Patient involvement in decision making improves adherence to tuberculosis treatments

Tuberculosis (TB) is a major killer, causing up to two million deaths worldwide every year.

Treatment takes many months and many patients fail to complete the course of drugs prescribed. Now a study published in PLoS Medicine casts new light on the difficulties patients face in trying to stick to the treatment they are given.

Salla Munro of the South African Medical Research Council, with colleagues in South Africa, Norway and the UK, conducted a systematic review of research into adherence to TB treatment that has been carried out using sualitative methods. In other words, they searched the medical literature for studies where patients and their families had been asked to say how they felt about their treatment. (This is different from suantitative research where numbers are collected, rather than recording what patients actually say.)

The researchers found 44 qualitative studies on TB treatment that met their prespecified criteria. From a careful appraisal of these studies they were able to classify the major factors associated with difficulties in completing treatment. They conclude that adherence to treatment is influenced by: structural factors (including poverty and gender discrimination), social context factors, health service factors and personal factors (including attitudes towards treatment and illness).

From this research, it is clear that patients often take their TB medications under very difficult conditions and that they cannot control many of the factors that prevent them from taking their drugs. So, although current efforts to improve adherence to tuberculosis treatments emphasize instilling into patients a willingness to take their medications, this new study suggests that more must be done to address how factors such as poverty and gender affect treatment adherence and to tailor support systems to patients needs.

Most importantly, it indicates that future interventions should involve patients far more in the decisions made about their treatment. As Salla Munro of the Medical Research Council notes: "Adherence to treatment is a complex phenomenon. We need more patient-centred interventions, and more attention to structural barriers, to improve treatment adherence and reduce the global disease burden of tuberculosis."