Table 1.

Presents an overview of all the studies included in the final sample and all data collected and used during sample analysis

Author(year)	Journal	Sample	Main finding
PSS Rao [15]	Indian journal of leprosy	6.291 patients with leprosy	Adherence to MDT and its successful completion are equally important. Unfortunately, due to a number of personal, psychosocial, economic, medical and health service factors, a significant number of patients become irregular and default from MDT. In this paper, the extent of such defaulting was based on a study of six leprosy mission hospitals. Nearly 50% of patients closer to the hospitals as compared to 60% beyond have defaulted. Patients from outside the district had significantly higher default rate for all types of leprosy cases as compared to patients living close to the centres. Motivation, counselling and frequent contact with the patients will help.
Heukelbach et al. [13]	PLoS Neglected Tropical Diseases	1.635 leprosy patients of 78 cities.	Was performed a population-based study in municipalities in Tocantins State, Brazil, Was used two outcomes for assessment of risk factors: defaulting (not presenting to health care center for supervised treatment for >12 months); and interruption of MDT. In total, 3.0% patients defaulted, and 18.2% interrupted MDT. Defaulting and interruption of MDT are associated with some poverty-related variables such as family income, household size, and migration. Intermittent problems of drug supply need to be resolved, mainly on the municipality level. MDT producers should consider oral drug formulations that may be more easily accepted by patients. Thus, an integrated approach is needed for further improving control, focusing on vulnerable population groups and the local health system. This study showed higher rates of discontinuation treatment in young males (34.4%), when the data were stratified by sex.
Trindade et al. [18]	Caderno de Saúde Coletiva do Rio de Janeiro	56 patient who dropout leprosy treatment	Shows that alcoholism is associated significantly with treatment dropout of leprosy in Paraíba, Brazil. The study shows that 53.4% of patients who dropout treatment made regular use of alcohol. Among those who took treatment regularly, none made regular use of alcohol. Those patients who abandoned treatment had lower income. The average income of patients who abandoned the treatment was R$ 300.00 monthly, while those who continued the treatment dimension regular income was R$ 700.00.
Honrado et al. [12]	Dermatology Clinic	233 leprosy patients	The rate of noncompliance among those who have not had their drugs from health centers (57.1%) was significantly higher than among those who obtained their drugs from health centers (27.3%). Even so the rate of treatment abandonment in patients that it was not told the name of the disease was significantly higher than those previously reported (44.4% versus 23.6%, respectively).
Kar S. et al. [10]	Journal of Neurosciences in Rural Practice	254 leprosy cases	The distribution of defaulters to treatment in relation to the state of alphabetization, per capita income and socioeconomic status in India as compared to the control group reflects that the majority (32.28%) had attended school leaving certification exam (completed primary education), per capita income between R 500–749 (30.71%) and belonging to social class IV (33.86%) and V (30.71%).
Luna et al. [22]	Revista Brasileira de Enfermagem	6 patiens in leprosy treatment.	In research conducted by Activity Life Model of Roper, Logan and Tierney identified the weakness in credibility by the patient regarding medical diagnosis and non-acceptance of the use of MDT as a tool to obtain the cure of the disease. Using the Activity Life Model with a focus on home visit was important because it provided a holistic approach to research, offered for leprosy patients, allowing a detailed knowledge of the issues involved in maintenance practices and healthy lifestyles. This study is important to help health services to meet the life activities of leprosy patients, and thus direct the actions related to these patients and contributing to the planning educational activities that encourage the individual to self-care in order to develop a life healthy.
Souza et al. [6]	International Journal of Dermatology	Leprosy patients	The study listed the main adverse factors that disturb the patient and lead to dropping out of treatment: anemia, agranulocytosis, neuropathy, hepatotoxicity, hyperpigmentation. Reaction episodes may present abruptly and cause a range of severe symptoms.
Chalise [20]	Journal Of The Nepal Medical Association	436 leprosy patients who failed to complete the cycle of MDT.	Was noted in the study that about 86% of non-adherence cases of treatment of leprosy have a wrong concept about the disease. It was also observed that the majority (94.7%) cases of noncompliance have a strong belief that the disappearance of the skin lesion is the only meaning of “cure the disease”. These two factors create a negative outcome in relation to treatment due to lack of necessary information about the disease.
Araújo e Oliveira [23]	Hansenologia Internationalis	Study with 57 patients with leprosy in irregular treatment.	The majority of those that were in irregular treatment were men (71.9%), between the ages of 20 and 49 years (54.3%), a productive age. The women who dropout treatment were concentrated between 50 and 69 years old.
Penna et al. [5]	Revista da Sociedade Brasileira de Medicina Tropical	1124 leprosy patients	Leprosy reaction episodes were recorded in 328 pacients (29.2%). Was observed that type 2 leprosy reactions were common, especially in those with lepromatous form. The treatment is prolonged and sometimes difficult, requiring multiple medications with diverse side effects that can result in dropout the tratment and increased the rates of leprosy reaction.
Hacker et al. [24]	Ciênc. saúde coletiva	1353 leprosy patiens of Rio de Janeiro	The paper compares the epidemiological data on leprosy patients living in two municipalities with socioeconomic profile and level of endemicity different, Rio de Janeiro and Duque de Caxias, Brazil and were followed by the reference centers. There were no statistically significant differences regarding gender, disability level, reaction in the diagnosis, abandonment and regularity of treatment. The differences found between the patients monitored in a single center of reference, could be partly related to contextual differences between the municipalities.
Lustosa et al. [14]	Revista da Sociedade Brasileira de Medicina Tropical	107 patients	An observational study done in Piaui, Brazil, aiming to analyze the quality of life related to health of people in treatment of leprosy in Teresina - Piaui. A specific questionnaire for assessing quality of life that sought the determinants of decline in the quality of life for people with leprosy, outlining the profile sociodemographic, clinical and epidemiological patients interviewed. The study of the impact of leprosy on quality of life reinforces the need to implement more effective strategies for early diagnosis and to break the chain of disease transmission and to increase the commitment of the leprosy patient to his treatment.
Raposo et al. [19]	Revista da Sociedade Brasileira de Medicina Tropical.	Data from national basis.	The study evaluates epidemiological and operational program of leprosy in the period before and after the integration of primary care services in the city of Aracaju, Brazil. The proportion of cases with disability grade assessed at diagnosis, increased of 60.9% to 78.8% (p < 0.001), and the conclusion of the treatment, from 41.4% to 44.4% (p < 0.023); and a lower level of treatment default with a decrease from 5.64 to 3.35 (p < 0.008). Abandonment rates have decreased in the post-integration of primary care services.
Silva et al. [17]	Revista da Sociedade Brasileira de Medicina Tropical	42 patients with leprosy	This study was developed to evaluate the situation of leprosy in municipality of Buriticupu, State of Maranhão, Brazil. Was used the method of active search to identify new cases from 2008 to 2010. The study shows that the good therapeutic response is consequence of the effectiveness of MDT, the early diagnosis, the patient’s knowledge about the disease, the commitment of the patients to the therapy and trained health professionals.
Silva et al. [11]	Escola Anna Nery	14 healthcare Professional	This research discusses the experience of professionals basic health services in the municipality of Rio de Janeiro,Brazil, which perform activities of health education in Leprosy Control Program. This program aim to increase the knowledge of the patient about the disease and consequently increase the rates of treatment adhesion. The education activites also want to reduce the social prejudice.
Miranzi [16]	Revista da Sociedade Brasileira de Medicina Tropical	455 patients	This retrospective study describes the epidemiological profile of the population diagnosed with leprosy in the district of Uberaba, State of Minas Gerais, Brazil, from 2000 to 2006. It is estimated that only 1/3 of patients are notified and that among these, many are irregular treatment or drop out, increasing the impact of the disease.
Lira et al. [3]	The Brazilian Journal of Infectious Diseases	70 leprosy patients	It was observed that 57.1% of patients in the study had no difficulty adhering to treatment, while 38.6% reported little difficulty. This study shows that although patients who claim to be familiar with leprosy and its treatment, the Morisky-Green test clearly shows that they really had no knowledge of the principles of therapy, which is evidenced by the low level of adherence to treatment.
Ferreira et al. [8]	Revista Brasileira de Epidemiologia	Data from national basis.	Cross-sectional study of diagnosed cases of leprosy relapse in reference units from 2005 to 2007 in 5 municipalities in the state of Mato Grosso, Brazil.
			The diagnosis of recurrences occurred in early and late periods, compared to the time interval between initial treatment and recurrence rates correspond to the findings of other research. Several factors can influence the time to relapse: a clinical form, the therapeutic regimen, reactive episodes, irregular treatment and bacterial load.
Ferreira et al. [9]	Rev de Saúde Pública	159 pacientes	A retrospective case–control study in the state, of Mato Grosso-Brazil, to investigate the factors of recurrence that were related to living conditions, living habits, organization of health services, clinical and therapeutic regimens. Were associated with relapse of leprosy: living in rental housing; living in houses constructed of wood and mud; living with dwellings with more than five people; alcohol use disorder; irregular treatment; lack of knowledge about the disease/treatment; use of public transportation to get to the clinic; clinical form of the disease, and treatment regimen.
Weiand et al. [21]	Lepr Rev.	55 patients	The objective of this study was to measure medication adherence among outpatients attending an urban leprosy clinic in Hyderabad, India. Fifty two patients met the inclusion criteria for this study; 13 patients (25%) were non-adherent according to the Morisky scale questionnaire and 17 patients (33%) according to the urine spot test. 48% of patients were non-adherent on the basis of the urine spot test and/or the Morisky scale questionnaire.