Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: A scoping review

Abstract

Background Improving adherence to anti-tuberculosis (TB) treatment is a public health priority in high income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings.

Methods Key terms related to tuberculosis, 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 frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, imprisonment, 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.