Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: a scoping review

A S K Jones, N Bidad, R Horne, H R Stagg, F B Wurie, K Kielmann, A S Karat, H Kunst, C N J Campbell, M Darvell, A L Clarke, M C I Lipman

Research output: Contribution to journalA1: Web of Science-articlepeer-review


BACKGROUND: Improving adherence to anti-TB treatment is a public health priority in high-income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings.METHODS: Key terms related to TB, treatment and adherence were used to search MEDLINE, EMBASE, Web of Science, PsycINFO and CINAHL in June 2019. Quantitative studies examining determinants (demographic, clinical, health systems or psychosocial) of non-adherence to anti-TB treatment in HILI settings were included.RESULTS: From 10,801 results, we identified 24 relevant studies from 10 countries. Definitions and methods of assessing adherence were highly variable, as were documented levels of non-adherence (0.9-89%). Demographic factors were assessed in all studies and clinical factors were frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, incarceration, and alcohol or drug misuse. Health system (8/24) and psychosocial factors (6/24) were less commonly evaluated.CONCLUSION: Our review identified some key factors associated with non-adherence to anti-TB treatment in HILI settings. Modifiable determinants such as psychosocial factors are under-evidenced and should be further explored, as these may be better targeted by adherence support. There is an urgent need to standardise definitions and measurement of adherence to more accurately identify the strongest determinants.

Original languageEnglish
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number6
Pages (from-to)483-490
Number of pages8
Publication statusPublished - 2021
Externally publishedYes


  • Homeless Persons
  • Humans
  • Incidence
  • Income
  • Public Health


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