Effects of Communication Strategies on Treatment Adherence and Success in Tuberculosis: A Systematic Review and Meta-Analysis.

Abstract

Introduction: Tuberculosis, although curable, presents challenges related to treatment adherence, which compromises treatment effectiveness. Individual, social and structural barriers interfere with patients' ability to properly follow the therapeutic regimen, thereby impacting treatment outcomes. Given the limitations of the conventional healthcare model, which relies primarily on in-person consultations and standard treatment protocols without additional adherence support technologies, new approaches have been explored to improve patient outcomes. This study seeks to identify effective communication approaches in this context.

Objective: To identify the most effective communication strategies to optimise treatment adherence and improve therapeutic success in patients diagnosed with tuberculosis.

Methods: A systematic review with meta-analysis was conducted. We included studies available in the MEDLINE (via PubMed), EMBASE and SCOPUS databases, with publication dates between January 2005 and December 2024. The primary outcomes were adherence to and success in tuberculosis treatment.

Results: This systematic review included 17 studies on tuberculosis treatment adherence. Of these, 12 were included in the meta-analysis for adherence and 8 for treatment success. The most effective strategies for adherence were community education (2 studies; RR: 0.25, 95% CI: 0.11-0.56) and video observed therapy (VDOT) (2 studies; RR: 0.29, 95% CI: 0.21-0.40). The combination of electronic devices with SMS also showed positive results (3 studies; RR: 0.53, 95% CI: 0.37-0.77). SMS alone (5 studies) and electronic devices alone (3 studies) were not effective. For treatment success, only the combination of electronic devices with SMS (RR: 0.31, 95% CI: 0.17-0.55) and community education (RR: 0.51, 95% CI: 0.40-0.64) were effective.

Conclusion: The combination of electronic devices with SMS and community education is an effective strategy for improving adherence and therapeutic success in tuberculosis treatment. Isolated interventions with SMS or electronic technologies did not show significant results. Adapting approaches to local realities is crucial for optimising outcomes.