Predictors of Treatment Success and Interventions in Increasing Treatment Success Rate in Drug-sensitive Tuberculosis in Low- and Middle-income Countries: A Systematic Review and Meta-analysis

Background This study aimed to synthesize evidence and estimate pooled treatment success rates for drug-sensitive tuberculosis (TB), identify associated predictors, and evaluate the effectiveness of interventions in low- and middle-income countries (LMICs). Methods A systematic review and meta-analysis were conducted following PRISMA guidelines, examining literature from January 2018 to April 2023. Eligible studies reported on treatment success rates, patient-level predictors, or interventions. Random-effects models were employed to compute pooled effect sizes. Findings The pooled treatment success rate was 88%, exceeding the World Health Organization (WHO) benchmark of 85%. Significant predictors of treatment success included HIV-negative status, being a newly diagnosed case, receiving Directly Observed Treatment, Short-course (DOTS), and the absence of smoking or alcohol use. Factors such as residence type (urban vs. rural), TB type (pulmonary vs. extrapulmonary), comorbidities (non-diabetic), and bacteriological confirmation did not show statistically significant associations with outcomes. Four interventions demonstrated statistically significant improvements in success rates: asynchronous video-observed therapy (aVOT), Medication Event Monitoring Systems (MEMS), patient support groups, and pharmaceutical care. The feasibility of some interventions, such as aVOT, may vary based on digital access and healthcare infrastructure. Conclusion A complex interplay of clinical, behavioral, and contextual factors influences TB treatment outcomes in LMICs. This study underscores the importance of implementing evidence-informed interventions tailored to local needs while considering the multifactorial nature of treatment success.