Tuberculosis (HIV-negative people): improving adherence.

Abstract

Introduction: About one third of the world's population has immunological evidence of previous exposure to Mycobacterium tuberculosis. In 2013, an estimated 9.0 million people developed tuberculosis (TB) and 1.5 million died from the disease.

Methods and outcomes: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of directly observed treatment (DOT) versus self-administered treatment (SAT) in people with tuberculosis without HIV infection? What are the effects of support mechanisms for DOT in people with tuberculosis without HIV infection? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

Results: At this update, searching of electronic databases retrieved 189 studies. After deduplication and removal of conference abstracts, 104 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 86 studies and the further review of 18 full publications. Of the 18 full articles evaluated, three systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for 12 PICO combinations.

Conclusions: In this systematic overview, we categorised the efficacy for 13 interventions based on information relating to the effectiveness and safety of directly observed treatment and support mechanisms for directly observed treatment.