Stigma related to tuberculosis interventions to improve treatment adherence in developing countries: a systematic review

Despite considerable effort invested for tuberculosis (TB) control, the outcome has not been optimal due to several barriers. Stigma has been an important factor that hinders the completion of full course of TB treatment, i.e. it results in poor treatment adherence. This systematic review is aimed to review the interventions targeting tuberculosis related stigma in order to improve treatment adherence among tuberculosis patients in developing countries. Methods: A systematic electronic database search (PubMed, Google Scholar, ProQuest, Science Direct, Ovid, Spring and Cochrane) covering articles published between 2008 and 2019 had been conducted using truncated search words of “stigma related to tuberculosis”, “TB Stigma”, “Intervention”, “treatment adherence”, “treatment compliance”, and “developing countries”. Only English articles exploring stigma among TB patients and its anti-stigma intervention in developing countries were included. Results: A total of 846 articles were retrieved and 346 were excluded due to duplication while another 361 non-relevant articles at the stage of title screening were excluded. Subsequently, 119 articles were excluded for not fulfilling inclusion criteria and only 3 studies remained. Conclusion: From the three articles, TB treatment outcomes were improved with the use of stigma intervention, including health education and counselling, self-support, and psychological support interventions. Optimal implementation of stigma interventions may vary by setting, resources, and the local TB epidemiology. More controlled interventional research is needed in stigma reduction that leads to improve TB adherence in developing countries