Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: a scoping review
METHODS: Key terms related to TB, treatment and adherence were used to search MEDLINE, EMBASE, Web of Science, PsycINFO and CINAHL in June 2019. Quantitative studies examining determinants (demographic, clinical, health systems or psychosocial) of non-adherence to anti-TB treatment in HILI settings were included.
RESULTS: From 10,801 results, we identified 24 relevant studies from 10 countries. Definitions and methods of assessing adherence were highly variable, as were documented levels of non-adherence (0.9–89%). Demographic factors were assessed in all studies and clinical factors were frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, incarceration, and alcohol or drug misuse. Health system (8/24) and psychosocial factors (6/24) were less commonly evaluated.
CONCLUSION: Our review identified some key factors associated with non-adherence to anti-TB treatment in HILI settings. Modifiable determinants such as psychosocial factors are under-evidenced and should be further explored, as these may be better targeted by adherence support. There is an urgent need to standardise definitions and measurement of adherence to more accurately identify the strongest determinants.
Keywords: adherence; determinants; treatment; tuberculosis
Document Type: Research Article
Affiliations: 1: Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London (UCL) School of Pharmacy, London, UK 2: Usher Institute, University of Edinburgh, Edinburgh, Scotland 3: Research Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK, Migrant Health, Public Health England, London, UK 4: Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland 5: Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, TB Centre, London School of Hygiene & Tropical Medicine, London, UK 6: Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK 7: UCL Respiratory, Division of Medicine, UCL, London, UK 8: UCL Respiratory, Division of Medicine, UCL, London, UK, Royal Free London NHS Foundation Trust, London, UK
Publication date: 01 June 2021
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