journal article·2025-12-08Open access

Improving Tuberculosis Medication Adherence: A Millennial Disease in the Age of New Technologies: Application of the World Health Organization-Multidimensional Adherence Model: A Review

Lucky Norah Katende-Kyenda

Applied Sciences· Volume 15· Issue 24

Abstract

Tuberculosis is a serious public health issue. It is the most prevalent cause of death from a single infectious agent and globally, it is among the top 10 causes. One of the most crucial strategies to combat the TB pandemic is to administer basic anti-TB treatment for at least six months. However, the long duration of TB therapy raised the issue of non-adherence, which negatively impacted the clinical and public health outcomes of TB treatment. As a result, directly observed therapy has been used as a standard method to encourage adherence to anti-TB medication. However, this strategy has been challenged because of the difficulty, stigma, decreased economic output, and decreased quality of life, all of which might eventually make adherence problems worse. Furthermore, there is disagreement regarding the efficacy of the directly observed treatment (DOT) strategy in enhancing anti-TB adherence. Digital technology might therefore be a key tool to enhance DOT implementation. The World Health Organization Multidimensional Adherence Model (WHO-MAM) may be used with digital technologies to further improve drug adherence and change behavior. Aim: This paper aimed at reviewing the latest evidence on TB drug non-adherence, its contributing factors, the efficacy of DOT and its alternatives, and the use of digital technologies and WHO-MAM to improve medication adherence. This report analyzed linked publications using a narrative review process to address the study goals. Conventional DOT has several drawbacks when it comes to TB therapy. Medication adherence may be enhanced by incorporating WHO-MAM into the creation of digital technologies. To address several challenges associated with DOT implementation, digital technology offers a chance to enhance drug adherence.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Medication Adherence and Compliance · Tuberculosis Research and Epidemiology · Diverse Scientific Research Studies

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Internal Medicine and Pharmacology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Sissons Street, Fortgale, Mthatha 5117, Eastern Cape, South Africa

References (74)

Show source-provided references
1. World Health Organization (2024, October 05). World TB Day: Key Facts. WHO, 2024. Available online: https://www.afro.who.int/health-topics/tuberculosis-tb.
2. Daily Maverick (2025, May 02). South Africa’s TB Crisis: Progress and Challenges Highlighted in Latest WHO Report. WHO, 2024. Available online: https://www.dailymaverick.co.za/article/2024-10-31-sa-records-56000-tb-deaths-in-2023-says-who.
3. World Health Organization (2022). Global Tuberculosis Report 2020 [Internet], WHO. Available online: https://www.who.int/publications/i/item/9789240013131.
4. Pan American Health Organization-World Health Organization (2025, May 28). Tuberculosis Deaths and Disease Increase During the COVID-19 Pandemic. PANO-WHO 2022. Available online: https://www.paho.org/en/news/27-10-2022-tuberculosis-deaths-and-disease-increase-during-covid-19-pandemic.
5. Burden of tuberculosis among vulnerable populations worldwide: An overview of systemic reviews10.1016/S1473-3099(23)00372-9 ↗
6. World Health Organization (2025, May 05). Treatment. TB Alert. WHO Tuberculosis Report 2024. Available online: https://www.tbalert.org/about-tb/what-is-tb/treatment.
7. World Health Organization (2025, May 10). Tuberculosis: Multidrug-Resistant (MDR-TB) or Rifampicin-Resistant TB (RR-TB) Multidrug-Resistant-Tuberculosis-(mdr-tb). WHO 2024. Available online: https://www.who.int/news-room/questions-and-answers/item/tuberculosis.
8. Narayana Health (2025, April 09). Tuberculosis of the Kidney: Symptoms, Diagnosis, and Treatment Options. Narayana Health 2023. Available online: https://www.narayanahealth.org/blog/tuberculosis-of-the-kidney-symptoms-diagnosis-and-treatment-options.
9. Factors contributing to pulmonary TB treatment lost to follow-up in developing countries: An overview
10. Pietersen, E., Anderson, K., Cox, H., Dheda, K., Aihua Bian, A., and Shepherd, B.E. (2023). Variation in missed doses and reasons for discontinuation of anti-tuberculosis drugs during hospital treatment for drug-resistant tuberculosis in South Africa. PLoS ONE, 8.10.1371/journal.pone.0281097 ↗
11. World Health Organization (2025, July 10). WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment Drug-Resistant Tuberculosis Treatment. WHO 2020. Available online: https://www.who.int/publications-detail-redirect/9789240007048.
12. Kimani, E., Muhula, S., Kiptai, T., Orwa, J., Odero, T., and Gachuno, O. (2021). Factors influencing TB treatment interruption and treatment outcomes among patients in Kiambu County, 2016–2019. PLoS ONE, 16.10.1371/journal.pone.0248820 ↗
13. Iweama, C.N., Agbaje, O.S., Umoke, P.C.I., Igbokwe, C.C., Ozoemena, E.L., Omaka-Amari, N.L., and Idache, B.M. (2021). Nonadherence to tuberculosis treatment and associated factors among patients using directly observed treatment short-course in north-west Nigeria: A cross-sectional study. SAGE Open Med., 9.10.1177/2050312121989497 ↗
14. National Department of Health (2025, May 07). Clinical Management of Rifampicin-Resistant Tuberculosis. National Department of Health 2023, Available online: https://www.health.gov.za/wp-content/uploads/2023/10/Updated-RR-TB-Clinical-Guidelines-September-2023.pdf.
15. Innovative Approaches to Enhance and Measure Medication Adherence in Chronic Disease Management: A Review10.12659/MSM.944605 ↗
16. Improving Tuberculosis Medication Adherence: The Potential of Integrating Digital Technology and Health Belief Model10.4046/trd.2022.0148 ↗
17. Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.10.1136/bmj.n71 ↗
18. Medication nonadherence: Health impact, prevalence, correlations and interventions10.1080/08870446.2022.2144923 ↗
19. Panahi, S., Rathi, N., Hurley, J., Sundrud, J., Lucero, M., and Kamimura, A. (2022). Patient Adherence to Health Care Provider Recommendations and Medication among Free Clinic Patients. J. Patient Exp., 9.10.1177/23743735221077523 ↗
20. Risk factors analysis of non-compliance of Tuberculosis (TB) patients taking medicine in Puskesmas Polonia, Medan, 202110.1016/j.gaceta.2021.10.027 ↗
21. Kyrbashov, B., Kulzhabaeva, A., Kadyrov, A., Toktogonova, A., Timire, C., Satyanarayana, S., and Istamov, K. (2023). Time to Treatment and Risk Factors for Unsuccessful Treatment Outcomes among People Who Started Second-Line Treatment for Rifampicin-Resistant or Multi-Drug-Resistant Tuberculosis in the Kyrgyz Republic, 2021. Trop. Med. Infect. Dis., 8.10.3390/tropicalmed8080407 ↗
22. Ferreira, I.B.B., Carvalho de Meneze, R., Pereira, M.A., and Rolla, V.C. (2025). Effects of missed anti-tuberculosis therapy doses on treatment outcome: A multi-center cohort study. Lancet Reg. Health, 48.10.1016/j.lana.2025.101212 ↗
23. Netto, T.A.L., Diniz, B.D., Odutola, P., Dantas, C.R., Caldeira de Freitas, M.C.F.L., and Hefford, P.M. (2024). Video-observed therapy (VOT) vs. directly observed therapy (DOT) for tuberculosis treatment: A systematic review on adherence, cost of treatment observation, time spent observing treatment and patient satisfaction. PLoS Negl. Trop. Dis., 18.10.1371/journal.pntd.0012565 ↗
24. Sahra, S., and Bronze, M.S. (2024). Tuberculosis (TB) Treatment & Management. Infect. Dis., Available online: https://emedicine.medscape.com/article/230802-treatment.
26. I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities10.1377/hlthaff.2022.00475 ↗
27. Charalambous, S., Maraba, N., Jennings, L., Rabothata, I., Cogill, D., Mukora, R., Hippner, P., Naidoo, P., Xaba, N., and Mchunu, L. (2024). Treatment adherence and clinical outcomes amongst in people with drug-susceptible tuberculosis using medication monitor and differentiated care approach compared with standard of care in South Africa: A cluster randomized trial. Lancet, 75.10.1016/j.eclinm.2024.102745 ↗
28. Religioni, U., Rocío Barrios-Rodríguez, R., Requena, P., Borowska, M.B., and Ostrowski, J. (2025). Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life. Medicina, 61.10.3390/medicina61010153 ↗
29. Chapman, S.C.E., and Chan, A.H.Y. (2025). Medication nonadherence—Definition, measurement, prevalence, and causes: Reflecting on the past 20 years and looking forwards. Front. Pharmacol., 16.10.3389/fphar.2025.1465059 ↗
30. Association Between Medication Adherence and Healthcare Costs Among Patients Receiving the Low-Income Subsidy10.1016/j.jval.2020.06.005 ↗
31. Chauke, D., Nakwafila, O., Chibi, B., Sartorius, B., and Mashamba-Thompson, T. (2022). Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: A systematic scoping review. Heliyon, 8.10.1016/j.heliyon.2022.e09716 ↗
32. Izudi, J., Tamwesigire, I.K., and Bajunirwe, F. (2024). Effect of missed clinic visits on treatment outcomes among people with tuberculosis: A quasi-experimental study utilizing instrumental variable analysis. IJID Reg., 13.10.1016/j.ijregi.2024.100461 ↗
33. The role of adherence in patients with chronic diseases. The role of adherence in patients with chronic diseases10.1016/j.ejim.2023.07.008 ↗
34. Exploring the Agreement Between Self-Reported Medication Adherence and Pharmacy Refill-Based Measures in Patients with Kidney Disease10.2147/PPA.S388060 ↗
35. GPG National Collaborating Centre for Primary Care (UK) (2009). Medicines Adherence: Involving Patients in Decisions About Prescribed Medicines and Supporting Adherence [Internet]. Assessment Adherence. London: Royal College of General Practitioners (UK); 2009 Jan. NICE Clin. Guidel., 76, Available online: https://www.ncbi.nlm.nih.gov/books/NBK55447/.
36. Factors Influencing Treatment Adherence Among Drug-Sensitive Tuberculosis (DS-TB) Patients in Armenia: A Qualitative Study10.2147/PPA.S370520 ↗
37. Ozaltun, C.S., and Akin, L. (2024). An Evaluation of Medication Adherence in New Tuberculosis Cases in Ankara: A Prospective Cohort Study. Healthcare, 12.10.3390/healthcare12232353 ↗
38. Shahin, W., Kennedy, G.A., and Stupans, I. (2021). The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pr., 2.10.18549/PharmPract.2021.2.2300 ↗
39. Appiah, M.A., Arthur, J.A., Gborgblorvor, D., Asampong, E., Kye-Duodu, G., Kamau, E.M., and Dako-Gyeke, P. (2023). Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: A qualitative study from patient’s perspective. BMC Public Health, 23.10.1186/s12889-023-16259-6 ↗
40. Manu, E., Sumankuuro, J., Douglas, M., Aku, F.Y., Adoma, P.O., and Kye-Duodu, G. (2024). Client-reported challenges and opportunities for improved antiretroviral therapy services uptake at a secondary health facility in Ghana. Heliyon, 10.10.1016/j.heliyon.2024.e35788 ↗
41. Magnitude, Nature, and Risk Factors of Adverse Drug Reactions Associated with First Generation Antipsychotics in Outpatients with Schizophrenia: A Cross-Sectional Study
42. Pradipta, I.S., Idrus, L.R., Probandari, A., Lestari, B.W., Diantini, A., Alffenaar, J.-W.C., and Hak, E. (2021). Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: A qualitative study from the patient’s perspective. BMC Public Health, 21.10.1186/s12889-021-12005-y ↗
43. Kigozi-Male, G., Heunis, C., Engelbrecht, M., and Tweheyo, R. (2024). Possible depression in new tuberculosis patients in the Free State province, South Africa. S. Afr. J. Infect. Dis., 39.10.4102/sajid.v39i1.653 ↗
44. Depression Is a Risk Factor for Noncompliance with Medical Treatment: Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence10.1001/archinte.160.14.2101 ↗
45. World Health Organization (2025, July 15). Global Tuberculosis Control Surveillance, Planning, Financing. Key Findings. WHO REPORT 2007. Available online: https://iris.who.int/bitstream/handle/10665/43629/9789241563141_eng.pdf?.
46. Aremu, T.O., Oluwole, O.E., Adeyinka, K.O., and Schommer, J.O. (2022). Medication Adherence and Compliance: Recipe for Improving Patient Outcomes. Pharmacy, 10.10.3390/pharmacy10050106 ↗
47. Gonah, L., Moodley, I., and Hlongwana, K. (2020). Effects of HIV and non-communicable disease comorbidity on healthcare costs and health experiences in people living with HIV in Zimbabwe. S. Afr. J. HIV Med., 21.10.4102/sajhivmed.v21i1.1102 ↗
48. Access to essential medicines to guarantee women’s rights to health: The pharmaceutical patents connection10.1111/jwip.12161 ↗
49. Li, X., Dessie, Y., Mwanyika-Sando, M., Assefa, N., Millogo, O., and Manu, A. (2024). Co-occurrence of and factors associated with health risk behaviors among adolescents: A multi-center study in sub-Saharan Africa, China, and India. Co-occurrence of and factors associated with health risk behaviors among adolescents: A multi-center study in sub-Saharan Africa, China, and India. Eclinical Med., 70.10.1016/j.eclinm.2024.102525 ↗
50. Barreto-Duarte, B., Villalva-Serra, K., Croda, J., Arcêncio, R.A., Maciel, E.L.N., and Andrade, B.B. (2025). Directly observed treatment for tuberculosis care and social support: Essential lifeline or outdated burden?. Lancet Reg. Health Am., 43.10.1016/j.lana.2025.101015 ↗
51. Olowoyo, K.S., Esan, D.T., Olowoyo, P., Oyinloye, B.E., Fawole, I.O., and Aderibigb, S. (2025). Treatment Adherence and Outcomes in Patients with Tuberculosis Treated with Telemedicine: A Scoping Review. Trop. Med. Infect. Dis., 10.10.20944/preprints202501.1322.v1 ↗
52. World Health Organization (2025, July 15). Quality Assurance of Sputum Microscopy in DOTS Programmed: Regional Guidelines in Countries in Western Pacific. Overview. WHO 2013. Available online: https://www.who.int/publications/i/item/9290610565#.
53. Ezelote, C.J., Nwoke, E.A., Ibe, S.N., Nworuh, B.O., Iwuoha, G.N., Iwuala, C.C., Udujih, O.G., Osuoji, J.N., Inah, A.S., and Okaba, A.E. (2024). Brief communication: Effect of mobile health intervention on medication time adherence among people living with HIV/AIDS receiving care at selected hospitals in Owerri, Imo State Nigeria. AIDS Res. Ther., 21.10.1186/s12981-024-00653-0 ↗
54. Zhu, Z., Guo, L., Yang, M., and Cheng, J. (2025). The effectiveness of monetary incentives in improving viral suppression, treatment adherence, and retention in care among the general population of people living with HIV: A systematic review and meta-analysis. AIDS Res. Ther., 22.10.1186/s12981-025-00748-2 ↗
55. Ridho, A., Alfian, S.D., van Boven, J.F.M., Levita, J., Yalcin, E.A., Le, L., and Alffenaar, J.W. (2022). Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients with Tuberculosis: Systematic Review of Randomized Controlled Trials. J. Med. Internet Res., 24.10.2196/33062 ↗
56. Chen, E.C., Owaisi, R., Goldschmidtc, L., Maimets, I., and Daftary, A. (2023). Patient perceptions of video directly observed therapy for tuberculosis: A systematic review. J. Clin. Tuberc. Other Mycobact. Dis., 35.10.1016/j.jctube.2023.100406 ↗
57. Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: A systematic review10.1016/j.glohj.2022.03.001 ↗
58. Rosu, L., Madan, J., Bronson, G., Nidoi, J., Tefera, M.G., Malaisamy, M., Squire, B.S., and Worrall, E. (2023). Cost of digital technologies and family-observed DOT for a shorter MDR-TB regimen: A modelling study in Ethiopia, India and Uganda. BMC Health Serv. Res., 23.10.1186/s12913-023-10295-z ↗
59. Wong, Y.J., Thum, C.C., Ng, K.Y., and Lee, S.W.H. (2023). Engaging community pharmacists in tuberculosis-directly observed treatment: A mixed-methods study. Prim. Health Care Res. Dev., 24.10.1017/S1463423623000105 ↗
60. World Health Organization (2025, April 29). A Patient-Centered Approach to TB Care Centered Approach to TB Care. WHO 2018. Available online: https://iris.who.int/bitstream/handle/10665/272467/WHO-CDS-TB-2018.13-eng.pdf.
61. Predictors of treatment adherence in patients with chronic disease using the Multidimensional Adherence Model: Unique considerations for patients with hemophilia10.17225/jhp00152 ↗
62. Marin, P.M., Munyeme, M., Kankya, C., Jubara, A.S., Matovu, E., Waiswa, P., Romano, J.S., Mutebi, F., Onafruo, D., and Kitale, E. (2024). Medication nonadherence and associated factors in patients with tuberculosis in Wau, South Sudan: A cross- sectional study using the world health organization multidimensional adherence model. Arch. Public Health, 82.10.1186/s13690-024-01339-9 ↗
63. Ukoaka, B.M., Ugwuanyi, E.A., Ukueku, K.O., Ajah, K.U., Udam, N.G., Daniel, F.M., Tajuddeen Adam Wali, T.A., and Gbuchie, M.A. (2024). Digital tools for improving antiretroviral adherence among people living with HIV in Africa. J. Med. Surg. Public Health, 2.10.1016/j.glmedi.2024.100077 ↗
64. World Health Organization (2025, July 15). WHO Guideline Recommendations on Digital Interventions for Health System Strengthening. WHO 2019. Available online: https://iris.who.int/bitstream/handle/10665/311941/9789241550505-eng.pdf.
65. Vilyte, G., Fox, T., Rohwer, A.C., Volmink, J., and McCaul, M. (2023). Digital devices for Tuberculosis treatment adherence. Cochrane Database Syst. Rev., 2023.10.1002/14651858.CD015709 ↗
66. Morse, R.M., Myburgh, H., Reubi, D., Archey, A.E., Busakwe, L., Garcia-Prats, A.J., Hesseling, A.C., Jacobs, S., Mbaba, S., and Meyerson, K. (2020). Opportunities for Mobile App–Based Adherence Support for Children with Tuberculosis in South Africa. JMIR Mhealth Uhealth, 8.10.2196/preprints.19154 ↗
67. Individual factors increasing complexity of drug treatment—A narrative review10.1007/s00228-019-02818-7 ↗
68. Is the medication regimen complexity often overlooked, and what can we do about it?10.1002/jppr.70013 ↗
69. Pharmacy Programs Administrator (2025, March 19). Program Rules: Home Medicines Review. Canberra: Commonwealth of Australia. 2024. Available online: https://www.ppaonline.com.au/wp-content/uploads/2019/01/HMR-Program-Rules.pdf.
70. Adherence and Impact of Medication Regimen Complexity among Geriatric Patients: A Review10.5530/ijopp.20250125 ↗
71. Biddell, C.B., Waters, A.R., Angove, R.S.M., Gallagher, K.D., Rosenstein, D.L., Lisa, L.P., Kent, E.E., Planey, A.M., and Wheeler, S.B. (2023). Facing financial barriers to healthcare: Patient-informed adaptation of a conceptual framework for adults with a history of cancer. Front. Psychol., 14.10.3389/fpsyg.2023.1178517 ↗
72. Anawade, P., Sharma, D., and Gahane, S. (2024). A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus, 16.10.7759/cureus.55996 ↗
73. Integrated Care Models in Primary Care: A Mainstay in Curbing the Burgeoning Menace of Mental Health Issues
74. Global System for Mobile A (2025, May 29). Half of the World’s Population Connected to the Mobile Internet by 2020, According to New GSMA Figures. GSMA Publishes Digital Inclusion Report Highlighting Efforts to Connect ‘Offline’ Populations. GSMA 2014. Available online: https://www.gsma.com/newsroom/press-release/half-worlds-population-connected-mobile-internet-2020-according-gsma.