Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: a mixed method systematic review

Sep 29, 2026

Upload by Elsa

Adherence to tuberculosis (TB) treatment is critical for improving outcomes and lowering TB-related mortality, yet people living with HIV (PLWH) face higher risk of both developing and dying from TB. This mixed-method systematic review identifies barriers and enablers shaping TB treatment adherence in HIV/TB coinfection, using a structured synthesis of evidence. Results highlight patient, disease, psychosocial, and health-system drivers, informing targeted interventions to strengthen adherence and service quality.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Background

Methods

Search strategy and inclusion

Data synthesis framework

Results

Barriers to adherence

Enablers of adherence

Inconclusive factors

Conclusion

Keywords

Lawal etal. BMC Public Health (2026) 26:39 BMC Public Health [https://doi.org/10.1186/s12889-025-25631-7](https://doi.org/10.1186/s12889-025-25631-7) SYSTEMATIC REVIEW Open Access Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: a mixed method systematic review AbdulAzeez Lawal 1,2, Abimbola Hussein3, Simon Tiberi4 and Heinke Kunst4,5,6* Abstract Background Adherence to tuberculosis (TB) treatment is essential in improving treatment outcomes and reducing TB-related mortality. People living with HIV (PLWH) are at a higher risk of developing and dying from TB. This systematic review aims to identify barriers and enablers affecting TB treatment adherence among people with HIV/TB coinfection. Methods A systematic search of the literature was carried out in January 2023 across four databases including MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews. The search strategy incorporated both subject keywords and MeSH terms related to “tuberculosis” AND“HIV” AND “adherence” AND “barriers” OR “enablers”and relevant synonyms, limited to English language publications from 2010 onwards. An integrative method was used to synthesise the data obtained from selected studies. Identified factors were categorized using a modified World Health Organization (WHO) framework for treatment adherence. Results Of the 3,216 studies yielded by the search, 21 studies met the inclusion criteria and were included in the final analysis. Reported barriers to adherence included male gender, presence of comorbidities, advanced HIV/TB disease, alcohol consumption, tobacco use, low socioeconomic status, limited knowledge of TB, stigma, negative interactions with healthcare services, and systemic deficiencies in healthcare delivery. In contrast, enablers of adherence included being married, educational achievement, employment, social support, nutritional support, SMS reminders, adequate disease knowledge, concurrent antiretroviral therapy (ART), and positive relationships with healthcare providers. The influence offactors such as age, family size, partner’s HIV status, and partner’s ART status on adherence remained inconclusive. Conclusion Adherence to TB treatment among individuals with HIV/TB coinfection is significantly influenced by social determinants, including educational level, socioeconomic status, and the quality of healthcare service delivery. Targeted interventions addressing these determinants may enhance treatment adherence and improve treatment outcomes. Keywords HIV, Tuberculosis (TB), HIV/TB coinfection, Adherence *Correspondence: Heinke Kunst [h.kunst@qmul.ac.uk](h.kunst@qmul.ac.uk) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Lawal et al. BMC Public Health (2026) 26:39 Background A total of 1.25 million people died from tuberculosis (T

FAQs

What was the purpose of this systematic review?

To identify barriers and enablers affecting adherence to active drug-sensitive TB treatment among people living with HIV with TB coinfection.

How were studies searched and selected?

A literature search in January 2023 covered four databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews), focusing on English publications from 2010 onward, and using subject keywords/MeSH terms for TB, HIV, adherence, barriers, and enablers.

What kinds of barriers and enablers were found?

Barriers included factors such as male gender, comorbidities, advanced HIV/TB disease, substance use, stigma, limited TB knowledge, and health-care service deficiencies; enablers included being married, education, employment, social and nutritional support, SMS reminders, ART use, and positive provider relationships.

Sep 29, 2026

Upload by Elsa