Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis

Meaghann S Weaver, Knut Lönnroth, Scott C Howard, Debra L Roter & Catherine G Lam


To assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions.


We searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices.


We included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion.


Various interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries.

October 1, 2015
Year of publication
Resource types
Journal and research articles, Literature review, Reports and Fact sheets
adherence support, adherence, treatment, paediatric tuberculosis, pediatric TB, TB, tuberculosis, low- and middle-income countries

Similar Resources

Adolescents living with HIV are an underserved population, with poor retention in HIV health care services and high mortality, who are in need of targeted effective interventions.

This supplement to Acta Paediatrica presents a series of meta-analyses and systematic literature reviews examining a variety of health effects potentially related to breastfeeding.

The Cochrane Library (ISSN 1465-1858) is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about Cochrane groups.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on vulnerable populations, including TB in prisons and intimate partner violence in the context of HIV.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on key populations.

On the sidelines of the 2017 United Nations General Assembly, U.S. Secretary of State Rex Tillerson announced the new PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020).

Background. We conducted a systematic review and meta-analysis to evaluate the incidence and prevalence of 14 opportunistic infections (OIs) and other infections as well as the impact of antiretroviral therapy (ART) among human immunodeficiency virus (HIV)–infected children (…

Adolescents newly diagnosed with HIV need to be rapidly incorporated into HIV care networks to have the best chances of remaining in care in the long term, research from the United States published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes shows.

A co-formulation of tenofovir alafenamide (TAF) plus emtricitabine, used with a third antiretroviral drug, maintained viral suppression as well as tenofovir disoproxil fumarate (TDF) plus emtricitabine in older individuals, and was associated with improvements in kidney function and bone density…

Globally 3.9% of new and 21% of re-treatment tuberculosis (TB) cases are multidrug-resistant or rifampicin-resistant (MDR/RR), which is often interpreted as evidence that drug resistance results mainly from poor treatment adherence.