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Table 5 Grading of body of evidence for the effectiveness of social interventions. Question: Do social interventions result in higher initiation, adherence, or completion rates than usual care 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 interventionb Risk of bias Inconsistency Indirectness Imprecision Other considerations Social intervention OR (95 % CI)c Absoluted (per 1000 (95 % CI))
No social intervention
Initiation
1 (946) [18] Observational study Immigrants Not seriouse Not serious Not serious Not serious None 389/442 = 88 % 2.7 (1.9–3.8) 149 (107–181)  OO Low Critical
Cultural case management 557/762 = 73 %
Adherence
         N Cumulative mean number of pills taken over 9 months f    
1 (286) [19] RCT General population Not seriousg Not serious Not serious Serioush None 92 180  OO Low Critical
Adherence coaching 98 151
1 (184) [57] Observational study Immigrants Not seriousi Not serious Not serious Serious None 53 157 OOO Very low Critical
Cultural intervention 131 129
Completion
3 (928) [19, 27, 58] RCT General population Not seriousj Not serious Not serious Not serious None 331/515 = 64 % (range: 46–84 %) 1.4 (1.1–1.9) 78 (53–80) O High Critical
Counsellor/contingency contracting & adherence coaching/self-esteem counselling & peer based 253/413 = 61 % (range: 38–76 %)
1 (946) [18] Observational study Immigrants Not seriouse Not serious Not serious Not serious None 319/389 = 82 % 7.8 (5.7–10.7) 452 (400–494)  OO Low Critical
Case management taking into account cultural background 205/557 = 37 %
1 (216) [15] RCT Inmatesk Not seriousl Not serious Not serious Seriousm None 24/106 = 23 % 2.2 (1.0–4.7)n 108 (4–267)  O Moderate Critical
Education 12/103 = 12 %
1 (520) [35] RCT Homeless Not seriouso Not serious Not serious Not serious None 173/279 = 62 % 3.0 (2.2–4.2)p 268 (189–339)  High Critical
Nurse case management 94/241 = 39 %
1 (199) [17] RCT PWID Not seriousq Not serious Not serious Not serious None 79/101 = 78 % 1.0 (0.7–1.5) 2 (−75-62)  High Critical
Peer support vs. no peer support 79/100 = 79 %
  1. Bibliography: Goldberg et al. 2004 [18]; Hovell et al. 2003 [19]; Ailinger et al. 2010 [57]; Kominski et al. 2007 [27]; Hirsch-Moverman et al. 2013 [58]; White et al. 2002 [15]; Nyamathi et al. 2006 [35]; Chaisson et al. 2001 [17]
  2. n/N: No of individuals with LTBI who initiated, or adhered to or completed treatment/total number of subjects. CI: confidence interval; H: isoniazid; OR: odds ratio; RCT: randomized controlled trial
  3. aIf >1 articles, weighed pooled point estimates and 95 % CI were calculated
  4. bAll groups H > 4 months
  5. cIf >1 articles, pooled estimates and 95%CI were calculated using a random effects model (without quality index)
  6. dCalculated via GradePro
  7. eGoldberg et al. 2004 [18]: use of unvalidated patient-reported outcomes (self-report); proportion of children aged 5-14 years was higher during one period than the other (19 % vs. 13 %, p = 0.003)
  8. fNo adherence rates were provided as outcome; instead, the cumulative mean number of pills taken per group was presented
  9. gHovell et al. 2003 [19]: unclear allocation concealment; unclear sequence generation; partly blinded. Not downgraded for these risk of bias aspects because already downgraded for imprecision
  10. hTotal sample size <230
  11. iAilinger et al. 2010 [57]: use of unvalidated patient-reported outcomes (self-report) convenience sample
  12. jHovell et al. 2003 [19]: unclear allocation concealment; unclear sequence generation; partly blinded. Kominski et al. 2007: unclear allocation concealment; no blinding; unclear if intention-to-treat analysis was performed; use of unvalidated patient-reported outcomes (self-report). Hirsch-Moverman et al. 2013: unclear allocation concealment; unclear sequence generation; partly blinded; use of unvalidated patient-reported outcomes (self-report)
  13. kInmates who started treatment in jail and were released before treatment completion
  14. lWhite et al. 2002 [15]: partly blinded
  15. mTotal number of events <125
  16. nAdjusted OR, not reported which factors this OR was adjusted for
  17. oNyamathi et al. 2006 [35]: unclear allocation concealment; unclear sequence generation; partly blinded; dissimilarities between treatment arms (daily alcohol or drug use [significantly associated with non-completion in this study]; male, recruitment site [both not significantly associated with completion in this study], lifetime intravenous drug use, recent self-help program)
  18. pAdjusted OR, adjusted for: age, sex, high-school graduate, never married, medical insurance, recruited from homeless shelter, years homeless, treatment completion important, intended to adhere, daily alcohol/drug use, recent self-help program, emotional well-being, social support, recent hospitalization, recent victimization
  19. qChaisson et al. 2001 [17]: unclear allocation concealment; no blinding; use of unvalidated patient-reported outcomes (self-report; urine tests and MEMS in a subset of patients in this study show that self-report is subject to serious under-reporting)