Psychosocial interventions to improve tuberculosis preventive treatment uptake and psychosocial outcomes: a systematic review.

Abstract

Despite its importance in global TB elimination, tuberculosis preventive treatment (TPT) remains underutilized. Psychosocial barriers significantly contribute to this issue. This systematic review aims primarily to synthesize psychosocial interventions to improve the initiation of TPT. We analyzed psychosocial outcomes as secondary objectives when relevant data were available. This review included studies indexed in PubMed, Scopus, and PsycInfo until August 25, 2025. Original studies addressing psychosocial interventions for people with latent tuberculosis infection (LTBI) indicated for TPT were included in this review. The risk of bias was assessed via the Crowe Critical Appraisal Tool (CCAT). A narrative synthesis summarized the characteristics of interventions, including the format of delivery, settings, intervention providers, psychosocial content, duration, and outcomes. Among the 1725 identified studies, nine (14,428 participants) met the inclusion criteria. The CCAT classification was moderate to high quality, with strengths in clearly articulated study rationales but weaknesses in study design. Most studies were from upper-middle-income countries with a high burden of TB; none were from Asia. Health education is a core component, often incorporating culturally adapted survivor testimonials to reduce stigma and increase motivation. Interventions were mostly community-based and led by multidisciplinary healthcare professionals and community workers. TPT initiation improved in all included studies, with risk differences ranging from 10-52%. This review emphasizes the potential of psychosocial interventions in supporting behavior change and increasing TPT initiation. Methodological limitations and a lack of research in high-burden Asian contexts restrict the current evidence. Future studies should focus on developing rigorous, contextually appropriate strategies for scalable psychosocial interventions that are effective and sustainable.