Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: A mixed method systematic review

BACKGROUND: Adherence to tuberculosis (TB) treatment is essential in improving treatment outcomes and reducing TB-related mortality. People living with HIV (PLWH) are at a higher risk of developing and dying from TB. This systematic review aims to identify barriers and enablers affecting TB treatment adherence among people with HIV/TB coinfection. METHODS: A systematic search of the literature was carried out in January 2023 across four databases including MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews. The search strategy incorporated both subject keywords and MeSH terms related to “tuberculosis” AND “HIV” AND “adherence” AND “barriers” OR “enablers” and relevant synonyms, limited to English language publications from 2010 onwards. An integrative method was used to synthesise the data obtained from selected studies. Identified factors were categorized using a modified World Health Organization (WHO) framework for treatment adherence. RESULTS: Of the 3,216 studies yielded by the search, 21 studies met the inclusion criteria and were included in the final analysis. Reported barriers to adherence included male gender, presence of comorbidities, advanced HIV/TB disease, alcohol consumption, tobacco use, low socioeconomic status, limited knowledge of TB, stigma, negative interactions with healthcare services, and systemic deficiencies in healthcare delivery. In contrast, enablers of adherence included being married, educational achievement, employment, social support, nutritional support, SMS reminders, adequate disease knowledge, concurrent antiretroviral therapy (ART), and positive relationships with healthcare providers. The influence of factors such as age, family size, partner’s HIV status, and partner’s ART status on adherence remained inconclusive. CONCLUSION: Adherence to TB treatment among individuals with HIV/TB coinfection is significantly influenced by social determinants, including educational level, socioeconomic status, and the quality of healthcare service delivery. Targeted interventions addressing these determinants may enhance treatment adherence and improve treatment outcomes

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Employment
  • Food security
  • Income
  • Health services
  • Stigma/discrimination
  • Other
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Substance Use
  • Alcohol
  • Tobacco
• Co-infections
  • Tuberculosis
• Health Systems
  • Governance arrangements
  • Delivery arrangements