Table 2. Summary of the effects of different types of adherence interventions on TB treatment outcomes.
| Outcomes |
SAT versus any DOT (No. of studies) |
SAT versus any DOT-HIV/TB (No. of studies) |
Family/community DOT versus HCW DOT (No. of studies) |
Lay provider DOT versus HCW DOT (No. of studies) |
Home DOT versus clinic DOT (No. of studies) |
Community DOT versus clinic DOT (No. of studies) |
Home DOT versus community DOT (No. of studies) |
Patient education2 (No. of studies) |
Incentives/enablers2 (No. of studies) |
Reminders/tracers2 (No. of studies) |
Patient-centered DOT versus SAT (No. of studies) |
Patient-centered DOT versus DOT (No. of studies) |
Patient-centered SAT versus SAT (No. of studies) |
Psychological interventions2 (No. of studies) |
Staff education2 (No. of studies) |
Phone reminders2 (No. of studies) |
VOT versus DOT (No. of studies) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mortality—CSs | Ø (23) |
↑ (4) |
Ø (3) |
Ø (3) |
↑ (8) |
Ø (6) |
Ø (2) |
-- | ↓ (3) |
Ø (3) |
Ø (4) |
Ø (4) |
-- | Ø (1) |
-- | Ø (2) |
Ø (1) |
| Mortality—RCTs | Ø (4) |
-- | -- | -- | -- | Ø (2) |
Ø (1) |
Ø (2) |
Ø (2) |
Ø (3) |
Ø (1) |
↓ (2) |
-- | -- | Ø (2) |
Ø (1) |
-- |
| Success—CSs | ↓ (4) |
↓ (3) |
Ø (3) |
Ø (2) |
↑ (3) |
↑ (9) |
↓ (1) |
-- | ↑ (4) |
Ø (2) |
↑ (2) |
↑ (4) |
-- | -- | ↑ (1) |
-- | -- |
| Success—RCTs | ↓ (5) |
-- | -- | -- | -- | Ø (1) |
Ø (2) |
Ø (2) |
↑ (3) |
↑ (4) |
↑ (1) |
↑ (2) |
-- | -- | Ø (3) |
Ø (3) |
-- |
| Completion—CSs | Ø (14) |
↓ (1) |
Ø (2) |
Ø (1) |
Ø (5) |
Ø (3) |
Ø (2) |
-- | Ø (4) |
Ø (1) |
↑ (2) |
Ø (2) |
-- | ↑ (1) |
-- | Ø (2) |
Ø (2) |
| Completion—RCTs | Ø (5) |
-- | -- | -- | -- | Ø (1) |
-- | ↑ (1) |
↑ (2) |
Ø (3) |
↑ (1) |
Ø (2) |
-- | ↑ (1) |
Ø (2) |
Ø (1) |
-- |
| Cure—CSs | ↓ (18) |
↓ (2) |
Ø (3) |
Ø (1) |
Ø (6) |
Ø (6) |
Ø (2) |
-- | ↑ (4) |
↑ (2) |
↑ (2) |
Ø (2) |
-- | -- | -- | ↑ (2) |
-- |
| Cure—RCTs | Ø (4) |
-- | -- | -- | -- | Ø (2) |
Ø (1) |
↑ (1) |
Ø (1) |
Ø (2) |
↑ (2) |
↑ (2) |
-- | Ø (1) |
Ø (3) |
Ø (1) |
-- |
| Failure—CSs | Ø (15) |
Ø (5) |
↑ (3) |
Ø (2) |
Ø (4) |
↓ (6) |
Ø (2) |
-- | Ø (2) |
Ø (3) |
Ø (2) |
Ø (2) |
-- | -- | -- | Ø (3) |
-- |
| Failure—RCTs | Ø (2) |
-- | -- | -- | -- | Ø (1) |
Ø (1) |
Ø (1) |
↓ (1) |
Ø (3) |
-- | Ø (2) |
-- | -- | Ø (2) |
Ø (1) |
-- |
| Loss to follow-up—CSs | Ø (21) |
Ø (3) |
Ø (3) |
Ø (2) |
Ø (7) |
↓ (6) |
Ø (2) |
-- | ↓ (5) |
↓ (4) |
Ø (4) |
Ø (4) |
-- | ↓ (1) |
-- | Ø (2) |
-- |
| Loss to follow-up—RCTs | Ø (4) |
-- | -- | -- | -- | Ø (2) |
Ø (1) |
Ø (3) |
↓ (1) |
Ø (4) |
↓ (1) |
↓ (3) |
-- | Ø (1) |
Ø (2) |
Ø (1) |
-- |
| Relapse—CSs | Ø (6) |
Ø (1) |
-- | -- | -- | -- | -- | -- | -- | -- | Ø (1) |
-- | -- | -- | -- | -- | -- |
| Relapse—RCTs | Ø (1) |
-- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Adherence—CSs | ↓ (1) |
-- | ↓ (1) |
-- | ↓ | -- | -- | ↑ (1) |
-- | -- | -- | -- | -- | -- | -- | -- | -- |
| Adherence—RCTs | Ø (1) |
-- | -- | -- | -- | -- | -- | ↑ (1) |
-- | ↑ (1) |
-- | ↑ (1) |
Ø (1) |
-- | -- | -- | -- |
| Smear conversion—CSs | Ø (2) |
-- | -- | -- | ↑ | ↑ (2) |
-- | -- | -- | -- | -- | -- | -- | -- | -- | ↑ (1) |
-- |
| Smear conversion—RCTs | ↓ (1) |
-- | -- | -- | -- | Ø (1) |
-- | -- | ↑ (1) |
↑ (3) |
↑ (1) |
-- | -- | -- | -- | Ø (1) |
-- |
| Development of drug resistance—CSs | ↓ (3) |
-- | -- | -- | -- | -- | -- | -- | -- | ↓ (1) |
Ø (1) |
-- | -- | -- | -- | -- | -- |
| Development of drug resistance-RCTs | -- | -- | -- | -- | -- | -- | -- | -- | Ø (1) |
-- | -- | -- | -- | -- | -- | -- | -- |
| Unfavorable outcome*—CSs | -- | -- | -- | -- | -- | ↓ (1) |
-- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Poor adherence1—RCTs | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | Ø (1) |
-- |
Ø No evidence of a difference with the use of intervention versus control.
↑ Statistically significant increased risk of outcome associated with the use of intervention versus control.
↓ Statistically significant decreased risk of outcome associated with the use of intervention versus control.
-- No available data for comparison.
*Unfavorable outcome is defined as combined failure, default, death, or transfer out by the study.
1Percentage of patient-months during which >20% of doses were missed.
2Comparison of adherence intervention in addition to standard of care versus standard of care alone. Standard of care was DOT or SAT, depending on study setting.
Abbreviations: CS, cohort study; DOT, directly observed therapy; HCW, healthcare worker; RCT, randomized controlled trial; SAT, self-administered therapy.