Background The burden of non-adherence to anti-tuberculosis (TB) treatment is poorly understood. One type is early discontinuation, that is, stopping treatment early. Given the implications of early discontinuation for treatment outcomes, we undertook a systematic review to estimate its burden, using the timing of loss to follow-up (LFU) as a proxy measure. Methods Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3–<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated. Results We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2–4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1–1.3 months). Conclusions A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment. PROSPERO registration number CRD42021218636. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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量化因早期停药而导致的不坚持抗结核治疗：对失访时间的系统文献综述

背景 人们对不坚持抗结核 (TB) 治疗的负担知之甚少。一类是早期停药，即提前停止治疗。考虑到早期停药对治疗结果的影响，我们使用失访时间（LFU）作为替代指标，进行了系统评价来估计其负担。方法 使用涵盖 LFU、TB 和治疗的术语对 Web of Science、Embase 和 Medline 进行了截至 2021 年 1 月 14 日的搜索。纳入了成人（≥ 18 岁）对药物敏感结核病标准治疗方案的研究，报告了 LFU（世界卫生组织定义）的时间。使用唐斯和布莱克的改编版本进行了叙述综合和质量评估。论文按照 2 个月内最终 LFU 的百分比进行分组。创建了三组：2 个月时 <28.3% LFU、≥28.3–<38.3%、≥38.3%）。计算 (1) 这些 LFU 和 (2) 所有患者中因提前停药而错过剂量月数的百分比。结果 我们找到了来自 21 个国家的 40 项相关研究。 LFU 的时间在国家内部和国家之间各不相同。 36/40 篇论文 (90.0%) 报告了 2 个月末患者 LFU 的百分比。 31/36 研究 (86.1%) 报告 2 个月后发生 LFU 的患者比例高于或符合预期。达到 LFU 的患者错过剂量月数的百分比范围在 37% 至 77% 之间（相当于 2.2-4.6 个月）。在所有患者中，错过剂量月数的百分比在 1% 至 22% 之间（相当于 0.1-1.3 个月）。结论 在治疗的前 2 个月内，出现 LFU 的患者比例高于预期。由于提前停药，这些患者错过治疗剂量月的比例很高。促进依从性和保留患者护理的干预措施绝不能忽视治疗的最初几个月。 PROSPERO 注册号 CRD42021218636。与研究相关的所有数据都包含在文章中或作为补充信息上传。