INT J TUBERC LUNG DIS 23(6):741–749

Q 2019 The Union

http://dx.doi.org/10.5588/ijtld.18.0672

Prevalence of tuberculosis treatment non-adherence in Ethiopia:

a systematic review and meta-analysis

H. H. Tola,*† K. Holakouie-Naieni,* E. Tesfaye,† M. A. Mansournia,* M. Yaseri*

*Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences
International Campus, Tehran, Iran; †Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, Addis
Ababa, Ethiopia

SUMMARY

S E T T I N G : Non-adherence to treatment is one of the
challenges facing global tuberculosis (TB) control. In
Ethiopia, an extremely variable and high magnitude of
TB treatment non-adherence have been reported from
different parts of the country. However, there has been
no attempt to estimate the pooled prevalence of non-
adherence from this heterogeneous data.
O B J E C T I V E : To review the available literature and
estimate the overall prevalence of treatment non-
adherence among patients with TB on first-line treat-
ment in Ethiopia.
D E S I G N : A systematic review and meta-analysis of
published articles on TB treatment non-adherence.
R E S U LT S : We included 26 studies, which contained
data on 37 381 patients with TB. The crude prevalence
of non-adherence reported by the studies included was
extremely variable (range 0.2–35%). The overall pooled
estimate of non-adherence prevalence was 10.0%
(95%CI 8.0–11.0). The pooled prevalence of patients
lost to follow-up alone was 5.0% (95%CI 4.0–6.0),
while the pooled prevalence of intermittent non-adher-
ence was 20.0% (95%CI 15.0–25.0).
C O N C L U S I O N : The rate of TB treatment non-adher-
ence in Ethiopia remains too high to achieve target
treatment success rates and prevent drug resistance.
Implementing an effective patient retention scheme,
along with the DOTS strategy, is critical to improving
treatment adherence and preventing drug resistance.
K E Y W O R D S : intermittent treatment non-adherence;
lost to follow-up; TB

THE WHO DEFINES ‘treatment adherence’ as the
extent to which a person’s behaviour in taking
medication, following a diet and/or executing lifestyle
changes corresponds with agreed recommendations
from a health care provider.1 Treatment adherence is
considered to be one of the most important elements
of chronic disease control programmes, as it is vital in
ensuring complete cure and preventing the develop-
ment of drug resistance.1–3
However, evidence indicates that a considerable
proportion of patients with chronic conditions
interrupt the treatment prescribed.1,4 Treatment
interruption is a major public health concern, and is
considered one of the major obstacles to public health
action and patient treatment.3,4 Intermittent treat-
ment interruption and loss to follow-up (LTFU) are
the most common and costly problems for global
health. This is because these lead to poor treatment
outcomes and quality of life, and increase the
duration and severity of illness, worsen disease
transmission, and result in possible hospitalisation
and the development of drug resistance.2–7 ‘LTFU’ is
defined as treatment interruption for 2 consecutive
months.8 ‘Intermittent treatment interruption’ is
defined as missing a prescribed dose for 1 day, but
for a period of ,2 consecutive months.9
In particular, non-adherence to tuberculosis (TB)
treatment is serious because of the infectious nature
of the disease, and the increased risk of prolonged
transmission, development of multidrug-resistant
(MDR-) or extensively drug-resistant TB (XDR-TB)
and treatment failure.7,10 MDR- and XDR-TB are the
greatest threats to health worldwide due to their
infectious nature and poor response to currently
available medications.11–14 In addition, MDR- and
XDR-TB require lengthy, more complicated, expen-
sive and toxic treatment regimens.11,12 Non-adher-
ence to first-line medications is one of the main risk
factors leading to the development of MDR- or XDR-
TB.10,15 For example, patients with TB who miss
first-line treatment even for 1 day are at greater risk
of developing MDR-TB than those who do not.10 In
addition, non-adherence to TB treatment is an
enormous economic burden in terms of cost to the
health care system and to individuals.3,4,16,17
Although several strategies, including DOTS, have

Correspondence to: Kourosh Holakouie-Naieni, Department of Epidemiology and Biostatistics, School of Public Health,
Tehran University of Medical Sciences International Campus, Tehran, Iran. e-mail: holakoik@hotmail.com
Article submitted 3 October 2018. Final version accepted 30 November 2018.
742 The International Journal of Tuberculosis and Lung Disease
been implemented to enhance TB treatment adher-
ence, a significant proportion of TB patients fail to
complete treatment without interruption. For exam-
ple, in Argentina 40% of patients with TB are non-
adherent.18 Similarly, in Kenya the prevalence of non-
adherence to anti-tuberculosis treatment is 21%.19 A
study conducted in Uganda indicated that 28% of
patients with TB are treatment non-adherent.20
Another study in Uganda stated that 26% of TB
patients failed to adhere to their treatment correct-
ly.21 In Equatorial Guinea, 21.4% of patients with TB
were non-adherent.22 In 2014 in England, UK, only
73.3% of drug-susceptible TB patients completed
their treatment in 6–8 months.23 These findings
indicate that a significant number of patients with
TB are not completing their treatment correctly.
Treatment non-adherence is a dynamic behaviour-
al process caused by several factors.1 The WHO
classified these factors into five broad dimensions:1
personal, treatment-related, socio-economic, disease
or condition and health system-related. These
factors are interrelated and influence the ability of
patients to adhere to their treatment. Evidence also
indicates that several factors, such as low educa-
tional status, lack of family support,22 perceived
physical and psychological barriers, and psycholog-
ical distress and poverty24 also affect TB treatment
adherence.22,24–26
Ethiopia is one of the 30 high TB, TB-HIV (human
immunodeficiency virus) and MDR-TB burden coun-
tries in the world.27 DOTS was introduced in
Ethiopia in 1995,28 and several other measures have
been implemented in the country to enhance treat-
ment adherence. However, based on the studies
reported from different parts of the country, the
prevalence of TB treatment non-adherence varies
considerably, from 0.2%29 to 35%.30 A systematic
review and meta-analysis from Ethiopia indicated
that 45.1% of patients with TB are lost to follow-
up.31 Several studies have been conducted to assess
the extent of TB treatment non-adherence and its
associated factors in Ethiopia. However, no system-
atic review or meta-analysis has summarised the
available evidence to guide policy planning in the
country.
We aimed to estimate the pooled prevalence of TB
treatment non-adherence and to summarise the
factors associated with non-adherence in Ethiopia
under the DOTS strategy.
METHODS
Search strategy
We searched the electronic databases Web of Scienc-
es, PubMed/Medline, Scopus, Embase, Complemen-
tary Index and Academic Search Complete for
English language articles published between 2005
and August 2018. In addition, we searched for
relevant conference abstracts from local and interna-
tional conferences manually and electronically. We
also screened bibliographies of included articles for
relevant studies. We used a search strategy combining
the following search terms: ‘tuberculosis’, ‘TB’,
‘adherence’, ‘non-adherence’, ‘compliance’, ‘non-
compliance’, ‘interruption’, ‘lost to follow-up’, ‘de-
fault’, ‘treatment’, ‘therapy’, ‘medication’ and ‘Ethio-
pia’ as found in Medical Subject Heading (MeSH)
and free text terms. If required, the authors of eligible
studies were contacted for further clarifications and
additional information.
Study inclusion and exclusion criteria
We included cross-sectional and retrospective cohort
studies in TB patients who received DOTS treatment
since 2005 in Ethiopia and reported the prevalence
of treatment non-adherence or LTFU in all age
groups. We selected articles on patients treated since
2005 on the assumption that DOTS had been fully
implemented in the country after the DOTS expan-
sion programme was launched in 2005. We excluded
studies conducted on isoniazid chemoprophylaxis,
latent TB treatment, patients not treated under
DOTS and if results on important variables were
not reported (Figure 1). We also excluded studies
conducted on special populations, such as the
incarcerated, HIV sero-reactive individuals and
children alone. Two authors (HHT and ET) con-
ducted the search independently and screened
retrieved studies based on the title and abstracts.
The full texts of the selected studies were then
assessed based on the eligibility criteria. In case of
disagreement, the issue was reviewed and resolved
by a third author (KH).
Assessment of study quality
The quality of the studies selected was assessed
independently by two authors (HHT and ET) using
Crombie’s tool, which contains seven items for
quality assessment of cross-sectional/prevalence stud-
ies.32 These items were assessed for appropriateness
of design, adequacy of data description, representa-
tiveness of the total sample, clarity, reliability and
validity of the measurements, statistical significance,
appropriateness and adequacy of the analyses. The
quality of each article was then scored accordingly
from 0 to 7.
Data extraction
Data were extracted independently from eligible
studies in two databases. Our primary outcome was
treatment non-adherence. We considered treatment
non-adherence if a patient missed a prescribed dose of
treatment for 1 day within a period of full-dose
treatment. In this review, treatment non-adherence
included those who 1) missed their medication and
were identified as non-adherents; 2) interrupted their

Figure 1 Flow chart showing study selection process. HIV ¼ human immunodeficiency virus.
treatment for 1 day for any cause and were
considered as treatment interrupters; or 3) were
identified as LTFU based on WHO TB treatment
outcome definitions.8 For each study, we collected
information about patient characteristics (age, HIV
status, previous treatment history and TB type),
treatment non-adherence (interruption, non-adher-
ence, LTFU) and study characteristics (first author,
publication year, study year, study setting, study
duration and region where the study was conducted).
Statistical analysis
We estimated the pooled prevalence of TB treatment
non-adherence with its 95% confidence intervals
(CIs) using a random-effects model assuming that the
true effect size varies between studies.33 The pooled
prevalence of non-adherence was expressed as the
ratio of the number of non-adherent patients to the
total sample size. We examined the heterogeneity in
the prevalence of the different studies using a v2-
based Q-test with a significance level of P , 0.1 and
I2 statistic with values .75% considered to denote
significant heterogeneity.34 We also assessed potential
publication bias using funnel plots and Egger’s test (P
, 0.1 was considered significant). In addition, we
investigated the effect of potential heterogeneity
factors on non-adherence rates using subgroup
analysis and a moment-based meta-regression model.
We carried out all data analysis using STATA v14
(StataCorp, College Station, TX, USA).
TB treatment non-adherence 743
Ethical considerations
Ethics clearance was not requested because this review
was based on published articles. The protocol of this
review was pre-registered with the PROSPERO Centre
for Reviews and Dissemination, University of York,
York, UK (registration number CRD42018085947;
http://www.crd.york.ac.uk/PROSPERO/display_
record.php?ID¼ CRD42018085947).
RESULTS
Characteristics of included studies
A total of 26 studies (22 full articles and four
abstracts) in this systematic review and meta-analysis
were included (Figure 1). In terms of study popula-
tion, the participants of 16 studies belonged to all age
groups;29,35–49 participants of 10 studies were
adults.30,50,51,52–58 Sixteen studies reported the HIV
status of participants; 29, 37–4 1,4 3,4 4,4 6–52 ,55 –57
the pooled prevalence of HIV co-infection was
20.0% (95%CI 14.0–27.0). Eleven studies reported
the previous TB treatment history of partici-
pants;37,38,42–44,46–58,52,55,56 the pooled prevalence
of previous TB treatment history was 6.0% (95%CI
4.0–8.0). Similarly, the pooled prevalence for pulmo-
nary positive TB (PPTB; defined as a TB case with 1
sputum acid-fast bacilli or culture-positive result at
treatment initiation) was 25% (95%CI 21.0–29.0),
while that of pulmonary negative TB (PNTB; defined
as a TB case with 1 sputum acid-fast bacilli or
culture-negative result at treatment initiation) was
744 The International Journal of Tuberculosis and Lung Disease

Table 1 Subgroup analysis based on study design, type of non-adherence, method used to
measure non-adherence and study population
Heterogeneity tests
Studies Non-adherence rate I2
Group variable n % (95%CI) v2 df % P value
Type of non-adherence
Intermittent non-adherence 10 20.0 (15.0–25.0) 148.79 9 93.95 ,0.001
LTFU 16 5.0 (4.0–6.0) 1023.22 15 98.53 ,0.001
Study design
Cross-sectional 11 20.0 (14.0–25.0) 151.56 10 93.40 ,0.001
Retrospective cohort 15 4.0 (3.0–6.0) 958.71 14 98.54 ,0.001
Method used to measure non-adherence
Participant interview 9 21.0 (16.0–27.0) 103.24 8 92.25 ,0.001
Record review 17 5.0 (4.0–6.0) 1041.59 16 98.46 ,0.001
Study population
All age groups 15 5.0 (4.0–6.0) 977.47 14 98.57 ,0.001
Adults 11 20.0 (13.0–26.0) 351.20 10 97.15 ,0.001
Overall 25 10.0 (8.0–11.0) 1875.52 25 98.67 ,0.001

CI ¼ confidence interval; df ¼ degree of freedom; LTFU ¼ loss to follow-up.

43% (95%CI 36–51). In addition, 13 studies attributable to heterogeneity) suggested considerable

reported results on extra-pulmonary TB (EPTB);
pooled EPTB prevalence was 29.0% (18.0–41.0)
(See https://figshare.com/account/home for Ta-
ble).29,37–40,42–48,53
The publication year of the articles is from 2009 to
2018; study periods were from 6 months to 5 years.
Included studies were conducted in seven states and
two city administrations in Ethiopia. However, of the
nine states in Ethiopia, no studies fulfilling our
inclusion criteria were reported from two states
(Beneshangul-Gumuz and Somali). Most of the
studies were from the state of Amhara (7 studies)
and Southern Nation, Nationalities and Peoples’
Regional State (7 studies). Of the 26 studies included
in this review, 10 were cross-sectional, while 16 were
retrospective. Except for the four abstracts included
in this review,30,35,36,50 all studies were published as
full texts. The minimum sample size used was 24
participants,51 and the maximum was 15 140
participants.37 Of the studies included, only one
study was community-based,51 while all other studies
were health facility-based. The majority of the studies
(n ¼ 16) defined non-adherence as LTFU based on
WHO TB treatment outcome definitions as men-
tioned above, while eight of them used definitions
specific to the study. However, two abstracts included
in this meta-analysis did not provide any definition of
non-adherence.30,50 Ten studies measured non-adher-
ence using questionnaire-guided interviews, while 16
used non-adherence data from TB registers (See
https://figshare.com/account/home for Table).
Pooled prevalence of non-adherence
Data from 37 381 participants were pooled to
estimate the prevalence of treatment non-adherence.
A random-effects model was used for the meta-
analysis because the results of the overall v2-based Q-
test and I 2 statistics (variation in effect sizes
heterogeneity in estimating non-adherence rates (Q ¼
1875.25, degree of freedom ¼ 25, P , 0.001 and I2 ¼
98.67%). The overall pooled non-adherence preva-
lence was 10.0% (95%CI 8.0–11.0) (Figure 2). The
minimum crude non-adherence reported in the
studies was 0.2%,29 and the maximum was 35%.30
However, the minimum pooled estimate of non-
adherence prevalence was 0.0% (95%CI 0.0–1.0)
and the maximum was 35% (95%CI 31.0–40.0) (See
https://figshare.com/account/home for Table; Figure
2).
We conducted subgroup analyses based on four
potential sources of heterogeneity: type of non-
adherence, study designs, non-adherence measure-
ment methods and study populations (Table 1). We
identified two main types of non-adherence: the first
was LTFU based on the WHO TB treatment outcome
definition; the second was intermittent non-adher-
ence according to the definition specific to this study,
and was based on the proportion and number of
doses missed during the study or full course of
treatment (See https://figshare.com/account/home for
Table). Based on subgroup analysis by non-adherence
type (intermittent vs. LTFU), the pooled prevalence of
LTFU was 5.0% (95%CI 4.0–6.0), and the pooled
intermittent non-adherence prevalence was 20.0%
(95%CI 14.0–25.0) (Figure 2). Table 1 gives the
results of subgroup analyses based on non-adherence
type, study design, non-adherence measurement
method and study population. The results of all
subgroup analyses showed significant between-group
and within-group heterogeneity (Table 1).
We also assessed the effect of the year of study and
sample size on heterogeneity between studies using
meta-regression analysis. The results of the adjusted
meta-regression model indicated that only sample size
significantly predicted treatment non-adherence het-
erogeneity across the studies based on reported
 TB treatment non-adherence 745

Figure 2 Pooled prevalence of tuberculosis treatment non-adherence in Ethiopia with 95%CIs (weighted according to a random-
effects model). ES ¼ effect size (prevalence in this study); CI ¼ confidence interval.

prevalence (P ¼ 0.044; Table 2). However, the common associated factors, the most frequently
publication year (P ¼ 0.796) was not a significant reported factors associated with treatment non-
predictor of treatment non-adherence prevalence adherence were being HIV sero-reactive, inability to
heterogeneity (Table 2). Results of funnel plots and pay for transport costs, and lack of knowledge of TB
Egger’s test (P , 0.001) suggested evidence of and drug side effects. Other factors associated with
publication bias in the studies included in estimating treatment non-adherence were low education status,
treatment non-adherence. forgetfulness, being in the continuation phase,
perceived physical and psychological barriers, and
Factors associated with treatment non-adherence
psychological distress (See https://figshare.com/
Ten studies reported the heterogeneous factors account/home for Table).
asso ci ated wi th T B tre atm en t n on -ad he r-
ence.30,38,47,50,51,54–58 In some studies that reported
DISCUSSION
Table 2 Meta-regression analysis of year of publication and
Treatment adherence is a key element of the global TB
sample size as the cause of heterogeneity
control programme, which is why the WHO recom-
Predictive variable b (95%CI) SE P value mends 90% adherence for a successful treatment
Unadjusted model outcome.1 However, evidence indicates that a con-
Year of study 1.37 (21.47 to 24.21) 11.04 0.902
Sample size 0.015 (0.00–0.03) 0.007 0.041
siderable proportion of TB patients discontinue
Adjusted model
treatment during follow-up due to several fac-
Year of study 2.74 (24.42 to 18.95) 10.45 0.796 tors.18,20,22,25,26
Sample size 0.015 (0.00–0.03) 0.07 0.044 Our meta-analysis of 26 studies from different parts
CI ¼ confidence interval; SE ¼ standard error. of Ethiopia covering 37 381 patients with TB on first-
746 The International Journal of Tuberculosis and Lung Disease
line treatment showed an overall prevalence of
treatment non-adherence of 10.0%. The pooled
prevalence of intermittent non-adherence (20.0%)
was far greater than LTFU (5.0%). The most
frequently reported factors associated with TB treat-
ment non-adherence were being HIV sero-reactive,
inability to pay for transport costs and the lack of
knowledge of TB.
However, we found that LTFU prevalence among
TB patients on first-line treatment was lower than
reported previously in a review from Ethiopia in
which the pooled LTFU was 45.1%.31 This is
probably due to the difference in the number of
studies and the nature of the data included in the two
analyses. While Eshetie et al.’s review included data
both before and after full implementation of DOTS in
Ethiopia,31 we included only data from studies
conducted since 2005 after nationwide implementa-
tion of DOTS had been completed.
Although we could not find reviews on intermittent
TB treatment non-adherence, reviews on other
diseases and at-home treatment have reported longer
average intermittent treatment non-adherence than
our pooled result.4 This difference was most likely
due to differences in treatment duration, as well as the
type of and adherence measurement methods and
treatment methods used in the studies included. With
regard to treatment method, the patients in all of the
studies included in this review received DOTS
treatment, in which the drug intake was supervised
by an observer, whereas studies included in the
previous review were conducted among patients
who took their medication at home without supervi-
sion.4
We found intermittent treatment non-adherence
(20.0%) to be four-fold higher than LTFU (5.0%).
However, evidence indicates that LTFU (long-term
interruption) and intermittent non-adherence (short-
term interruption) are the most significant risk factors
for drug resistance, long-term transmission of disease
and treatment failure.7,10,59 In addition, intermittent
treatment interruption and prolonged treatment
duration are the most frequently reported risk factors
for LTFU.7 The prevention of LTFU and intermittent
treatment non-adherence is thus crucial to achieve the
required adherence level.
In our review, being HIV sero-reactive, inability to
pay for transport costs and lack of knowledge of TB
were the most frequently reported risk factors for TB
treatment non-adherence. The previous review from
Ethiopia also found that TB-HIV co-infection was
strongly associated with LTFU, treatment failure and
death.31 A systematic review by Lin and Melendez-
Torres reported that HIV status was inconsistently
associated with TB treatment non-adherence among
an immigrant population.60 The inconsistency was
likely due to the pill burden, long duration of
treatment, adverse drug reactions and counselling
provided to HIV sero-reactive patients. Although TB-
HIV co-infected patients on treatment for both
diseases often complain about the increased pill
burden (which might contribute to treatment non-
adherence61), these patients are in fact more adherent
because they are provided with more counselling
regarding the importance of treatment adherence
than patients who are on TB treatment alone.59
Reviews have shown that the inability to pay for
transport costs and financial burden of the disease are
the main structural factors to affect TB treatment
adherence behaviour.62,63 Financial burden also
interacts with different social, personal and health
care system characteristics, which could lead to
treatment non-adherence.62,63 We found that the
inability to pay for transport costs was the most
frequently reported risk factor for TB treatment non-
adherence.
Regardless of other social and cultural influences,
patient adherence behaviour has been reported to be
strongly influenced by the level of knowledge of the
disease and its treatment.61–63 These findings are
consistent with observations in which a lack of
knowledge was reported to be a factor associated
with TB treatment non-adherence. To address this
knowledge deficit among TB patients, it is necessary
to implement effective measures to enhance patients’
knowledge of TB disease and its treatment. Educating
TB patients about their illness, medications, duration
of treatment, curability of the disease and the
consequences of non-adherence could be crucial in
improving patients’ knowledge.
As there was significant between-group and within-
group heterogeneity in non-adherence prevalence
among the studies included in this review, we
conducted a subgroup analysis to assess the potential
sources of heterogeneity. Heterogeneity may be
expected in any meta-analysis because the included
studies are, in general, conducted using different
methods, which could lead to variations in study
parameters. Heterogeneity is acceptable if the prede-
fined eligibility criteria for the studies included are
reasonable and the data are correct.64,65 To take into
account variations in effect sizes attributable to
heterogeneity, we used a random-effects model for
this review.
Sample size was significantly predictive of pooled
non-adherence prevalence. This may be due to
variations in the prevalence of non-adherence at the
individual study level, and unexplained heterogeneity
of variables such as sample size and year of study
included in the meta-regression analysis. The previ-
ous review reported that a small sample size
(sampling error in general) at the study level could
lead to heterogeneity in the estimated effect size,66
which is in line with our findings.
The prevalence of non-adherence reported by
cross-sectional studies was significantly higher than

that reported by retrospective cohort studies. This
may be due to the different definitions used.
Furthermore, as data are collected from patient
registrations in retrospective cohort studies, some
data may be missing. For example, in the case of
cross-sectional studies, non-adherence is defined as
missing one dose for 1 day, whereas non-adherence
in retrospective studies is defined as treatment
interruption for 2 consecutive months.
The results of our systematic review have impor-
tant implications for the Ethiopian national TB
control programme. Programme officers at each level
of health care and health care workers at treatment
centres should be aware of the factors associated with
non-adherence, and closely monitor the patient for
non-adherence throughout the treatment follow-up
period. Our findings could be used as reference for
high TB burden countries.
We used a random-effects model to address the
problem of heterogeneity between studies. In addi-
tion, we conducted a subgroup and meta-regression
analyses to explore the potential sources of heteroge-
neity. Although we cannot exclude the risk of
publication bias, we used a sensitive search strategy
to identify all studies on the rate of non-adherence to
first-line TB treatment in Ethiopia.
The main limitations of our review were the
inconsistent reporting of important patient charac-
teristics, such as the prevalence of treatment non-
adherence by TB type (pulmonary vs. extra-pulmo-
nary), HIV status, antiretroviral treatment status,
drug adverse effects and distance between the
patient’s home and the treatment centre. These
inconsistencies limited our ability to further explore
potential sources of heterogeneity of the estimated
non-adherence rate. In addition, no studies fulfilling
our inclusion criteria were available from two
regional states of Ethiopia (Beneshangul-Gumuz
and Somali). The pooled prevalence in this review
may thus not be representative of treatment non-
adherence of all parts of Ethiopia. Furthermore, as
few studies reported the common factors associated
with TB treatment non-adherence, we were unable to
estimate the effect of each factor associated with TB
treatment non-adherence.
CONCLUSION
Treatment non-adherence is clearly a major problem
in Ethiopia among TB patients on first-line treatment.
Several extremely heterogeneous factors were associ-
ated with TB treatment non-adherence. Awareness of
these heterogeneous factors and close monitoring of
patients on treatment is vital to ensure strict
adherence.
Acknowledgements
The authors thank the librarians at the Ethiopian Public Health
TB treatment non-adherence 747
Institute, Addis Ababa, Ethiopia, for their support in searching
electronic databases, and the Tehran University of Medical Sciences
International Campus, Tehran, Iran, for providing free electronic
access to their library.
Conflicts of interest: none declared.
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C O N T E X T E : La non adhérence au traitement est l’un
des défis auquel est confronté les programmes de lutte
contre la tuberculose (TB). En Ethiopie, on a rapporté
une magnitude élevée mais extrêmement variable de non
adhérence au traitement TB dans différentes régions du
pays. Cependant, aucune étude n’a été conçue pour
estimer une prévalence globale de la non-adhérence au
traitement à partir de ces données hétérogènes.
O B J E C T I F : Revoir la littérature disponible et estimer la
pr évalence d’ensemble de la non observance au
traitement TB parmi les patients sous traitement de
première ligne en Ethiopie.
S C H É M A : Une revue systématique et une méta analyse
des articles publiés sur la non adhérence au traitement
TB ont été conduites en Ethiopie.
R É S U LT A T S : Nous avons inclus 26 études, impliquant
un total de 37 381 données de patients TB. La
M A R C O D E R E F E R E N C I A: La falta de adhesión al
tratamiento es uno de los fenómenos problemáticos
que afronta el programa mundial de control de la
tuberculosis (TB). En Etiopı́a, se ha comunicado una
inobservancia del tratamiento antituberculoso
extremadamente variable y de gran magnitud en
diferentes partes del paı́s. Sin embargo, no existen
estudios encaminados a estimar una prevalencia
agregada de la falta de adhesión a partir de estos datos
tan heterogéneos.
O B J E T I V O: Examinar las publicaciones existentes y
estimar la prevalencia global de inobservancia del
tratamiento antituberculoso por parte de los pacientes
que reciben esquemas terapéuticos de primera lı́nea en
Etiopı́a.
M É T O D O: Se llevó a cabo una revisión sistemática y un
metanálisis de los artı́culos publicados sobre la falta de
adhesión al tratamiento de la TB en Etiopı́a.
R E S U LT A D O S: Se incluyeron 26 estudios con datos
TB treatment non-adherence i
R É S U M É
prévalence brute de la non adhérence rapportée par les
études incluses a été extrêmement variable (allant de
0,2% à 35%). L’estimation totale combinée de la
prévalence de la non adhérence a été de 10,0%
(IC95% 8,0–11.0). La prévalence combinée des perdus
de vue seuls a été de 5,0% (IC95% 4,0–6,0), tandis que
la prévalence de la non adhérence intermittente a été de
20,0% (IC95% 15,0–25,0).
C O N C L U S I O N : La proportion de non adhérence au
traitement de la TB reste considerable en Ethiopie et
entrave l’objectif de taux de succès du traitement et la
prévention de la pharmacorésistance. Il est crucial de
mettre en œuvre un plan efficace de rétention des
patients parallèlement au programme de traitement sous
observation directe (DOTS) afin d’améliorer l’adhérence
au traitement et de prévenir la pharmacorésistance.
RESUMEN
sobre 37 381 pacientes con TB. En los estudios
incluidos se observó una gran variabilidad en la
notificaci ón de la prevalencia bruta de falta de
adhesión (osciló entre 0,2% y 35%). La prevalencia
global combinada fue 10,0% (IC95% 8,0–11,0). La
prevalencia combinada de p érdida durante el
seguimiento fue 5,0% (IC95% 4,0–6,0), en contraste
con la prevalencia combinada de falta de adhesión
intermitente, que fue 20,0% (IC95% 15,0–25,0).
C O N C L U S I Ó N: La proporci ón de casos con
inobservancia del tratamiento antituberculoso es aún
demasiado alta en Etiopı́a y puede impedir el logro de las
metas fijadas de éxito terapéutico y la prevención de la
farmacorresistencia. Es primordial poner en práctica un
mecanismo eficaz de retención de los pacientes en
paralelo con la estrategia DOTS, con el fin de mejorar
la adhesión al tratamiento y evitar la aparición de
farmacorresistencias.