Abstract
Background: The global loss to follow-up (LTFU) rate among drug-resistant TB (DR-TB) patients remains high at 15%. We conducted a systematic review to explore interventions to reduce LTFU during DR-TB treatment.
Methods: We searched for studies published between Jan. 2000 and Dec. 2017 that provided any form of psychosocial or material support for patients with DR-TB. We estimated point estimates and 95% confidence intervals (CI) of the proportion LTFU. We performed subgroup analyses and pooled estimates using an exact binomial likelihood approach.
Findings: We included 35 DR-TB cohorts from 25 studies. Cohorts that received any form of psychosocial or material support had lower LTFU rates than those that received standard care. Psychosocial support throughout treatment – via counselling sessions or home visits – was associated with lower LTFU rates compared to when support was provided through a limited number of visits or not at all, with pooled proportions LTFU of 8.4% (4.0–16.7%) and 20.5% (15.2–27.0%), respectively.
Conclusion: Our review suggests psychosocial support should be provided throughout DR-TB treatment in order to reduce treatment LTFU. Future studies should explore the potential of providing self-administered therapy complemented with psychosocial support during the continuation phase.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Law has nothing to disclose.
Conflict of interest: Dr. Daftary has nothing to disclose.
Conflict of interest: Dr. Padayatchi has nothing to disclose.
Conflict of interest: Dr. Calzavara has nothing to disclose.
Conflict of interest: Dr. Menzies has nothing to disclose.
Conflict of interest: Dr. O'Donnell has nothing to disclose.
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