Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: a scoping review

A. S.K. Jones, N. Bidad, R. Horne, Helen Stagg, F. B. Wurie, K. Kielmann, A. S. Karat, H. Kunst, Colin Campbell, M. Darvell, A. L. Clarke, M. C.I. Lipman*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


B A C K G R O U N D: Improving adherence to anti-TB treatment is a public health priority in high-income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings. M E T H O D S: Key terms related to TB, treatment and adherence were used to search MEDLINE, EMBASE, Web of Science, PsycINFO and CINAHL in June 2019. Quantitative studies examining determinants (demographic, clinical, health systems or psychosocial) of non-adherence to anti-TB treatment in HILI settings were included. R E S U L T S: From 10,801 results, we identified 24 relevant studies from 10 countries. Definitions and methods of assessing adherence were highly variable, as were documented levels of non-adherence (0.9–89%). Demographic factors were assessed in all studies and clinical factors were frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, incarceration, and alcohol or drug misuse. Health system (8/24) and psychosocial factors (6/24) were less commonly evaluated. C O N C L U S I O N: Our review identified some key factors associated with non-adherence to anti-TB treatment in HILI settings. Modifiable determinants such as psychosocial factors are under-evidenced and should be further explored, as these may be better targeted by adherence support. There is an urgent need to standardise definitions and measurement of adherence to more accurately identify the strongest determinants.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number6
Publication statusPublished - 1 Jun 2021

Bibliographical note

Funding Information:
This work was supported by the National Institute for Health Research (NIHR; London, UK) Health Technology Assessment Programme (UK grant number 16/88/06). The views expressed are those of the authors and not necessarily those of the National Health Service, UK, the NIHR or the Department of Health and Social Care. HRS is funded by the Medical Research Council (MRC; London, UK) (MR/R008345/1).

Funding Information:
Conflict of interests: ASK reports grants from the National Institute for Health Research (London, UK), during the conduct of the study; personal fees from The Aurum Institute (Johannesburg, South Africa), The Center for Health Policies and Studies (Chisinau, Republic of Moldova), Edanz Group (Fukuoka, Japan), Vital Strategies (Singapore), University of Cape Town (Cape Town, South Africa), the Bill & Melinda Gates Foundation (Seattle, WA, USA) and Bloomberg Philanthropies (New York, NY, USA) outside the submitted work; non-financial support from Kyoto University (Kyoto, Japan) and the Africa Health Research Institute (Durban, South Africa) outside the submitted work. CNJC reports personal fees from Public Health England (PHE; London, UK) outside the submitted work. HRS reports grants from Medical Research Council (London, UK) and the NIHR during the conduct of the study; from Korean CDC (Seoul, Korea) and Johnson and Johnson (New Brunswick, NJ, USA) and other from Latvian Society Against Tuberculosis (Riga, Latvia) outside the submitted work; and HRS is a core group member of the World Health Organization’s European Tuberculosis Research Initiative and co-chair of UK Academics and Professionals Against Tuberculosis. KK, MCIL, and MD report grants from the NIHR during the conduct of the study. RH is supported by the NIHR (Collaboration for Leadership in Applied Health Research and Care, North Thames at Bart’s Health NHS Trust and Asthma UK (AUKCAR). Speaker engagements with honoraria with the following companies: Abbvie (North Chicago, IL, USA), Amgen (Thousand Oaks, CA, USA), Astellas (Chuo City, Tokyo, Japan), AstraZeneca (Cambridge UK), Biogen (Cambridge, MA, USA), Erasmus (Rotterdam, The Netherlands), Idec (Osaka, Japan), Gilead Sciences (Foster City, CA, USA), GlaxoSmithKline (Brentford, UK), Janssen (Beerse, Belgium), Merck Sharp Dohme (Kenilworth, NJ, USA), Novartis (Basel, Switzerland), Pfizer (New York, NY, USA), Roche (Basel, Switzerland), Shire Pharmaceuticals (Lexington, MA, USA) and TEVA (Petah Tikva, Israel). RH is founding director of a University College London-Business spin-out company (Spoonful of Sugar Ltd, London, UK) providing consultancy on treatment engagement and patient support programmes to healthcare policy makers, providers, and industry. FBW is an employee of PHE. All other authors declare no conflicts of interest.

Publisher Copyright:
Q 2021 The Union


  • Adherence
  • Determinants
  • K E Y W O R D S: tuberculosis
  • Treatment


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