What factors influence adherence and non-adherence to multi-drug therapy for the treatment of leprosy within the World Health Organisation South East Asia region? A systematic review

Introduction Leprosy is an infection caused by Mycobacterium leprae. Despite curative treatment being available, leprosy is still prevalent worldwide, with little change in annual cases observed in the past decade. The WHO South East Asia region is the worst affected, accounting for over 70% of new cases. One reason leprosy transmission still occurs is non-adherence to multi-drug therapy. This project aims to determine the factors that influence adherence. Methods A systematic review was performed using 6 databases. This returned 402 unique results. Screening of the title and abstract resulted in 362 of these being excluded. From the remaining 40, full-text analysis identified 17 studies that met the inclusion criteria and formed the review. Both qualitative and quantitative methods of collecting and analyzing data were used to form a non-quantitative synthesis of the findings. Results Four factors influenced adherence: medication-related, healthcare-related, patient-related and society-related. From these, lack of knowledge about leprosy and multi-drug therapy was a predominant barrier to adherence, which related to all of these factors. Stigma and being female were also seen as important barriers to adherence - these manifested in numerous ways. Conclusion The review identified diverse barriers to adherence to MDT and no simple intervention will overcome these. Rather, wider issues such as continuous access to healthcare (particularly for women), stigma reduction and patient education need to be addressed. Improving these will increase patient confidence in, and access to, MDT, which will ultimately result in improved adherence to therapy.