Patient-centered factors

Knowledge and attitudes: Patients with limited understanding of TB, its treatment, and the importance of completing the full course are more likely to discontinue treatment prematurely.^[3] Educational interventions can improve knowledge and empower patients to take an active role in their treatment.

Stigma: The social stigma associated with TB can be a significant deterrent to adherence. Fear of discrimination or isolation from society may lead patients to avoid seeking treatment or conceal their diagnosis, jeopardizing their own health and potentially transmitting the disease to others.^[1] Addressing stigma through awareness campaigns and promoting social support networks can be crucial in determining the treatment outcomes and preventing the spread of TB infection.

Mental health: Comorbid mental health conditions like depression, anxiety, or substance abuse can significantly impact adherence.^[1] These conditions can make it difficult for patients to prioritize treatment or cope with the demands of adhering to a complex medication schedule. Integrating mental health support into TB treatment programs can be beneficial.

Side effects: TB medications can cause unpleasant side effects like nausea, fatigue, or peripheral neuropathy.^[2], ^[3] Patients experiencing these side effects may be tempted to stop treatment. Providing education on how to manage side effects and exploring alternative medication options, if necessary, can improve adherence.

Social and economic factors

Socioeconomic status: Poverty can create significant barriers to adherence. Patients may struggle to afford transportation to treatment centers, nutritious food to support recovery, or childcare to attend appointments.^[1], ^[2] Financial assistance programs and social support services can help alleviate these burdens.

Social support: A strong support network of family and friends can significantly improve a patient's adherence to treatment. Social support can provide encouragement, help manage treatment logistics, and reduce feelings of isolation.^[1] Interventions that promote social support can be beneficial.

Housing: Unstable housing situations or crowded living conditions can increase the risk of transmitting TB to others and pose challenges in adhering to treatment protocols, such as proper ventilation.^[1] Addressing housing needs can be crucial for successful TB control efforts.

Healthcare system factors

Drug availability: Stockouts or limited access to essential TB medications can disrupt treatment continuity and discourage patients from adhering to the regimen. Ensuring consistent drug availability is crucial for successful treatment programs.^[1], ^[2]

Long treatment duration: The lengthy treatment duration, often lasting 6 months or more, can be challenging for patients to maintain motivation and commitment.^[4] Exploring options for shorter treatment regimens or developing strategies to enhance patient motivation are ongoing areas of research.

Quality of care: Limited access to healthcare facilities, long wait times for appointments, or a lack of patient-centered care can discourage patients from seeking and adhering to treatment.^[1], ^[5] Strengthening healthcare systems and promoting patient-centered care approaches can improve treatment experiences and adherence rates.

Directly observed therapy (DOT)

DOT remains a cornerstone intervention for TB treatment adherence. A healthcare worker directly observes patients ingesting their medications, promoting accountability and ensuring proper medication intake.^[4], ^[6] However, DOT can be burdensome for patients and healthcare systems due to logistical challenges and potential stigma associated with requiring supervision.

Technological interventions

Mobile health (mHealth) technologies are increasingly being explored as potential tools to improve adherence. Text message reminders can prompt patients to take their medications and offer channels for communication and support.^[4] Studies suggest that text message interventions can be effective, particularly in low- and middle-income countries (LMICs).^[7] Additionally, smartphone apps can be used for medication tracking, educational resources, and appointment reminders, potentially enhancing patient engagement in their treatment journey.^[8], ^[9], ^[10]

Patient-centered care

Shifting towards patient-centered care models that emphasize clear communication, shared decision-making, and addressing individual needs can significantly impact adherence.^[9], ^[11] This approach empowers patients to take an active role in their treatment and fosters a sense of trust and collaboration with healthcare providers.^[5] Interventions like motivational interviewing can help address concerns, build motivation, and develop strategies for overcoming challenges to adherence.

Social support interventions

Social support networks play a crucial role in adherence. Interventions that involve family members in treatment education sessions or connect patients with support groups can provide encouragement, logistical assistance, and a sense of community, ultimately improving adherence rates.^[12] Additionally, addressing social determinants of health, such as poverty and housing instability, can indirectly improve adherence by alleviating burdens that may hinder treatment completion.

Financial incentives

Conditional cash transfers, where patients receive financial rewards for completing treatment milestones, have shown promise in some studies to improve adherence, particularly in populations facing financial hardship.^[13] However, the long-term sustainability and ethical considerations of such interventions require further exploration.

Combination approaches

The most effective interventions often combine different strategies. For example, integrating mHealth reminders with adherence counseling or combining DOT with social support interventions may yield more robust results than single interventions.^[14], ^[15], ^[16] Tailoring interventions to address the specific needs and circumstances of individual patients is crucial for maximizing the effectiveness of adherence support strategies.