Public health and private sector practitioners can promote TB treatment adherence by allowing patients to be active partners in making their own treatment decisions; improving patients knowledge and understanding of tuberculosis disease, treatment and potential spread; and by discussing expected interim and long-term outcomes with patients. CDC also recommends use of incentives and enablers. Incentives are monetary rewards for a healthy behavior (e.g.transport or food vouchers), while enablers function to remove economic burdens impeding healthcare access (e.g. grouping clinic visits, providing after hours clinic visits, or home visits). However, more research is needed to determine whether incentives and enablers have a significant effect on long-term treatment adherence for TB. Smartphones are considered to have potential to improve compliance.Individuals with tuberculosis may also benefit from the emotional support of peers and survivors. Advocacy organizations and patient support groups such as STOP TB, TB Alert, Treatment Action Group (TAG) and others work to connect TB survivors. Adverse effects
For information on adverse effects of individual anti-TB drugs, please refer to the individual articles for each drug. The relative incidence of major adverse effects has been carefully described:
INH 0.49 per hundred patient months
RMP 0.43
EMB 0.07
PZA 1.48
All drugs 2.47This works out to an 8.6% risk that any one patient will need to have his drug therapy changed during the course of standard short-course therapy (2HREZ/4HR).
4R—Rifampicin for 4 months is an alternative for those who are unable to take isoniazid or who have had known exposure to isoniazid-resistant TB. 3HR—Isoniazid and rifampicin may be given for 3 months. 2RZ—The 2-month regimen of rifampicin and pyrazinamide is no longer recommended for treatment of LTBI because of the greatly increased risk of drug-induced hepatitis and death. 3RPT/INH - 3-month (12-dose) regimen of weekly rifapentine and isoniazid.Evidence for treatment effectiveness:
A 2000 Cochran review containing 11 double-blinded, randomized control trials and 73,375 patients examined six and 12 month courses of isoniazid (INH) for treatment of latent tuberculosis. HIV positive and patients currently or previously treated for tuberculosis were excluded. The main result was a relative risk (RR) of 0.40 (95% confidence interval (CI) 0.31 to 0.52) for development of active tuberculosis over two years or longer for patients treated with INH, with no significant difference between treatment courses of six or 12 months (RR 0.44, 95% CI 0.27 to 0.73 for six months, and 0.38, 95% CI 0.28 to 0.50 for 12 months).A 2013 systematic review published by the Cochrane Collaboration, compared Rifamycins (monotheraphy and combination therapy) to INH monotheraphy as an alternative in preventing active TB in HIV negative populations. The evidence suggested that shorter Rifampicin regimes (3 or 4 months) had higher treatment completion rates and fewer adverse events when compared to INH. However, the overall quality of evidence as per GRADE criteria was low to moderate.