the treatment commenced quickly, appropriately and uninterrupted throughout TB treatment duration. However, high default rate, treatment interruption and therapy non-adherence coupled with inadequate disease knowledge significantly contribute to poor TB treatment outcome, especially in developing countries. This study therefore assessed knowledge about TB and possible reasons for treatment non-adherence among drug-sensitive TB (DS-TB) patients, as well as evaluated treatment outcomes for the DS-TB managed within a 5-year period. Methods A mixed-method design comprising a cross-sectional questionnaire-guided survey among 140-ambulatory DS-TB patients from January–March 2019, and a retrospective review of medical-records of DS-TB managed from 2013 to 2017 in two WHO-certified TB directly-observed-treatment centres. Data were summarized using descriptive statistics, while categorical variables were evaluated with Chi-square at p < 0.05. Results Among the prospective DS-TB patients, males were 77(55.0%) and females were 63(45.0%). Most (63;45.0%) belonged to ages 18-34 years. A substantial proportion knew that TB is curable (137;97.9%) and transmittable (128;91.4%), while 107(46.1%) accurately cited coughing without covering the mouth as a principal mode of transmission. Only 10(4.0%) mentioned adherence to TB medications as a measure to prevent transmission. Inaccessibility to healthcare facility (33;55.0%) and pill-burden (10,16.7%) were topmost reasons for TB treatment non-adherence. Of the 2262-DS-TB patients whose treatment outcomes were evaluated, 1211(53.5%) were cured, 580(25.6%) had treatment completed, 240(10.6%) defaulted, 54(2.3%) failed treatment and 177(7.8%) died. Overall, the treatment success rate within the 5-year period ranged from 77.4 to 81.9%. Conclusions Knowledge about TB among the prospective DS-TB patients is relatively high, especially with respect to modes of TB transmission and preventive measures, but a sizeable number lacks the understanding of ensuring optimal TB medication-adherence to prevent TB transmission. Inaccessibility to healthcare facility largely accounts for treatment non-adherence. Outcomes of treatment within the 5-year period show that nearly half were cured, while almost one-tenth died. Overall treatment success rate is about 12% below the WHO-defined target. There is generally a need for concerned stakeholders to step-up efforts in ensuring consistent TB enlightenment, while improving access to TB care is essential for better treatment outcome.

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Section: Discussionmentioning

confidence: 59%

Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria

2021

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“…Contact and respond to the patient if any adverse event or any other issue that occurs within 24 hours. 9. Take notes of any response in the record row of the dashboard.…”

Section: Sops Of the Vot At The Observers' End (Observer Sop)mentioning

confidence: 99%

“…However, family-based DOT is administered to 60%-75% of TB cases owing to the complacency of the health care system [6,7]. Family-based DOT is also complacent because of the nature of family relationships [8][9][10]. Ultimately, nobody has been formally accountable for DOT with regard to the patient.…”

Section: Introductionmentioning

confidence: 99%

Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study

Kumwichar¹,

Chongsuvivatwong²,

Prappre³

2021

JMIR Form Res

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Background Directly observed therapy programs for monitoring tuberculosis (TB) treatment in Thailand are unsustainable, especially during the COVID-19 pandemic. The current video-observed therapy (VOT) system, the Thai VOT (TH VOT), was developed to replace the directly observed therapy program. Objective This study aimed to describe the VOT system design and identify the potential for system improvements. Methods This pilot study was conducted in Na Yong district, a small district in Trang province, south of Thailand. The TH VOT system consists of a smartphone app for patients, a secured web-based platform for staff, items used, and standard operating procedures. There were three groups of users: observers who were TB staff, healthy volunteers as simulated patients, and patients with active TB. All participants were trained to follow the standard operating procedures. After 2-week usage, VOT session records were analyzed to measure the compliance of the patients and observers. The User Experience Questionnaire was used to lead the participant users to focus on 6 standard dimensions of usability, and was supplemented with an in-depth interview to identify potential system improvements from users’ experience. Results Only 2 of 16 patients with currently active TB had a usable smartphone. Sixty of 70 drug-taking sessions among 2 patients and 3 simulated patients in 2 weeks were recorded and uploaded. Only 37 sessions were inspected by the observers within 24 hours. All participants needed a proper notification system. An audit system was also requested. Conclusions Before upscaling, the cost of smartphone lending, audit management, and notification systems should be elucidated.

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“…Tuberculosis treatment lasts at least 6 months, depending on the clinical presentation in each patient, which causes patients to be at high risk of forgetting to take medication or dropping out of treatment. Medication non-adherence will prolong therapy duration, and increase the risk of drug resistance, morbidity, and mortality [ 5 , 6 ]. Resistance cannot be eliminated but can be controlled with the appropriate use of anti-TB drugs.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients

Herawati

Megawati

Aslichah³

et al. 2021

Pharmacy

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The long period of tuberculosis treatment causes patients to have a high risk of forgetting or stopping the medication altogether, which increases the risk of oral anti-tuberculosis drug resistance. The patient’s knowledge and perception of the disease affect the patient’s adherence to treatment. This research objective was to determine the impact of educational videos in the local language on the level of knowledge, perception, and adherence of tuberculosis patients in the Regional General Hospital (RSUD) Bangil. This quasi-experimental study design with a one-month follow-up allocated 62 respondents in the intervention group and 60 in the control group. The pre- and post-experiment levels of knowledge and perception were measured with a validated set of questions. Adherence was measured by pill counts. The results showed that the intervention increases the level of knowledge of the intervention group higher than that of the control group (p-value < 0.05) and remained high after one month of follow-up. The perceptions domains that changed after education using Javanese (Ngoko) language videos with the Community Based Interactive Approach (CBIA) method were the timeline, personal control, illness coherence, and emotional representations (p-value < 0.05). More than 95% of respondents in the intervention group take 95% of their pill compared to 58% of respondents in the control group (p-value < 0.05). Utilization of the local languages for design a community-based interactive approach to educate and communicate is important and effective.

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Interventions to improve medication adherence in tuberculosis patients: a systematic review of randomized controlled studies

Cited by 62 publications

References 29 publications

Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria

Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria

Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study

The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients

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