Background
Methods
Data extraction
GRADE
Results
Results of the review process
Determinants of LTBI treatment initiation, adherence and completion
Determinant | Specification determinant (vs. reference group) | Number of articles | |||
---|---|---|---|---|---|
Positive association | Inverse association | ||||
P | R | P | R | ||
Determinants of LTBI treatment initiation | |||||
Age | Older age (vs. younger age) | – | 1 [49] | – | |
Gender | Men (vs. women) | – | 1 [26] | – | 1 [49] |
Sub-population within general population with LTBI | Refugee/immigrants (vs. born in country of study) | 1 [25] | 1 [26] | – | – |
Immigrants born in WHO category 3 or 5 country (vs. category 1 country)A | 1 [25] | – | – | – | |
HCW (vs. no HCW) | – | – | – | ||
Case contact (vs. no case contact) | 1 [24] | – | – | ||
Education | Lower education level (vs. n.r.) | 1 [24] | – | – | – |
Behaviour | Alcohol use reported at baseline (vs. no alcohol use reported) | – | – | – | 1 [49] |
Other | Continuity of primary care by consulting a regular physician (vs. n.r.) | 1 [24] | – | – | – |
Pregnant (vs. not pregnant) | – | – | – | 1 [47] | |
Prior incarceration (vs. n.r.) | 1 [24] | – | – | – | |
Fear of getting sick with TB without medicine (vs. no fear of getting sick) | 1 [24] | – | – | – | |
Previous BCG vaccination (vs. n.r.) | – | – | – | 1 [22] | |
Abnormal CXR findings consistent with previous TB (vs. n.r.) | – | 1 [22] | – | – | |
A non-employment reason for screening (vs. n.r.) | 1 [24] | – | – | – | |
Determinants of LTBI treatment adherence | |||||
Age | Older age (vs. younger age) | – | – | 1 [75] | – |
Ethnicity | BiculturalD (vs. Hispanic or non-Hispanic) | 1 [75] | – | – | |
Education | Higher grades in school (vs. lower grades) | 1 [75] | – | – | – |
Behaviour | Risk behaviours (vs. n.r.)E | – | – | – | |
Adverse events | Some somatic complaints (vs. n.r.) | – | – | 1 [76] | – |
Determinants of LTBI treatment completion | |||||
Age | Older (vs. younger) | ||||
Gender | Male (vs. female) | – | – | – | |
Ethnicity | Hispanic/Latino ethnicity (vs. Asian ethnicity) | – | – | 1 [78] | |
White Hispanic (vs. black, non-Hispanic) | – | – | – | ||
Country of birth (i.e. Haiti, Dominican Republic, China with HK or Vietnam) (vs. other countries) | Varying results found between countries [80] | ||||
Asian/Pacific Islander (vs. white) | – | – | – | ||
Region of origin (i.e. Latin America and Caribbean or Asia and other) (vs. USA, Canada, Europe) | – | 1 [41] | – | – | |
Black race (vs. n.r.) | – | – | – | 1 [29]G | |
Ethnicity (i.e. Asian, Non-Hispanic black or Hispanic (vs. non-Hispanic white) | 1 [31] | ||||
Sub-population within source population | HCW (vs. no HCW) | – | – | – | 1 [23] |
Case contact (vs. no case contact) | – | 1 [31] | – | 1 [29]F | |
Currently homeless (vs. not currently homeless) | – | – | – | ||
PWID (vs. no PWID) | – | – | – | ||
Refugees/immigrants (vs. born in country of study) | 1 [27] | ||||
Indication for LTBI treatment immunosuppression (vs. case contact) | 1 [43]C | – | – | – | |
Health | History of hepatitis A, B or C (vs. no history of liver disease) | 1 [77] | – | – | – |
Other medications reported at baseline (vs. none reported) | – | – | – | 1 [29]F | |
Use of concomitant medications by women (vs. no use of concomitant medication) | – | – | – | 1 [49] | |
Behaviour | (Excess) alcohol use (vs. no alcohol use) | – | – | – | |
Smoking (vs. non-smoking) | 1 [43]C | – | – | – | |
Treatment | Treatment without H (vs. treatment with H) | 1 [43]C | – | – | |
9-months H (vs. other regimens) | – | – | – | 1 [23] | |
Regimen choice offered (vs. no regimen choice offered) | – | 1 [79] | – | – | |
Twice weekly RZ (vs. daily RZ) | – | 1 [81] | – | – | |
DOT (vs. SAT) | – | – | – | ||
Adverse events | Adverse events (vs. no adverse events) | – | – | – | |
Adverse events (i.e. grade 1 or 2 hepatotoxicity, grade 3 or 4 hepatotoxicity or adverse events other than hepatotoxicity) (vs. n.r.) | Conflicting results found between adverse events [51] | ||||
Other | Not having been incarcerated within 6 months of diagnosis (vs. n.r.) | 1 [25] | – | – | – |
Referral reason (i.e. correctional/rehabilitation or postpartum women) (vs. TST positive from screening) | – | – | – | 1 [28] | |
Risk group (i.e. contact, medical riskH, population riskI) (vs. low riskJ) | – | 1 [31] | – | – | |
Cause of screening/referral (i.e. asylum seekers or contacts) (vs. anti-TNF-α candidates) | – | – | – | 1 [82] | |
Fear for venepuncture (vs. n.r.) | – | – | 1 [83] | – | |
Low TB risk perception (vs. n.r.) | – | – | 1 [83] | – | |
Plan to tell friends or family about LTBI diagnosis (vs. n.r.) | 1 [24] | – | – | – | |
Home situation (i.e. child living with no or one natural parent) (vs. living with both natural parents) | – | – | 1 [27] | – | |
Spanish language (vs. non-Spanish language) | – | 1 [60] | – | – | |
Resident in a congregate setting (vs. never or unknown) | – | – | – | 1 [23] | |
Missed appointment call or letter (vs. no missed appointment call) | – | – | – | 1 [60] | |
No medical insurance (vs. medical insurance) | – | – | – | 1 [47] | |
Clinic attendance before treatment (vs. clinic non-attendance before treatment) | – | 1 [79] | – | – | |
Presumed non-recent TB infection (vs. presumed recent TB infection) | – | – | – | 1 [34] | |
Public health nurse referral (vs. no public health nurse referral) | – | – | – | 1 [60] |
Interventions to improve LTBI treatment initiation, adherence and completion
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 | ||
Long LTBI treatment | ||||||||||||
Initiation | ||||||||||||
0 (0) | No evidence available | – | – | – | – | – | – | – | – | – | – | Critical |
Adherence | ||||||||||||
RCT | Case contacts | Seriousd | 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 | |
3HR or 2RZ vs. 6H or 9H | 353/431 = 82 % (range:7–86 %) | |||||||||||
Completion | ||||||||||||
1 (352) [21] | RCT | Case contacts | Seriouse | Not serious | Not serious | Not serious | None | 106/153 = 69 % | 0.8 (0.5–1.3) | −46 (−156-49) | ⊕ ⊕ ⊕O Moderate | Critical |
2RZ vs. 6H | 145/199 = 73 % | |||||||||||
1 (7731) [20] | RCT | Case contacts | Very seriousf | Not serious | Not serious | Not serious | None | 3273/3986 = 82 % | 2.1 (1.9–2.3) | 134 (119–146) | ⊕ ⊕ OO Low | Critical |
3H + RPT + DOT vs. 9H + SAT | 2585/3745 = 69 % | |||||||||||
1 (590) [38] | RCT | Immigrants | Seriousg | Not serious | Not serious | Not serious | None | 213/296 = 72 % | 2.5 (1.7–3.6) | 206 (125–273) | ⊕ ⊕ ⊕O Moderate | Critical |
3HR vs. 6H | 154/294 = 52 % | |||||||||||
RCT | General population | Serioush | 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 | |
2RZ or 4R vs. 6H or 9H | 459/767 = 60 % (range: 57–76 %) |
Quality assessment | n/N = % | Effect | Quality | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No of studies (No of participants) | Design | Population treatment intervention | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | DOT | OR (95 % CI) | Absolutea (per 1000 (95 % CI)) | ||
SAT | ||||||||||||
Initiation | ||||||||||||
0 (0) | No evidence available | – | – | – | – | – | – | – | – | – | – | Critical |
Adherence | ||||||||||||
0 (0) | No evidence available | – | – | – | – | – | – | – |
–
| – | – | Critical |
Completion | ||||||||||||
1 (199) [17] | RCT | PWIDb long H | Seriousc | Not serious | Not serious | Not serious | None | 79/99 = 80 % | 1.1 (0.5–2.1) | 15 (−137-98) | ⊕ ⊕ ⊕O Moderate | Critical |
Outreach DOT vs. SAT | 79/100 = 79 % | |||||||||||
1 (111) [16] | RCT | PWIDb long H | Very seriousd | Not serious | Not serious | Seriouse | None | 49/72 = 68 % | 14.5 (5.0–42) | 552 (296-732) | ⊕OOO Very low | Critical |
DOT + Methadone treatment vs. SAT + no incentivef | 5/39 = 13 % | |||||||||||
1 (7731) [20] | RCT | Case contacts | Very seriousg | Not serious | Not serious | Not serious | None | 3273/3986 = 82 % | 2.1 (1.9–2.3) | 134 (119–146) | ⊕ ⊕ OO Low | Critical |
DOT + 3H + RPT vs. SAT + long H | 2585/3745 = 69 % | |||||||||||
1 (135) [54] | RCT | Immigrants long H | Serioush | Not serious | Not serious | Seriouse | None | 6/82 = 7.3 % | 0.1 (0.04–0.3) | −342 (−239- -387) | ⊕ ⊕ OO Low | Critical |
Clinic-based DOTi vs. SAT dailyc | 22/53 = 41 % |
Quality assessment | n/N = % | Effect | Quality | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No of studies (No of participants) | Design | Population - treatment-intervention | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Incentives | OR (95 % CI) | Absolutea (per 1000 (95 % CI)) | ||
No incentives | ||||||||||||
Initiation | ||||||||||||
0 (0) | No evidence available | – | – | – | – | – | – | – | – | – | – | Critical |
Adherence | ||||||||||||
0 (0) | No evidence available |
–
| – | – | – | – | – | – | – | – | – | Critical |
Completion | ||||||||||||
1 (111) [16] | RCT | PWID - long Hb | Very seriousc | Not serious | Not serious | Seriousd | None | 49/72 = 68 % | 14.5 (5.0-42) | 552 (296-732) | ⊕OOO Very low | Critical |
Methadone treatment + DOT vs. no incentive + SATe | 5/39 = 13 % | |||||||||||
1 (108) [55] | RCT | PWID - long Hb | Not seriousf | Not serious | Not serious | Seriousd | None | 29/53 = 53 % | 32.0 (7.1–145)g | 511 (174–809) | ⊕ ⊕ ⊕O Moderate | Critical |
Monetary incentive vs. no incentive | 2/55 = 3.6 % | |||||||||||
1 (216) [15] | RCT | Inmatesh - long H | Not seriousi | Not serious | Not serious | Seriousd | None | 14/113 = 12 % | 1.1 (0.5–2.4)j | 7 (−58–124) | ⊕ ⊕ ⊕O Moderate | Critical |
Non-cashk incentive vs. no incentive | 12/103 = 12 % | |||||||||||
1 (119) [56] | RCT | Homeless - long H or short HR | Seriousl | Not serious | Not serious | Seriousd | None | 58/68 = 85 % | 1.7 (0.7–4.3) | 80 (−69–164) | ⊕ ⊕ OO Low | Critical |
Cash vs. non-cash incentivem | 44/57 = 77 % |
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 | ||||||||||||
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 % |
Quality assessment | n/N = % | Effect | Quality | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No of studies (No of participants) | Design | Population treatment interventiona | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Other intervention | OR (95 % CI) | Absolutea (per 1000 (95 % CI)) | ||
Usual care | ||||||||||||
Initiation | ||||||||||||
1 (107) [59] | Observational study | Healthcare workers H | Not seriousb | Not serious | Not serious | Seriousc | 32/62 = 52 % | 8.8 (3.1–23) | 413 (168–631) | ⊕OOO Very low | Critical | |
Use of IGRAs | 5/45 = 11 % | |||||||||||
Adherence | ||||||||||||
0 (0) | No evidence available | – | – | – | – | – | – | – |
–
| – | – | Critical |
Completion | ||||||||||||
0 (0) | No evidence available | – | – | – | – | – | – | – | – | – | – | Critical |