Incentives and Support Programs to Improve Adherence to Tuberculosis Treatment

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Initial infection leads to latent TB, which has no active symptomology as the disease is contained by the host’s immune defences. However, in a small subset of infected patients (5% to 10%), the infection can proceed to active TB, which has visible symptoms and high mortality. Worldwide, TB kills more people than any other infectious disease. WHO’s End TB Strategy aims to reduce TB death by 90% by 2035. TB is curable, with TB treatment given in 2 phases: initial intensive treatment and continuation treatment. In the initial phase, it is recommended that the medication be given daily; in the continuation phase, the medication can be given daily or intermittently. As treatment is intensive and frequent, medication nonadherence is a problem and can lead to poorer patient outcomes and development of drug-resistant TB. The intensive nature of treatment can lead to significant barriers for people attending treatment, especially those in hard-to-reach populations or those who are poorer and cannot afford to take time off work or to travel to the clinic for treatment. Therefore, a multi-faceted, patient-centred treatment strategy is often cited as an option to help overcome these barriers. Components of a patient-centred strategy could include enablers, such as transportation vouchers and social service assistance, and incentives, such as food stamps, snacks and meals, and provision of housing, stipends, coupons, or cash. Incentives are generally defined as items or services that reward healthy behaviour and enablers are defined as items or services that remove barriers to accessing health care. This report is an upgrade of a previous CADTH report, Support Programs for Tuberculosis Treatment: Clinical Utility and Guidelines, with an updated search using broader search terms. The purpose of this review is to identify clinical studies of support programs, material incentives, or material enablers in the treatment of TB, and to summarize the clinical effectiveness of these interventions. Evidence-based guidelines were also identified, and the recommendations regarding support programs and incentives were summarized. This report is a component of a larger CADTH Condition Level Review on TB. A condition level review is an assessment that incorporates all aspects of a condition, from prevention and detection to treatment and management. For more information on CADTH’s Condition Level Review of TB, please visit the TB project page on CADTH’s website.