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Assessment two: research summary on tuberculosis Assignment Sample

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Introduction - Assessment two: research summary on tuberculosis

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Treatment of tuberculosis is critical as it is a long-term procedure. This can affect the regular intervention for the process that is necessary to avoid further risk development, assures risk and minimises the chances of disease transmission. The long-term antibiotic treatment process leads to incomplete adherence, which is considered a major factor for the multi-drug resistance observed among TB patients. This essay mainly focuses on adherence intervention as non-pharmacological.

Mechanism of action for the adherence intervention process for tuberculosis

Tuberculosis is a single pathogen disease that is still considered a major cause of death in the global population. This disease is mainly caused by the attack of mycobacterium tuberculosis, and treatment with anti-tuberculosis medicines is needed [1]. The pharmaceutical intervention for tuberculosis involves the goal of curing the symptoms and their management for the process. The major medications involved in the treatment process include isoniazid, and rifampin, the first line of the treatment process.

Based on the basic condition of the infection of the patient, which can be both active or in a latent state, the therapies and their durations are suggested [2]. In most cases, the drugs are mainly advised to be treated for a minimum duration of six months. The major factor associated with the treatment process involves complete adherence to the treatment process. After taking the medications for a few weeks, the symptoms start to disappear, and the patient may feel fresh, which leads to stop taking the medication [3]. Also, the long-term disease may cause mental disruption, financial barriers and losing encouragement towards the treatment process. The engaged adherence intervention technologies includes the phone based technology that can be utilised for sensing SMS and reminders to the people. Also, effective monitoring including the direct observation technology involves video monitoring. The digital pillbox used for improved adherence intervention through using internet technology [3]. The advance technologies are mandatory for fulfilling the, monitoring gaps and requirement for effective adherence intervention of the tuberculosis treatment process.

Adherence intervention refers to the process that involves continuous encouragement and support for TB patients throughout the whole treatment process. This includes mental and moral support for the patient, regular encouragement, and a friendly reminder for their next treatment step [4]. The health programmes for TB intervention must also involve resources that can be used for overcoming individual challenges faced by the patients to increase their adherence to the system. Also, the patient-centred support intervention can be helpful for fulfilling the needs of every individual and valuing their cure process.

Research summary

Effectiveness of the intervention process

The selected research mainly includes cohort studies and randomised control trials. The major factors for this trial involve Directly Observed therapy (DOT) and Self Administration therapy (SAT). As per the result, it can be observed that the success rate of treatment outcomes is higher in the case of DOT while compared to DOT, with the success rate of nearly 95% [1]. The major success factor involves the completion of the treatment process, the cure of the patients, and complete adherence to the process [5]. On the other hand, failure is mainly associated with the SAT process, which involves factors such as mortality, treatment failure, incomplete treatment process, irregular follow-up and developing drug resistance.

The adherence process from the results is observed to be patient education and counselling, which is observed to have a higher success rate of more than 90% [1]. On the other hand, incentives and enablers are also effective for acquiring a higher rate of success. Reminders and tracing process, staff education and their psychological intervention are also included in the process [6]. The intervention for the adherence can be helpful for both medication as well as personal usage for patients. In case of patient, this can be effective for observation and reminder for pill intake for the patients. On the other hand, through the advance monitoring technologies, a proper data for medicinal monitoring can be accessible to the health care providers. This research involves all possibilities for further development and possibilities for effective monitoring of the tuberculosis treatment [4]. Hence the study is well defined and developed while compared to the provided adherence strategy for the tuberculosis treatment process.

From the overall analysis of the provided research, it can be said that DOT process is more effective for promoting adherence than the SAT procedure. In the provided intervention, SAT process has been mainly involved. The group associated with SAT have higher chances of developing drug resistance due to the increased rate of treatment failure [7]. The major success rates are largely associated with the socio-cultural background. Also, the DOT providers may involve home care providers and family members as well, which can be a major success factor for the SAT group in providing intervention [8]. One of the major success factors for adherence intervention involves technological interventions, such as phone reminders [9]. The adherence intervention also includes psychological encouragement factors that increase internal and external validations, along with a patient-centred approach.

Limitations of the intervention

The limitations of direct monitoring and adherence interventions are also discussed in the study. This includes the cost-effectiveness of the direct monitoring process that is imposed on TB patients and their families. This process is mainly implied in the case of effective identification and implementation of patient-centred interventions in critical cases. Effective management of resources is also a major factor in implementing certain adherence interventions [9]. The necessary aspects of the process include an effective resource mobilisation process. The major influences for this approach involve the social and educational factors that affect the medication purpose while following the overall nutritional and other development procedures. The psychosocial influences for the intervention involves the supporting factor from the families, peer support from the society, advocacy for the patients and their overall well being management [1]. The nutritional approach also plays a major role for treatment procedures for the TB patients, along with transportation and their management through the process. The health care challenges for management also involves in the process, that staffing limitation, performance quality management and the regulatory approaches. Using resources and data from digital technologies and data management processes can be effective for the overall factors [1]. The information has been identified for the overall impacts on the cost of data transmission, encryption and privacy for patient management.

Evaluation of the selected study

The papers included in the selected SLR include the randomised control trials (RCT) for tuberculosis, along with retrospective and prospective cohort studies. The major population involved in the process includes adults and children of different ages that are suffering from TB. The symptoms include pulmonary, smear-sensitive, extra pulmonary, drug-susceptible and drug-resistant groups of the people [10]. Another major aspect of the study involves TB patients associated with HIV co-infection. The exclusion criteria for the study involve an effective clinical setting treatment process that majorly involves the DOT mechanism [11]. On the other hand, the outcomes for researchers are included as per the definition and treatment guidelines provided by WHO, which involve Cure of TB patients with bacteriological confirmation, completion of treatment, success of treatment, that involves both cure and completed treatment process, failure of treatment, mortality due to the disease, loss of the follow-up process, and relapsing. Based on the defined outcomes, the articles are selected for this study [12]. While discussing, some researchers have also referred that SAT process has been more effective than DOT, though most of the cases have been considered while discussing the results.

The total article selected for the process primarily involves more than 7500 articles, which is reduced to 129 articles in total. The main aspect of the research article inclusion criteria involves quantitative analysis, and there are varied studies that have been involved in the cohort studies [1]. Along with it, the RCTs mainly involved the adherence process and non-pharmacological intervention process for the successful treatment of TB. Otherwise, all the details are included in the study, with a details analysis and description of outcomes from different studies, and that can be considered the strength of this study [1]. The limitation has also included, such as the studies involved in this study mainly included patients that are hard to follow up, and hence the success rate for DOT is increased for treatment succession. Also, the methods involved in studies are of various kinds, and the standardisation process may involve biases [1]. Another major limitation includes a lack of information on patients that focused on MDR-TB. The major limitation involves a lack of discussion about the effectiveness of the interventions for adherence. In the entire study, there are no certain ethical issues have been found.


Tuberculosis treatment is a long-term process that generally needs proper monitoring to avoid the development of drug resistance. The adherence interventions are necessary for active support and control over the process. Both the DOT and SAT processes can be effective in different patient backgrounds, although adherence is observed to be higher in the case of direct observation.


  • [1] Alipanah N, Jarlsberg L, Miller C, Linh NN, Falzon D, Jaramillo E, Nahid P. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS medicine. 2018 Jul 3;15(7):e1002595.
  • [2] Law S, Daftary A, O'Donnell M, Padayatchi N, Calzavara L, Menzies D. Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review. European Respiratory Journal. 2019 Jan 1;53(1).
  • [3] Musiimenta A, Tumuhimbise W, Mugaba AT, Muzoora C, Armstrong-Hough M, Bangsberg D, Davis JL, Haberer JE. Digital monitoring technologies could enhance tuberculosis medication adherence in Uganda: Mixed methods study. Journal of clinical tuberculosis and other mycobacterial diseases. 2019 Dec 1;17:100119.
  • [4] Nsengiyumva NP, Mappin-Kasirer B, Oxlade O, Bastos M, Trajman A, Falzon D, Schwartzman K. Evaluating the potential costs and impact of digital health technologies for tuberculosis treatment support. European Respiratory Journal. 2018 Nov 1;52(5).
  • [5] Killian JA, Wilder B, Sharma A, Choudhary V, Dilkina B, Tambe M. Learning to prescribe interventions for tuberculosis patients using digital adherence data. InProceedings of the 25th ACM SIGKDD International Conference on Knowledge Discovery & Data Mining 2019 Jul 25 (pp. 2430-2438).
  • [6] Subbaraman R, de Mondesert L, Musiimenta A, Pai M, Mayer KH, Thomas BE, Haberer J. Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities. BMJ global health. 2018 Oct 1;3(5):e001018.
  • [7] Garfein RS, Doshi RP. Synchronous and asynchronous video observed therapy (VOT) for tuberculosis treatment adherence monitoring and support. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2019 Dec 1;17:100098.
  • [8] Gupta RK, Lipman M, Story A, Hayward A, de Vries G, Van Hest R, Erkens C, Rangaka MX, Abubakar I. Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era. The International Journal of Tuberculosis and Lung Disease. 2018 May 1;22(5):479-87.
  • [9] Morse RM, Myburgh H, Reubi D, Archey AE, Busakwe L, Garcia-Prats AJ, Hesseling AC, Jacobs S, Mbaba S, Meyerson K, Seddon JA. Opportunities for mobile app–based adherence support for children with tuberculosis in South Africa. JMIR mHealth and uHealth. 2020 Nov 11;8(11):e19154.
  • [10] Dixit K, Biermann O, Rai B, Aryal TP, Mishra G, de Siqueira-Filha NT, Paudel PR, Pandit RN, Sah MK, Majhi G, Levy J. Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention. BMJ open. 2021 Oct 1;11(10):e049900.
  • [11] Sekandi JN, Buregyeya E, Zalwango S, Dobbin KK, Atuyambe L, Nakkonde D, Turinawe J, Tucker EG, Olowookere S, Turyahabwe S, Garfein RS. Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study. ERJ open research. 2020 Jan 1;6(1).
  • [12] Haberer JE, Subbaraman R. Digital technology for tuberculosis medication adherence: promise and peril. Annals of the American Thoracic Society. 2020 Apr;17(4):421-3.
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