Clinical and economic impact of medication non-adherence in drug-susceptible tuberculosis: a systematic review

Author:

Chimeh R. A.1,Gafar F.2,Pradipta I. S.3,Akkerman O. W.4,Hak E.5,Alffenaar J-W. C.6,van Boven J. F. M.7

Affiliation:

1. Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen

2. Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands

3. Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands, Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jawa Barat, Indonesia

4. Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, TB Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren

5. Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands

6. Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, NSW, Australia

7. Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands

Abstract

BACKGROUND: Despite considerable efforts to globally eradicate TB, and the availability of effective antibiotics, TB elimination goals are falling behind. While non-adherence to TB drug regimens may compromise effective treatment, its full impact is still unknown.OBJECTIVE: To determine the clinical and economic impact of non-adherence to TB medication on treatment outcomes in drug-susceptible TB patients (DS-TB).METHODS: A systematic review was performed using PubMed and Embase for studies published between 2009 and 2019 reporting associations between adherence and WHO-defined TB treatment outcomes and economic outcomes in DS-TB patients.RESULTS: A total of 14 studies were included. Eight focused on the association between non-adherence and death, 2 on treatment failure, 1 study on successful treatment outcome, 1 study on both successful and unsuccessful treatment outcomes and 2 on cost outcomes. Most studies (71.4%) were retrospective cohort or case-control studies. The results showed that non-adherence to TB drug regimens was associated with death, treatment failure and lower cure rates.CONCLUSION: Non-adherence to TB drugs has a profound impact on both clinical and economic TB outcomes. To reach WHO TB elimination goals, preventing non-adherence and the implementation of cost-effective intervention programmes should receive the highest priority.

Publisher

International Union Against Tuberculosis and Lung Disease

Subject

Infectious Diseases,Pulmonary and Respiratory Medicine

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