Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

Abstract

BackgroundTuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.Methods and FindingsWe searched 19 electronic databases (1966–February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms “Tuberculosis AND (adherence OR compliance OR concordance)”. We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies.ConclusionsAdherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: what are the rates and determinants?

“…Several studies have indicated that community members or peers have a strong influence on TB patients' treatment taking behaviour. 11 This underscores the importance not only of building a trusting relationship between the health care workers and the patients, but also of addressing TB related stigma in the Kibera community.…”

“…11 Family support could include financial assistance, collecting medication, supervising taking of medication, reminding of appointments and providing emotional support. The clinics should find innovative ways of engaging and encouraging the families of TB patients, as partners or co-service providers of TB services.…”

“…Evidence has shown a positive correlation between improved treatment adherence and a patient's understanding of their disease and its treatment. 11,13 We therefore recommend the development of a specific treatment literacy for all TB patients not currently benefiting from an HIV Treatment Literacy programme.…”

Benefits of health reform for households in rural South Africa following implementation of ward-based primary healthcare outreach teams: a qualitative inquiry

“…Established referral procedures and feedback mechanisms between home-based care and the health care system [13] are necessary aspects of PHC reforms. Studies conducted on treatment adherence show that a good healthcare worker-patient relationship can contribute to better treatment adherence [32–34]. Furthermore, literature shows that patients provided with adequate knowledge about treatment show high adherence rates as patient behaviour is largely influenced by knowledge and acceptance of their disease and treatment [33,34].…”

Avaliação da resistência aos tuberculostáticos de primeira linha em cepas do complexo Mycobacterium Tuberculosis isolados no Distrito Federal

“…Gastrointestinal side-effects such as diarrhea and malabsorption can hinder achievement of optimum blood concentrations of antituberculosis drugs in co-infected patients with HIV (Zumla, 2015), what suggest that 4-FDC therapy, for causing less gastrointestinal side-effects, would benefit those co-infected patients. As some patients reported stopping medication because of adverse effects (Munro, 2007), while others reported that they were not informed about side effects and what to do to counter them (Jaiswal, 2003;Edginton, 2002;Wares, 2003).…”