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Table 5 Grading of body of evidence for the effectiveness of social interventions. Question: Do social interventions result in higher initiation, adherence, or completion rates than usual care in individuals eligible for LTBI treatment?

From: Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review

   

Quality assessment

n/N = %a

Effect

Quality

Importance

No of studies (No of participants)

Design

Population interventionb

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Social intervention

OR (95 % CI)c

Absoluted (per 1000 (95 % CI))

No social intervention

Initiation

1 (946) [18]

Observational study

Immigrants

Not seriouse

Not serious

Not serious

Not serious

None

389/442 = 88 %

2.7 (1.9–3.8)

149 (107–181)

⊕ ⊕ OO Low

Critical

Cultural case management

557/762 = 73 %

Adherence

        

N

Cumulative mean number of pills taken over 9 months f

   

1 (286) [19]

RCT

General population

Not seriousg

Not serious

Not serious

Serioush

None

92

180

–

⊕ ⊕ OO Low

Critical

Adherence coaching

98

151

1 (184) [57]

Observational study

Immigrants

Not seriousi

Not serious

Not serious

Serious

None

53

157

–

⊕OOO Very low

Critical

Cultural intervention

131

129

Completion

3 (928) [19, 27, 58]

RCT

General population

Not seriousj

Not serious

Not serious

Not serious

None

331/515 = 64 % (range: 46–84 %)

1.4 (1.1–1.9)

78 (53–80)

⊕ ⊕ ⊕O High

Critical

Counsellor/contingency contracting & adherence coaching/self-esteem counselling & peer based

253/413 = 61 % (range: 38–76 %)

1 (946) [18]

Observational study

Immigrants

Not seriouse

Not serious

Not serious

Not serious

None

319/389 = 82 %

7.8 (5.7–10.7)

452 (400–494)

⊕ ⊕ OO Low

Critical

Case management taking into account cultural background

205/557 = 37 %

1 (216) [15]

RCT

Inmatesk

Not seriousl

Not serious

Not serious

Seriousm

None

24/106 = 23 %

2.2 (1.0–4.7)n

108 (4–267)

⊕ ⊕ O Moderate

Critical

Education

12/103 = 12 %

1 (520) [35]

RCT

Homeless

Not seriouso

Not serious

Not serious

Not serious

None

173/279 = 62 %

3.0 (2.2–4.2)p

268 (189–339)

⊕ ⊕ ⊕ ⊕ High

Critical

Nurse case management

94/241 = 39 %

1 (199) [17]

RCT

PWID

Not seriousq

Not serious

Not serious

Not serious

None

79/101 = 78 %

1.0 (0.7–1.5)

2 (−75-62)

⊕ ⊕ ⊕ ⊕ High

Critical

Peer support vs. no peer support

79/100 = 79 %

  1. Bibliography: Goldberg et al. 2004 [18]; Hovell et al. 2003 [19]; Ailinger et al. 2010 [57]; Kominski et al. 2007 [27]; Hirsch-Moverman et al. 2013 [58]; White et al. 2002 [15]; Nyamathi et al. 2006 [35]; Chaisson et al. 2001 [17]
  2. n/N: No of individuals with LTBI who initiated, or adhered to or completed treatment/total number of subjects. CI: confidence interval; H: isoniazid; OR: odds ratio; RCT: randomized controlled trial
  3. aIf >1 articles, weighed pooled point estimates and 95 % CI were calculated
  4. bAll groups H > 4 months
  5. cIf >1 articles, pooled estimates and 95%CI were calculated using a random effects model (without quality index)
  6. dCalculated via GradePro
  7. eGoldberg et al. 2004 [18]: use of unvalidated patient-reported outcomes (self-report); proportion of children aged 5-14 years was higher during one period than the other (19 % vs. 13 %, p = 0.003)
  8. fNo adherence rates were provided as outcome; instead, the cumulative mean number of pills taken per group was presented
  9. gHovell et al. 2003 [19]: unclear allocation concealment; unclear sequence generation; partly blinded. Not downgraded for these risk of bias aspects because already downgraded for imprecision
  10. hTotal sample size <230
  11. iAilinger et al. 2010 [57]: use of unvalidated patient-reported outcomes (self-report) convenience sample
  12. jHovell et al. 2003 [19]: unclear allocation concealment; unclear sequence generation; partly blinded. Kominski et al. 2007: unclear allocation concealment; no blinding; unclear if intention-to-treat analysis was performed; use of unvalidated patient-reported outcomes (self-report). Hirsch-Moverman et al. 2013: unclear allocation concealment; unclear sequence generation; partly blinded; use of unvalidated patient-reported outcomes (self-report)
  13. kInmates who started treatment in jail and were released before treatment completion
  14. lWhite et al. 2002 [15]: partly blinded
  15. mTotal number of events <125
  16. nAdjusted OR, not reported which factors this OR was adjusted for
  17. oNyamathi et al. 2006 [35]: unclear allocation concealment; unclear sequence generation; partly blinded; dissimilarities between treatment arms (daily alcohol or drug use [significantly associated with non-completion in this study]; male, recruitment site [both not significantly associated with completion in this study], lifetime intravenous drug use, recent self-help program)
  18. pAdjusted OR, adjusted for: age, sex, high-school graduate, never married, medical insurance, recruited from homeless shelter, years homeless, treatment completion important, intended to adhere, daily alcohol/drug use, recent self-help program, emotional well-being, social support, recent hospitalization, recent victimization
  19. qChaisson et al. 2001 [17]: unclear allocation concealment; no blinding; use of unvalidated patient-reported outcomes (self-report; urine tests and MEMS in a subset of patients in this study show that self-report is subject to serious under-reporting)