Title : Examining Interventions that Aim to Enhance TB Treatment Adherence in Southeast Asia

Abstract:

Background: 
Adherence is often a barrier to curative treatment of Mycobacterium tuberculosis (TB). There have been numerous interventions focused on increasing TB treatment adherence in Southeast Asia, but it is unclear if they are effective. This systematic review and meta-analysis aimed to compile and evaluate the literature on interventions designed to increase TB treatment adherence in Southeast Asia.  

Methods:
We searched Cochrane Library Reviews (CDSR) and Cochrane Library Trials (CENTRAL), Medline, CINAHL, Scopus, and Web of Science from 2000 to 2022 with no language restrictions. We included studies of any design conducted in Southeast Asia that implemented interventions to increase treatment completion in people diagnosed with TB and assessed completion as an outcome. We did not require a control group. Four investigators used a standardized data collection form to collate results. The heterogeneity across studies was explored by I² statistics. We assessed bias using the Newcastle-Ottawa Scale and Cochrane ROB 2.0. We used a random effects meta-analysis to calculate a pooled risk ratio with 95% confidence intervals. 

Results:
From 1,881 abstracts, we included 14 articles. There were 7,198 subjects with 3,163 (44%) receiving a TB treatment adherence intervention across eight countries. Interventions included directly observed therapy, text-message reminders, food incentives, and more. The risk ratio, derived from the meta-analysis of eight included studies with a control group and 6,618 participants overall, was 1.04 (95% CI 1.01,1.08; I² = 29%), favoring the interventions over controls with little concern for heterogeneity or risk of bias. When narratively assessed, the other six studies all reported increased adherence in the intervention group. 

Discussion:
The results suggested there is a small, statistically significant benefit of using interventions to promote TB treatment completion. Future research could look at additional strategies and combinations of strategies to promote adherence.

What will audience learn from your presentation?

• If TB treatment adherence programs are effective in Southeast Asia
• This presentation will present an overview of what interventions have been tried to increase TB treatment adherence in Southeast Asia
• This could lead to additional randomized controls trial testing TB treatment adherence programs so that money is allocated effectively
• Ideally this presentations will provide insight into specific barriers faced by TB patients in Southeast Asia
• This presentation can assist in designing new TB treatment program.

Biography:

Rebekah A. Davis, MPH received a degree in Finance from Northeastern University in Boston, MA. She then went on to study public health at The Dartmouth Institute for Health Policy and Clinical Practice. She currently is a medical student and hopes to combine clinical work with non-profit leadership upon completion of her training. Her passions include environmental disparities, global health and behavioural economics. In her spare time, she loves hiking, biking, and spending time with her dog Winter.