Educational and Behavioral Interventions to Improve Treatment Adherence in Patients with Active Tuberculosis: A Systematic Review and Meta-Analysis

Educational and behavioral support may improve adherence during treatment for active tuberculosis (TB). This systematic review and meta-analysis examined direct medication adherence and downstream treatment outcomes. Searches covered PubMed, CINAHL, the Cochrane Library, ScienceDirect, and Wiley Online Library for publications from January 2000 through August 2026. Twenty-five studies were included; 14 contributed to direct-adherence syntheses, comprising ten studies with dichotomous outcomes and four with continuous scores. The reported four-trial randomized estimate favored adherence support (odds ratio [OR] 3.48, 95% confidence interval [CI] 1.80–6.73), including a cluster trial represented by a reported adjusted estimate. The supporting ten-study analysis combining randomized and nonrandomized evidence yielded OR 3.76 (95% CI 2.58–5.47). Continuous-score results were heterogeneous and imprecise (Hedges’ g 1.17, 95% CI −0.67 to 3.01). Four studies contributed to the principal favorable-treatment-outcome synthesis (risk ratio 1.110, 95% CI 0.995–1.239); a multicomponent digital trial contributed only to an exploratory extension. Educational and behavioral support may improve dichotomously defined adherence, but sustained clinical benefits and superiority of individual components remain uncertain. Incomplete source-level documentation and incomplete numerical verification limit confidence in the reported pooled estimates. The review was not prospectively registered.