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Eur Respir J. 2019 Jan 10;53(1). pii: 1801030. doi: 10.1183/13993003.01030-2018. Print 2019 Jan.

Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review.

Author information

1
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
2
McGill International TB Centre, McGill University, Montreal, QC, Canada.
3
CAPRISA-MRC TB-HIV Pathogenesis and Treatment Unit, Durban, South Africa.
4
Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
5
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Abstract

The global loss to follow-up (LTFU) rate among drug-resistant tuberculosis (DR-TB) patients remains high at 15%. We conducted a systematic review to explore interventions to reduce LTFU during DR-TB treatment.We searched for studies published between January 2000 and December 2017 that provided any form of psychosocial or material support for patients with DR-TB. We estimated point estimates and 95% confidence intervals of the proportion LTFU. We performed subgroup analyses and pooled estimates using an exact binomial likelihood approach.We included 35 DR-TB cohorts from 25 studies, with a pooled proportion LTFU of 17 (12-23)%. Cohorts that received any form of psychosocial or material support had lower LTFU rates than those that received standard care. Psychosocial support throughout treatment, via counselling sessions or home visits, was associated with lower LTFU rates compared to when support was provided through a limited number of visits or not at all.Our review suggests that psychosocial support should be provided throughout DR-TB treatment in order to reduce treatment LTFU. Future studies should explore the potential of providing self-administered therapy complemented with psychosocial support during the continuation phase.

Conflict of interest statement

Conflict of interest: S. Law has nothing to disclose. Conflict of interest: A. Daftary has nothing to disclose. Conflict of interest: M. O'Donnell has nothing to disclose. Conflict of interest: N. Padayatchi has nothing to disclose. Conflict of interest: L. Calzavara has nothing to disclose. Conflict of interest: D. Menzies has nothing to disclose.

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