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Interventions to Improve Tuberculosis Treatment Adherence: An Umbrella Review
Arohi Chauhan , Urvashi Singh , Sanjay Kumar Mattoo , Sandeep Chauhan * , Yogesh Patel , Amar Shah , Bhavin Vadera , Sanghamitra Pati
WHO NTEP Technical Support Network, New Delhi, India; 5John Snow India Pvt. Ltd., New Delhi, India
Abstract:   (18 Views)
Introduction: Tuberculosis (TB) remains a major global health challenge, and ensuring treatment adherence is essential for successful outcomes. Although Directly Observed Therapy (DOT) and Digital Adherence Technologies (DATs) have been introduced to improve adherence, their effectiveness varies due to socioeconomic disparities, healthcare infrastructure, and patient-related factors. Evidence on their real-world impact remains fragmented, necessitating an umbrella review to synthesize existing findings and guide policy and practice. Methods: This umbrella review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42024595954). We systematically searched PubMed, Embase, and Web of Science from inception to 31 December 2024 to identify systematic reviews and meta-analyses on TB adherence interventions. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses, and the degree of overlap among primary studies across reviews was evaluated using the Graphical Representation of Overlap for Overviews (GROOVE) tool. Findings were synthesized descriptively. Results: The search identified 1,827 records; after removing 537 duplicates, 1,290 records were screened by title and abstract. Following full-text review (n=34), 11 systematic reviews (with or without meta-analysis) met the inclusion criteria. These reviews covered diverse TB populations and interventions, including DOT, DATs, counseling, incentives, and peer support. Community-based DOT consistently outperformed clinic-based and self-administered treatment, particularly in resource-limited settings. DATs, including medication monitors and video-observed therapy (VOT), demonstrated potential but were dependent on technological accessibility. Counseling and incentives improved adherence, particularly in low-income populations. Multi-component, patient-centered interventions integrating education, financial support, and digital tools yielded the highest adherence rates. Conclusion: TB treatment adherence can be significantly enhanced by integrating patient-centered strategies and DATs with community-based DOT models. National TB programmes should prioritize adaptable, multi-component interventions that address contextual barriers in resource-limited settings.

 
Keywords: Tuberculosis, Treatment adherence and compliance, Directly observed therapy, Digital adherence technologies, Umbrella review
     
Type of Study: Review article | Subject: Infectious diseases and public health
Received: 2025/09/29 | Accepted: 2026/09/10
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.