Adherence to tuberculosis treatment
- Lee B Reichman, MD, MPH
Lee B Reichman, MD, MPH
- Professor of Medicine
- New Jersey Medical School
- Alfred A Lardizabal, MD
Alfred A Lardizabal, MD
- Associate Professor of Medicine
- New Jersey Medical School
Tuberculosis (TB) is nearly always curable if patients are treated with effective, uninterrupted antituberculous therapy. Adherence to treatment is critical for cure of individual patients, controlling spread of infection, and minimizing the development of drug resistance [1,2].
Issues related to adherence to treatment of drug-sensitive TB in adults will be reviewed here. The clinical approach to treatment of TB is discussed in detail separately. (See "Treatment of drug-susceptible pulmonary tuberculosis in HIV-uninfected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults" and "Treatment of drug-resistant pulmonary tuberculosis in adults".)
CHALLENGES OF ADHERENCE
Incomplete adherence to treatment has been identified as the most serious problem in tuberculosis (TB) control  and a major obstacle to the elimination of the disease . In one retrospective study including 184 patients with TB in New York City (nearly half of whom were nonadherent), the nonadherent patients took longer to convert sputum to negative culture results (254 versus 64 days), were more likely to acquire drug resistance (relative risk 5.6), and required longer treatment regimens (560 versus 324 days) .
Adherence to tuberculosis treatment can be particularly challenging; the duration of treatment is long (usually six months or longer), combination therapy is required, and side effects may be unpleasant. Cost of medications (even relatively small copays or deductibles) can be a serious barrier to adherence if not covered by the public health system. Furthermore, patients often experience rapid improvement in symptoms, which may obfuscate the importance of continuing prolonged treatment with drugs that may be perceived as unnecessary.
Factors affecting adherence — Successful treatment among patients with TB may be influenced by several factors:
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- CHALLENGES OF ADHERENCE
- Factors affecting adherence
- Risk factors for nonadherence
- STRATEGIES TO IMPROVE ADHERENCE
- Comprehensive case management
- Directly observed therapy
- Fixed-dose combination therapy
- Patient education
- Incentives and enablers
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS