The Effects of Psycho-Emotional and Socio-Economic Support for Tuberculosis Patients on Treatment Adherence and Treatment Outcomes – A Systematic Review and Meta-Analysis

BACKGROUND: There is uncertainty about the contribution that social support interventions (SSI) can have in mitigating the personal, social and economic costs of tuberculosis (TB) treatment on patients, and improving treatment outcomes. OBJECTIVE: To identify psycho-emotional (PE) and socio-economic (SE) interventions provided to TB patients and to assess the effects of these interventions on treatment adherence and treatment outcomes. SEARCH STRATEGY: We searched PubMed and Embase from 1 January 1990–15 March 2015 and abstracts of the Union World Conference on Lung Health from 2010–2014 for studies reporting TB treatment adherence and treatment outcomes following SSI. SELECTION CRITERIA: Studies measuring the effects of PE or SE interventions on TB treatment adherence, treatment outcomes, and/or financial burden. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed titles and abstracts for inclusion of articles. One reviewer reviewed full text articles and the reference list of selected studies. A second reviewer double checked all extracted information against the articles. MAIN RESULTS: Twenty-five studies were included in the qualitative analysis; of which eighteen were included in the meta-analysis. Effects were pooled from 11 Randomized Controlled Trials (RCTs), including 9,655 participants with active TB. Meta-analysis showed that PE support (RR 1.37; CI 1.08–1.73), SE support (RR 1.08; CI 1.03–1.13) and combined PE and SE support (RR 1.17; CI 1.12–1.22) were associated with a significant improvement of successful treatment outcomes. Also PE support, SE support and a combination of these types of support were associated with reductions in unsuccessful treatment outcomes (PE: RR 0.46; CI 0.22–0.96, SE: RR 0.78; CI 0.69–0.88 and Combined PE and SE: RR 0.42; CI 0.23–0.75). Evidence on the effect of PE and SE interventions on treatment adherence were not meta-analysed because the interventions were too heterogeneous to pool. No evidence was found to show whether SE reduced the financial burden for TB patients. DISCUSSION AND CONCLUSIONS: Our review and meta-analysis concluded that PE and SE interventions are associated with beneficial effects on TB treatment outcomes. However, the quality of evidence is very low and future well-designed evaluation studies are needed.