- Using quantitative and qualitative evidence from the published literature, interviews with people with TB, their carers/close family, and HCPs from centres across the UK, and based on the PaPA conceptual framework, we developed a manualised intervention for use in a UK NHS setting that aimed to improve drug adherence by identifying and then offering management solutions to important modifiable factors likely to influence this in adults with TB disease.
- Within our pilot and feasibility study, the TNA component appeared better than the standard risk assessment at detecting people in need of adherence and social support and resulted in more people being offered this. The proportion of people who accepted adherence support was similar in both arms, suggesting that more needs to be done to translate the increased risk detection into patient acceptance, or that not everyone identified as being at risk is actually in need of support (i.e. it may be too sensitive for its purpose). In contrast, baseline acceptance of social support measures was much higher in the intervention arm versus standard care (70% vs. 0%). Repeated administration of the TNA during treatment did identify ongoing (though lower than baseline) need for both adherence and social support than standard care.
- Adherence was high in both study arms, with the percentage of doses taken over 168 doses exceeding 80% for both intervention and control. We did not see evidence of improved adherence in the intervention arm. We did not observe any particular difference in adherence patterns in the intervention versus control arms.
- The intervention (videos, patient booklet) produced short-term improvements in beliefs, necessity, concerns (BMQ-S), and practical barriers (MPRAQ), but these were not sustained over time.
- Collecting health economic data using self-completed questionnaires was feasible in this patient population whereas retrieving data from records and CRFs was more challenging.
- To get the most from a multicomponent intervention package such as this will likely require some adaptation of both the manualised intervention and current TB service practice. Our results will be useful in informing a future full trial and cost-effectiveness analysis that could test this out.
Manualised package intervention to achieve treatment adherence in people with tuberculosis: the IMPACT pilot cluster-RCT · Conclusions
Conclusions
Attribution. Marc Lipman; Ibrahim Abubakar; Colin NJ Campbell; Caroline Clarke; Andrew J Copas; Patricia Costello et al. (2026). Manualised package intervention to achieve treatment adherence in people with tuberculosis: the IMPACT pilot cluster-RCT. National Institute for Health and Care Research. Copyright © 2026 Lipman et al. Licensed under CC BY 4.0. NCBI Bookshelf NBK621906. CC BY 4.0. Original source ↗. Text reproduced from the Bookshelf XML without changing wording; figures, images and supplements are not reproduced.