Interventions for promoting adherence to tuberculosis management

People with tuberculosis need to take drugs for at least six months. Many do not complete their treatment course, and for this reason services for TB patients often use different approaches to encourage people to complete their treatments. This review showed that the following improved people's completion rate: reminder cards sent to their home when they missed treatments, and cash (about five US dollars) given each time they attended clinic. Directly observing patients taking their treatment resulted in more patients being cured than if they were given the drugs to take at home in one study, but no difference in another.

Studies to encourage people to come back to clinic to have skin tests read to help diagnose TB showed that people were more likely to return if offered money, were helped by community health workers, were phoned at home, or signed a written contract to return.

Authors' 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 and clinical outcomes.

This review summarises trials up to 2000. It is being replaced by a series of reviews on particular intervention strategies. The details are in the 'Published notes' section.

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Background: 

Up to half the people with tuberculosis do not complete their treatment. Strategies to improve adherence to diagnostic and treatment regimens are therefore important.

Objectives: 

To assess the effects of various interventions aimed at promoting adherence to anti-tuberculosis treatment and completion of TB diagnostic protocols.

Search strategy: 

We searched the Cochrane Controlled 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: 

Fourteen trials were included. Reminder cards sent to defaulters, a combination package of a monetary incentive and health education and more supervision of clinic staff increased the number of people completing their tuberculosis treatment. Intensive counselling/education did not help in one study. Direct observation showed better clinical outcomes in one study, and no difference in another. 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.

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