Non-adherence to tuberculosis treatment can lead to prolonged periods
of infectiousness, relapse, emergence of drug-resistance, and increased
morbidity and mortality. In this review, we assess whether patient
education or counselling, or both, promotes adherence to tuberculosis
To evaluate the effects of patient education or counselling, or both,
on treatment completion and cure in people requiring treatment for
active or latent tuberculosis.
Without language restriction, we searched for eligible studies in the
Cochrane Infectious Diseases Group Specialized Register, Cochrane
Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS;
checked reference lists of relevant articles; and contacted relevant
researchers and organizations up to 24 November 2011.
Randomized controlled trials examining the effects of education or
counselling, or both, on treatment completion and cure in people with
clinical tuberculosis; and treatment completion and clinical
tuberculosis in people with latent disease.
Data collection and analysis
We independently screened identified studies for eligibility, assessed
methodological quality, and extracted data; with differences resolved by
consensus. We expressed study results as risk ratios (RRs) with 95%
confidence intervals (CI).
We found three trials, with a total of 1437 participants, which
examined the effects of different educational and counselling
interventions on adherence to treatment for latent tuberculosis.
All three trials reported the proportion of people who successfully
completed treatment for latent tuberculosis. Overall, education or
counselling interventions may increase successful treatment completion
but the magnitude of benefit is likely to vary depending on the nature
of the intervention, and the setting (data not pooled, 923 participants,
three trials, low quality evidence).
In a four-arm trial in children from Spain, counselling by nurses via
telephone increased the proportion of children completing treatment from
65% to 94% (RR 1.44, 95% CI 1.21 to 1.72; 157 participants, one trial),
and counselling by nurses through home visits increased completion to
95% (RR 1.46, 95% CI 1.23 to 1.74; 156 participants, one trial). Both of
these interventions were superior to counselling by physicians at the
tuberculosis clinic (RR 1.20, 95% CI 0.98 to 1.47; 159 participants, one
In the USA, a programme of peer counselling for adolescents failed to
show an effect on treatment completion rates at six months (RR 1.01, 95%
CI 0.90 to 1.13; 394 participants, one trial). In this trial treatment
completion was around 75% even in the control group.
In the third study, in prisoners from the USA, treatment completion was
very low in the control group (12%), and although counselling
significantly improved this, completion in the intervention group
remained low at 24% (RR 1.94, 95% CI 1.03 to 3.68; 211 participants, one
None of these trials aimed to assess the effect of these interventions
on the subsequent development of active tuberculosis, and we found no
trials that assessed the effects of patient education or counselling on
adherence to treatment for active tuberculosis.
Educational or counselling interventions may improve completion of
treatment for latent tuberculosis. As would be expected, the magnitude
of the benefit is likely to depend on the nature of the intervention,
and the reasons for low completion rates in the specific setting.
Plain Language Summary: Counselling and education interventions for
promoting adherence to treatment for tuberculosis.
Many people do not take their medication as prescribed. The consequences
of this for chronic and debilitating infections like tuberculosis are
serious and can include prolonged periods of infectiousness, relapse,
emergence of drug-resistant Mycobacterium tuberculosis isolates, and
increased morbidity and mortality. Our review considered trials of
education and counselling in promoting adherence to the treatment of
both latent (dormant) and active tuberculosis.
We identified three very low quality evidence trials involving a total
of 1437 participants that evaluated education and counselling
interventions in promoting adherence to completion of medication for
treatment of latent tuberculosis. Two of these studies demonstrated a
beneficial effect of education and counselling upon adherence to drug
treatment, whereas one did not.
There were substantial differences between trials with respect to
populations targeted, interventions chosen and outcomes measured. The
existing evidence is insufficient to guide policy on the use of
education and counselling to promote adherence to tuberculosis therapy.
M’Imunya, J.M.; Kredo, T.; Volmink, J. Patient education and counselling for promoting adherence to treatment for tuberculosis. Cochrane Database of Systematic Reviews (2012) (Issue 5) Art. No.: CD006591. [DOI: 10.1002/14651858.CD006591.pub2]
Patient education and counselling for promoting adherence to treatment for tuberculosis