Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies

作者：Narges Alipanah, Leah G. Jarlsberg, Cecily Miller, Linh Nguyen, Dennis Falzon, Ernesto Jaramillo, Payam Nahid · 发表于：PLoS Medicine · 年份：2018 · DOI：10.1371/journal.pmed.1002595 · 被引用次数：525 · 研究领域：Tuberculosis Research and Epidemiology、HIV/AIDS Research and Interventions、Medication Adherence and Compliance

BACKGROUND: Incomplete adherence to tuberculosis (TB) treatment increases the risk of delayed culture conversion with continued transmission in the community, as well as treatment failure, relapse, and development or amplification of drug resistance. We conducted a systematic review and meta-analysis of adherence interventions, including directly observed therapy (DOT), to determine which approaches lead to improved TB treatment outcomes. METHODS AND FINDINGS: We systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retrospective cohort studies (CSs) with an internal or external control group that evaluated any adherence intervention and conducted a meta-analysis of their impact on TB treatment outcomes. Our search identified 7,729 articles, of which 129 met the inclusion criteria for quantitative analysis. Seven adherence categories were identified, including DOT offered by different providers and at various locations, reminders and tracers, incentives and enablers, patient education, digital technologies (short message services [SMSs] via mobile phones and video-observed therapy [VOT]), staff education, and combinations of these interventions. When compared with DOT alone, self-administered therapy (SAT) was associated with lower rates of t...