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Abstract
Background People in underserved groups have higher rates of tuberculosis (TB) and poorer treatment outcomes compared with people with no social risk factors.
Objectives This scoping review aimed to identify interventions that improve TB treatment adherence or completion rates.
Eligibility criteria Studies of any design focusing on interventions to improve adherence or completion of TB treatment in underserved populations in low incidence countries.
Sources of evidence MEDLINE, Embase and Cochrane CENTRAL were searched (January 2015 to December 2023).
Charting methods Piloted data extraction forms were used. Findings were tabulated and reported narratively. Formal risk of bias assessment or synthesis was not undertaken.
Results 47 studies were identified. There was substantial heterogeneity in study design, population, intervention components, usual care and definition of completion rates. Most studies were in migrants or refugees, with fewer in populations with other risk factors (eg, homelessness, imprisonment or substance abuse). Based on controlled studies, there was limited evidence to suggest that shorter treatment regimens, video-observed therapy (compared with directly observed therapy), directly observed therapy (compared with self-administered treatment) and approaches that include tailored health or social support beyond TB treatment may lead to improved outcomes. This evidence is mostly observational and subject to confounding. There were no studies in Gypsy, Roma and Traveller populations, or individuals with mental health disorders and only one in sex workers. Barriers to treatment adherence included a lack of knowledge around TB, lack of general health or social support and side effects. Facilitators included health education, trusted relationships between patients and healthcare staff, social support and reduced treatment duration.
Conclusions The evidence base is limited, and few controlled studies exist. Further high-quality research in well-defined underserved populations is needed to confirm the limited findings and inform policy and practice in TB management. Further qualitative research should include more people from underserved groups.
- Tuberculosis
- Medication Adherence
- Public health
- Organisation of health services
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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Footnotes
Contributors AR, RG, DM and AN are responsible for the conception of the study. All authors contributed to the development of the overall review methodology. JD, AN, LA and AR developed the search strategies and piloted screening criteria. JD, CH, AR and LA screened citations, reviewed full-text articles and achieved consensus on the final included studies. JD extracted the data. JD, CH, AR and AB contributed to organisation, synthesis and interpretation of data. JD drafted the manuscript. All authors provided important intellectual contribution and guidance throughout the development of the manuscript. All authors contributed to, edited and approved the final version of this manuscript. JD, AR and CH acted as guarantors.
Funding This work was funded by the UK Health Security Agency.
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Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
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