Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review

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.