HomePoor adherence to prescribed TB treatment is a common cause of treatment failure and relapse.29
Adherence is optimized when TB medications are delivered as part of a comprehensive, patient-centred program that promotes patient understanding and removes barriers to adherence, rather than a focus on adherence to pharmacologic therapy alone.1,37 Incentives and enablers can also help mitigate any social and economic marginalization a person may be experiencing. Early linkage with a social worker, along with early engagement with appropriate governmental and community organizations, is recommended when treating people from marginalized populations.
Examples of incentives and enablers that can be used include:1,37–40
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peer counseling;
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patient reminders and following up on missed appointments;
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integration into primary or specialty care (eg, HIV care, dialysis, mental health services, methadone delivery);
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financial supports, including stipends, personal products, coupons and gift cards;
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social assistance for housing and to gain access to or funding of healthcare services;
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assistance with transportation and childcare;
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reminder systems for appointments;
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field or home visits;
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blister packing medications;
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video directly observed therapy.
Good practice statements
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The decision by a care provider to initiate treatment of TB disease implies a commitment to ensuring that a person with TB completes their TB therapy safely and with minimal interruption. This is best done by providing a comprehensive, patient-centred treatment program, which may include incentives and enablers.
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People with TB disease should be provided all medications and services required to successfully complete TB therapy free of charge, regardless of their insurance coverage or residency status in Canada.
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