Clinical and economic impact of medication non-adherence in drug-susceptible tuberculosis: a systematic review

• Published in: The international journal of tuberculosis and lung disease Vol. 24; no. 8; pp. 811 - 819
• Main Authors: Chimeh, R. A., Gafar, F., Pradipta, I. S., Akkerman, O. W., Hak, E., Alffenaar, J-W. C., van Boven, J. F. M.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.08.2020; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Antibiotics; Antitubercular Agents - therapeutic use; Clinical outcomes; Cure; Economic impact; Economics; Failure; Humans; Impact analysis; Medication Adherence; Outcomes; Patient compliance; Patients; Pharmaceutical Preparations; Retrospective Studies; Systematic review; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.19.0754

BACKGROUND: Despite considerable efforts to globally eradicate TB, and the availability of effective antibiotics, TB elimination goals are falling behind. While non-adherence to TB drug regimens may compromise effective treatment, its full impact is still unknown.OBJECTIVE: To determine the clinical and economic impact of non-adherence to TB medication on treatment outcomes in drug-susceptible TB patients (DS-TB).METHODS: A systematic review was performed using PubMed and Embase for studies published between 2009 and 2019 reporting associations between adherence and WHO-defined TB treatment outcomes and economic outcomes in DS-TB patients.RESULTS: A total of 14 studies were included. Eight focused on the association between non-adherence and death, 2 on treatment failure, 1 study on successful treatment outcome, 1 study on both successful and unsuccessful treatment outcomes and 2 on cost outcomes. Most studies (71.4%) were retrospective cohort or case-control studies. The results showed that non-adherence to TB drug regimens was associated with death, treatment failure and lower cure rates.CONCLUSION: Non-adherence to TB drugs has a profound impact on both clinical and economic TB outcomes. To reach WHO TB elimination goals, preventing non-adherence and the implementation of cost-effective intervention programmes should receive the highest priority.