The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Indian J Tuberc. 2024 Jan;71(1):48-63. doi: 10.1016/j.ijtb.2023.03.001. Epub 2023 Mar 17.
Adherence is often a barrier to curative treatment of Mycobacterium tuberculosis (TB). There have been numerous interventions focused on increasing TB treatment adherence in Southeast Asia, but it is unclear if they are effective. This systematic review and meta-analysis aimed to compile and evaluate the literature on interventions designed to increase TB treatment adherence in Southeast Asia.
We searched Cochrane Library Reviews (CDSR) and Cochrane Library Trials (CENTRAL), Medline, CINAHL, Scopus, and Web of Science from 2000 to 2022 with no language restrictions. We included studies of any design conducted in Southeast Asia that implemented interventions to increase treatment completion in people diagnosed with TB and assessed completion as an outcome. We did not require a control group. Four investigators used a standardized data collection form to collate results. The heterogeneity across studies was explored by I statistics. We assessed bias using the Newcastle-Ottawa Scale and Cochrane ROB 2.0. We used a random effects meta-analysis to calculate a pooled risk ratio with 95% confidence intervals.
From 1881 abstracts, we included 14 articles. There were 7198 subjects with 3163 (44%) receiving a TB treatment adherence intervention across eight countries. Interventions included directly observed therapy, text-message reminders, food incentives, and more. The risk ratio, derived from the meta-analysis of eight included studies with a control group and 6618 participants overall, was 1.04 (95% CI 1.01,1.08; I = 29%), favoring the interventions over controls with little concern for heterogeneity or risk of bias. When narratively assessed, the other six studies all reported increased adherence in the intervention group.
The results suggested there is a small, statistically significant benefit of using interventions to promote TB treatment completion. Future research could look at additional strategies and combinations of strategies to promote adherence.
依从性常常是治愈性结核病（TB）治疗的障碍。东南亚已经有许多干预措施旨在提高结核病治疗的依从性，但尚不清楚这些干预措施是否有效。本系统评价和荟萃分析旨在收集和评估旨在提高东南亚结核病治疗依从性的文献。
我们从 2000 年到 2022 年在 Cochrane 图书馆评论（CDSR）和 Cochrane 图书馆试验（CENTRAL）、Medline、CINAHL、Scopus 和 Web of Science 中进行了无语言限制的搜索。我们纳入了任何设计的研究，这些研究在东南亚实施了干预措施，以提高被诊断为结核病的人的治疗完成率，并将完成情况作为结果进行评估。我们不需要对照组。四位研究人员使用标准化的数据收集表来整理结果。通过 I 统计数据探索了研究之间的异质性。我们使用纽卡斯尔-渥太华量表和 Cochrane ROB 2.0 评估偏倚。我们使用随机效应荟萃分析计算了一个汇总风险比及其 95%置信区间。
从 1881 篇摘要中，我们纳入了 14 篇文章。共有 7198 名受试者，其中 3163 名（44%）接受了 8 个国家的结核病治疗依从性干预。干预措施包括直接观察治疗、短信提醒、食物奖励等。荟萃分析纳入了 8 项有对照组和 6618 名参与者的研究，得出的风险比为 1.04（95%CI 1.01，1.08；I=29%），干预组比对照组有较小的优势，且对异质性或偏倚风险的担忧较小。当进行叙述性评估时，另外六项研究都报告了干预组的依从性增加。
结果表明，使用干预措施促进结核病治疗完成有一个小的、具有统计学意义的益处。未来的研究可以研究促进依从性的其他策略和策略组合。
