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Cited by 1,080Tuberculosis Research and EpidemiologyMedication Adherence and ComplianceHIV/AIDS Research and Interventions

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Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

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Munro, Salla A, Lewin, Simon A, Smith, Helen J, Engel, Mark E, Fretheim, Atle, Volmink, Jimmy·2007·PLoS Medicine
DOI 10.1371/journal.pmed.0040238PMC PMC1925126
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Abstract

BACKGROUND: Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence. METHODS AND FINDINGS: We searched 19 electronic databases (1966-February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms "Tuberculosis AND (adherence OR compliance OR concordance)". We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies. CONCLUSIONS: Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

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Crossref · 10.1371/journal.pmed.0040238

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Figure 1 Meta-ethnography Process
Figure 1 Meta-ethnography ProcessCC BY · PubMed Central
Figure 2 Search Process and Study Selection
Figure 2 Search Process and Study SelectionCC BY · PubMed Central
Figure 3 Model of Factors Affecting Adherence
Figure 3 Model of Factors Affecting AdherenceCC BY · PubMed Central

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Citations

Cites

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Metadata

Authors
Munro, S. A., Lewin, S. A., Smith, H. J., Engel, M. E., Fretheim, A., & Volmink, J.
Affiliations
  • South African Medical Research Council (ZA)
  • Liverpool School of Tropical Medicine (GB)
  • Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2007-07-24
Volume
4
Issue
7
Pages
e238
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.0040238
PMC
PMC1925126
OpenAlex
W2125168028
Cited by
1,080
References
76
Citations by year
2026: 53 · 2025: 59 · 2024: 62 · 2023: 63 · 2022: 59 · 2021: 77 · 2020: 75 · 2019: 63 · 2018: 65 · 2017: 56 · 2016: 75 · 2015: 66 · 2014: 64 · 2013: 63 · 2012: 53
FWCI
3.35
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
  • Research Explorer (The University of Manchester) (submittedVersion)
Funders
  • London School of Hygiene and Tropical Medicine
  • Medical Research Council
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
tuberculosis, medication adherence, barriers to adherence, facilitators of adherence, patient perspectives, caregivers, healthcare workers, financial burden of treatment, adverse effects, poverty, gender discrimination, social support, patient-centered interventions, HIV/AIDS
MeSH terms
Humans, Patient Compliance, Tuberculosis, Outcome Assessment, Health Care, Qualitative Research

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