Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review

Stuurman, Anke L.; Vonk Noordegraaf-Schouten, Marije; van Kessel, Femke; Oordt-Speets, Anouk M.; Sandgren, Andreas; van der Werf, Marieke J.

doi:10.1186/s12879-016-1549-4

BMC Infectious Diseases

Table 2 Grading of the body of evidence for effectiveness of short versus long LTBI treatment. Question: Does short LTBI treatment result in higher initiation, adherence, or completion rates than long LTBI treatment in individuals eligible for LTBI treatment?

From: Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review

			Quality assessment					n/N = %^a	Effect		Quality	Importance
No of studies (No of participants)	Design	Population Intervention	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Short LTBI treatment	OR (95 % CI)^b	Absolute (per 1000 (95 % CI))^c
No of studies (No of participants)	Design	Population Intervention	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Long LTBI treatment	OR (95 % CI)^b	Absolute (per 1000 (95 % CI))^c
Initiation
0 (0)	No evidence available	–	–	–	–	–	–	–	–	–	–	Critical
Adherence
2 (822) [21, 50]	RCT	Case contacts	Serious^d	Not serious	Not serious	Not serious	None	344/391 = 88 % (range: 82–92 %)	1.5 (1.0–2.3)	55 (4–92)	⊕ ⊕ ⊕O Moderate	Critical
2 (822) [21, 50]	RCT	3HR or 2RZ vs. 6H or 9H	Serious^d	Not serious	Not serious	Not serious	None	353/431 = 82 % (range:7–86 %)	1.5 (1.0–2.3)	55 (4–92)	⊕ ⊕ ⊕O Moderate	Critical
Completion
1 (352) [21]	RCT	Case contacts	Serious^e	Not serious	Not serious	Not serious	None	106/153 = 69 %	0.8 (0.5–1.3)	−46 (−156-49)	⊕ ⊕ ⊕O Moderate	Critical
1 (352) [21]	RCT	2RZ vs. 6H	Serious^e	Not serious	Not serious	Not serious	None	145/199 = 73 %	0.8 (0.5–1.3)	−46 (−156-49)	⊕ ⊕ ⊕O Moderate	Critical
1 (7731) [20]	RCT	Case contacts	Very serious^f	Not serious	Not serious	Not serious	None	3273/3986 = 82 %	2.1 (1.9–2.3)	134 (119–146)	⊕ ⊕ OO Low	Critical
1 (7731) [20]	RCT	3H + RPT + DOT vs. 9H + SAT	Very serious^f	Not serious	Not serious	Not serious	None	2585/3745 = 69 %	2.1 (1.9–2.3)	134 (119–146)	⊕ ⊕ OO Low	Critical
1 (590) [38]	RCT	Immigrants	Serious^g	Not serious	Not serious	Not serious	None	213/296 = 72 %	2.5 (1.7–3.6)	206 (125–273)	⊕ ⊕ ⊕O Moderate	Critical
1 (590) [38]	RCT	3HR vs. 6H	Serious^g	Not serious	Not serious	Not serious	None	154/294 = 52 %	2.5 (1.7–3.6)	206 (125–273)	⊕ ⊕ ⊕O Moderate	Critical
3 (1552) [51–53]	RCT	General population	Serious^h	Not serious	Not serious	Not serious	None	568/785 = 72 % (range: 61–91 %)	1.9 (1.1–3.5)	141 (23–241)	⊕ ⊕ ⊕O Moderate	Critical
3 (1552) [51–53]	RCT	2RZ or 4R vs. 6H or 9H	Serious^h	Not serious	Not serious	Not serious	None	459/767 = 60 % (range: 57–76 %)	1.9 (1.1–3.5)	141 (23–241)	⊕ ⊕ ⊕O Moderate	Critical

Bibliography: Spyridis et al. 2007 [50]; Tortajada et al. 2005 [21]; Sterling et al. 2011 [20]; Jimenez-Fuentes et al. 2013 [38]; Menzies et al. 2008 [53]; Menzies et al. 2004 [52]; Jasmer et al. 2002 [51]
n/N No of individuals with LTBI who initiated, or adhered to or completed treatment/total number of subjects; CI confidence interval; DOT directly observed therapy; 3H, 6H, 9H 3, 6 or 9 months isoniazid; 3HR 3 months isoniazid + rifampicin; OR odds ratio; 4R four months rifampin; RCT randomised controlled trial; RPT rifapentine; 2RZ 2 months rifampicin + pyrazinamide; SAT self-administered therapy
^aIf >1 articles, weighed pooled point estimates and 95 % CI were calculated
^bIf >1 articles, weighed pooled estimates and 95 % CI were calculated using a random effects model (without quality index)
^cCalculated via GradePro
^dSpyridis et al. 2007 [50]: no blinding. Tortajada et al. 2005 [21]: no blinding; use of unvalidated patient-reported outcomes (pill count and calendar annotations); early termination (due to higher toxicity in 2RZ arm, unplanned interim analysis); dissimilarities between treatment arms (more foreign-born in 2RZ); unequal number of patients in the two groups
^eTortajada et al. 2005 [21]: no blinding; use of unvalidated patient-reported outcomes (pill count and calendar annotations); early termination (due to higher toxicity in 2RZ arm, unplanned interim analysis); dissimilarities in treatment groups (more foreign-born in 2RZ); unequal number of patients in the two groups
^fSterling et al. 2011 [20]: unclear allocation concealment; no blinding; use of unvalidated patient-reported outcomes (pill count and self-report); dissimilarities between treatment arms (with respect to North American Indians, subjects enrolled in a cluster, homelessness); exposure bias (DOT only in short treatment arm)
^gJimenez-Fuentes et al. 2013 [38]: unclear allocation concealment; no blinding; dissimilarities between treatment arms (with respect to sex and undocumented migration status)
^hMenzies et al. 2004 [52]: unclear allocation concealment; no blinding. Menzies et al. 2008 [53]: unclear allocation concealment; no blinding; early termination (due to lower toxicity in 4R arm, planned interim analysis). Jasmer et al. 2002 [51]: lack of allocation concealment (alternate weeks); inadequate sequence generation (alternate weeks); no blinding; unclear treatment adherence assessment; dissimilarities between treatment arms (born outside United States, age >35 years)

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ISSN: 1471-2334

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