Table 1. Overview of studies quantitatively and/or qualitatively evaluating patient support in low tuberculosis incidence countries.
| Study, Country | Study Type and Aim | Study Population | Support Categories Described | ||||
|---|---|---|---|---|---|---|---|
| TS | HE support | SE support | PE support | Other1 | |||
| Studies quantitatively evaluating effects of patient support in comparison to a control group2 | |||||||
| Babalık et al., 2013 [48], Turkey |
Case-control study; Determine the factors influencing treatment outcomes and effectivity of the National Tuberculosis Program in relation to application of DOT | Adult TB patients with one year follow-up. Cases: adverse treatment outcome (n = 464), Controls: treatment outcome cured (n = 441); 92% on DOT | DOT at health care centres (50%), dispensaries (20%) and other (30%), provided by health care workers (76%) and other (24%)* | - | - | - | - |
| Caylà et al., 2009 [30], Spain | Prospective cohort study; Analyse anti-TB treatment adherence and fatality during standard TB treatments and identify factors associated with these event | Adult DS TB patients on standard anti-TB treatment. Exposed: patients on DOT3 (n = 140), Not exposed: patients on SAT (n = 1284) | DOT#¥ | - | - | - | - |
| Chaudhry et al., 2015 [66], Saudi Arabia |
Historical before-and-after study; Assess the effectiveness of the revised retrieval system (RRS) on non-compliance | Active PTB cases treated under DOT. IG: patients treated in 2005–2010 under RRS (n = 835), CG: patient treated in 2002–2004 before RRS (n = 501) | Out-patient DOT*#¥ | RRS: For all patients education at admission and discharge; additionally, education at each OPD visit for substance-abusing patients# | - | - | RRS: For all patients follow up after missed OPD appointments by national TB control nurse; additionally, reminders by national TB control nurses one day prior to their appointments for substance-abusing patients |
| Chuck et al., 2016 [65], USA | Non-randomized controlled trial; Determine completion rates of VOT in comparison with in-person DOT, feasibility, acceptability and resource and staffing needs | (DR) TB patients eligible for DOT. IG: patients on VOT (n = 49); CG: patients on in-person DOT (n = 267) | VOT: Live videos of the patients via webcam-equipped computers# | - | - | - | Missed VOT appointments followed up by phone calls and home visits# |
| Clark et al., 2007 [63], Turkey | Prospective randomized study; Assess the effect of a clinical pharmacist directed patient education program (EDU) on the therapy adherence compared to routine nursing care | First-time TB patients on first-line anti-TB drugs. IG: EDU (n = 56); CG: no EDU (n = 58) | - | EDU: Oral and written education by clinical pharmacist shortly before discharge from the hospital | - | - | EDU: Appointment reminders by clinical pharmacist |
| King, Munsiff and Ahuja, 2010 [35], USA | Retrospective cohort study; Review treatment outcomes of HIV- positive TB patients in New York City and determinants for treatment success | HIV-positive, first-time, Rifampicin-sensitive TB patients. Exposed: patient on DOT4 (n = 1819), Not exposed: patients on SAT (n = 592) | DOT at home, worksite or another location convenient to the patient # | - | - | - | - |
| Ricks et al., 2015 [64], USA |
Randomized intervention study; Compare treatment outcomes using two different types of DOT outreach workers | Substance abusing active TB patient for which DOT was prescribed. IG: (n = 48), CG: (n = 46) | Enhanced DOT: DOT provided by peers in a two-person mixed-sex team¥ | - | - | - | - |
| Wade et al., 2012 [39], Australia | Retrospective cohort study with CEA; Compare the effectiveness of in-person versus home videophone DOT (as measured by the proportion of appointments missed); to determine the cost-effectiveness of VOT; to determine acceptability, usability and sustainability of VOT | TB patients who had received VOT/DOT; Exposed: patient on VOT (n = 58), Not exposed: patients on DOT (n = 70) | VOT: DOT via desktop videophones and a call centre operating 24/7 and set up by a community nursing service | - | - | - | - |
| Studies quantitatively evaluating effects of patient support without allowing for comparison of effects to a control group2 | |||||||
| Charokopos et al., 2013 [49], Greece | Case-control study; Determine the effect of "modified DOT” (MDOT) on TB treatment outcomes, number of contacts tested for LTBI and number of contacts started on treatment in comparison to a SAT | Cases: newly diagnosed TB patients (n = 13) and close contacts (n = 30); Controls: past-treated TB patients (n = 41) and close contacts (n = 111)5 | MDOT: Treatment supervision by GP during nine home visits, every 20 days | MDOT: Health education by the GP for the patient and household members during the visits | - | - | - |
| Craig et al., 2008 [43], UK | Case series; Develop a social outreach model of care including a TB link worker (TBLW) for marginalized groups with TB | Adult TB/LTBI patients referred on the basis of social need to TBLW (n = 100) | DOT at the DDU, at the pharmacy or the TB clinic* | - | TBLW: helps patients with challenging health and social care needs to access community services | - | - |
| Escudero et al., 2006 [40], Spain | Case series; Evaluate the results of the treatment of non-HIV-infected MDR-TB patients | HIV-negative MDR PTB patients (n = 25) | In-patient DOT by nurses | - | - | Psychological support and counselling by repeated clinical interviews on need and difficulties related to treatment adherence during hospitalisation and during out-patient follow-up | - |
| Ferrer et al., 2010 [41], USA | Case series; Report treatment outcomes among MDR-TB patients born in Mexico and treated along the US-Mexican border under a binational TB control project (Programa Juntos) | MDR-TB patients on DOT (n = 48) | Out-patient DOT by social workers¥ | - | - | - | - |
| Garfein et al., 2015 [44], USA | Case series; Determine feasibility, acceptability, and potential efficacy of VOT in a high- and low-income setting | Adults newly diagnosed DS TB patients treated under VOT (n = 43 in San Diego; n = 9 in Tijuana) | VOT: Patients upload videos of themselves taking the medication to a cloud via a smart phone app# | - | - | - | Daily text message reminders (one before dose is due and one after the expected video had not been received) |
| Jit et al., 2011 [51], UK | Retrospective cohort study with CEA; Evaluate the cost-effectiveness of the Find and Treat Service for diagnosing and managing hard to reach individuals with active TB | Hard to reach individuals (e.g. homeless, substance abusing, imprisoned) a with active PTB. Cases: screened or managed by the Find and Treat service (n = 48), Controls: passively presenting controls (n = 252)6 | - | Awareness raising events by Find and Treat Service supported by peer workers | - | Company to appointments by Find and Treat Service staff; home visits to reduce the risk of loss to follow-up | - |
| Luzzati et al., 2011 [45], Italy | Case series; Evaluate a prolonged hospitalisation programme to improve early outcome of TB treatment in high risk patients | Adult patients admitted to referral TB Centre for high risk (DR-TB, foreign born, illegal immigrant, previously treated, IDU, HIV infected or in a social and/or familiar condition not assuring good adherence to treatment) with positive smear culture-confirmed PTB (n = 122); 100% on DOT | In-patient DOT, subsequently out-patient DOT#¥ | - | - | - | - |
| Mejuto et al., 2010 [38], Spain | Retrospective cohort study; Assess character, results and effectiveness of DOTS in the regional health area of Santiago de Compostela | TB patients who received DOTS treatment (n = 253) | DOT at TB unit, health centre, social services, family, DDU, school, hospital# | - | - | - | - |
| Pursnani et al., 2014 [50], USA | Case-control study nested in a retrospective cohort study; Compare patients undergoing court-ordered detention for TB treatment and time-matched control TB patients on outpatient DOT | Cases: Patients undergoing court-ordered detention for TB treatment (n = 79)7; Controls patients on outpatient DOT (n = 70) | Out-patient DOT*#¥ | - | - | - | - |
| Studies qualitatively assessing different aspects of patient support | |||||||
| Bender et al., 2011 [62], Canada | Interpretive phenomenology; Understand the nature of TB nurses’ relational work | Female nurses (n = 9) and their clients (n = 24) | DOT by nurses at patients’ homes, nurses’ cars, the street and other public settings* | Nurses repeatedly explain and clarify treatment plan | Incentives (such as grocery vouchers and public transit tokens)* | Nurses build rapport, encourage adherence without being authoritarian | - |
| Craig and Zumla, 2015 [54], UK | Interview study; Describe the social context of adherence to treatment in marginalized groups | Patients from a major TB centre (n = 17); 53% on DOT |
DOT at the DDU, the pharmacy in conjunction with methadone and at hostels via outreach workers* | - | - | Outreach workers accompany patients to appointments* | Outreach workers provide appointment reminders* |
| Gerrish, Naisby and Ismail, 2013 [61], UK | Focused ethnography; Explore experiences of the diagnosis and management of TB from the perspective of Somali patients living in the UK and healthcare professionals involved in their care | Healthcare practitioners with experience of caring for Somali TB patients (n = 18), Somalis who had received TB treatment in the UK (n = 14) | - | - | Somali health care workers and TB nurses help patients to access other health and welfare services | - | - |
| Horter et al., 2014 [55], Multi-national | Interview study; Identify potential risks and benefits associated with blogging to determine whether social media had a role to play in supporting patients with MDR-TB | MDR-TB patient bloggers (n = 5); MSF project staff closely involved with the bloggers (n = 8); Stakeholders: WHO European Region TB specialists (n = 2) and members of staff from MSF headquarters (n = 5) |
- | - | - | Blogging about MDR-TB treatment | - |
| Kawatsu et al., 2013 [56], Japan | Interview study; Explore the changes experienced by homeless TB patients and discuss the possible role of PHC-based DOTS treatment in effecting these changes | Ex-homeless TB patients who completed DOTS-based treatment at Shinjuku City PHC (n = 18) | DOT by nurses at the public health centre | - | Provision of food and drinks when patients come for DOT; nurses consult social welfare offices and other organizations | Nurses build rapport, address concerns, congratulation ceremony for successfully completed treatment | - |
| Mtui and Spence, 2014 [57], UK | Interview study; Explore the views and experiences of National Health Service (NHS) board TB nurses and consultants in public health medicine in relation to models of TB service delivery employed in their respective NHS boards in Scotland | TB specialist nurses (n = 6); health protection specialist nurse (n = 2); respiratory specialist nurse (n = 5); consultants in public health medicine (n = 5) | DOT at GP practices, in pharmacies for substance-abusers, on the streets / public bars by TB nurses for homeless patients | Nurses talk about TB and provide leaflets* | Nurses assist in accessing social care while delivering DOT; provide incentives for some cases, bring people to the clinic* | Nurses build rapport with patients, support in coping with the treatment, perform home visits* | - |
| Sagbakken, Bjune and Frich, 2011 [58], Norway | Interview study; Explore patients’ and health professionals’ views and experiences with DOT | Health professionals (n = 20), TB patients on DOT (n = 22) | DOT by homebased nursing services |
- | - | - | - |
| Searle, Park and Littleton, 2007 [60], New Zealand | Community-based ethnography; Document and analyse the nature of the process of TB care in older European (Pakeha) TB patients | European TB patients in the Auckland region (n = 8); 63% on DOT | DOT at home by public health nurses* | - | Nurses ease structural constrains by arranging housing, food and transport | Nurses provide moral support and encouragements | - |
| Shimamura et al., 2010 [59], Japan | Interview study; Describe the support provided by Japanese public health nurses (PHN) to high-risk TB patients | PHNs (n = 11); patient cases described by the PHN (n = 11) | DOT by PHN*¥ | PHN explain TB and co-morbidities to the patient and contacts, for patients with limited intelligence using a comic book or picture-story | PHN ensure physical place for homeless patients to receive medications, link patients with welfare service, build a support system for the future, including housing, food, or job training | PHN build rapport, encourage patients | Pill case provided for one patient with dementia who hoped to take her medicine independently |
*target patients not specified
#provider not specified
¥DOT location not specified
1Treatment administration support other than DOT
2Including mixed-method studies
3Patients with high risk of low adherence (intravenous drug users, homeless, prisoners)
4Offered to all out-patients
5Publication does not provide treatment outcomes for controls precluding calculation of RRs
6Treatment outcome data based on modelling precluding calculation of RRs
7Patients undergoing court-ordered detention for TB treatment are not considered a comparison group for this systematic review as court-ordered detention is not considered patient support
CG: control group, CEA: cost effectiveness analysis, DDU: drug dependency unit, DOT: directly observed treatment, DR: drug resistant, DS: drug susceptible, GP: general practitioner, HE: health educational, HIV: Human Immunodeficiency Virus, IDU: injecting drug user, IG: intervention group, LTBI: latent TB infection, MDR-TB: multi-drug resistant TB, MSF: Médecins Sans Frontières, NHS: National Health Service, OPD: out-patient department, PE: psycho-emotional, PHC: public health centre, PHN: public health nurse, PTB: pulmonary TB, RRS: revised retrieval system, SAT: self-administered treatment, SE: socio-economic, TB: Tuberculosis, TBLW: TB link worker, TS: Treatment Supervision, VOT: video observed treatment