Challenges to tuberculosis treatment adherence among people who use alcohol and tobacco: a literature review
DOI:
https://doi.org/10.21527/2176-7114.2026.51.16824Keywords:
Tuberculosis, Alcoholics, Smokers, Medication Adherence, Treatment OutcomeAbstract
Objective: To analyze the challenges to tuberculosis (TB) treatment adherence among people who use alcohol and tobacco. Method: An integrative literature review was conducted based on a guiding question formulated using the PVO framework to develop the search strategy. The descriptors “Tuberculosis,” “Alcoholics,” “Smokers,” “Treatment Adherence and Compliance,” “Medication Adherence,” and “Treatment Outcome,” as indexed in DeCS and MeSH, were used to search the PubMed, Scopus, Web of Science, and LILACS databases. Primary studies published between 2019 and 2024, available in full text and published in Portuguese, English, or Spanish, were included. Results: Among the 13 selected articles, factors associated with compromised TB treatment adherence, regardless of alcohol or tobacco use, included working age, male sex, Black race/skin color, low educational attainment, low income, TB/HIV coinfection, diabetes mellitus, illicit drug use, treatment re-entry following previous default, adverse drug reactions, homelessness, and the lack of provision of directly observed therapy. Conclusion: The findings indicate that socioeconomic, clinical, and behavioral conditions influence adherence to TB treatment, highlighting the need for strategies that address the specific characteristics of these populations, with the aim of interrupting the chain of transmission and controlling the disease.
References
1 World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization; 2024.
2 World Health Organization. Global tuberculosis report 2023. Geneva: World Health Organization; 2023.
3 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico. Brasília: Ministério da Saúde; 2024.
4 Pinto FG, Garcia WMB, Junior RGP da S, Ferro GB, Costa AG da, Zavarise M de C, et al. Adherence to tuberculosis treatment in Primary Health Care: favorable and unfavorable factors for this process. RSD. 2022;11(4):e3011426962. DOI: https://doi.org/10.33448/rsd-v11i4.26962
5 Mansour GK, Ferreira L de PQ, Martins G de O, Melo JLL, Freitas PS, Nascimento MC do. Fatores associados à não adesão ao tratamento para tuberculose pulmonar. Medicina (Ribeirão Preto). 2021;54(2):e-172543. DOI: https://doi.org/10.11606/issn.2176-7262.rmrp.2021.172543
6 Sousa MNA de, Bezerra ALD, Egypto IAS do. Trilhando o caminho do conhecimento: o método de revisão integrativa para análise e síntese da literatura científica. OLEL. 2023;21(10):18448-83. DOI: https://doi.org/10.55905/oelv21n10-212
7 Martins TR, Carmo OFB do, Vilhaba JJ. Cases of tuberculosis in Brazil. Res Soc Dev. 2023;12(11):e124121143863. DOI: https://doi.org/10.33448/rsd-v12i11.43863
8 Santos IP dos, Menezes PRS de, Oliveira MS de, Souza LFA de, Barreto SL, Mascarenha GR, et al. Desigualdades sociais e os desafios no controle da tuberculose: um olhar sobre a vulnerabilidade no brasil. Rev cpaqv. 2024;16(3). DOI: https://doi.org/10.36692/V16N3-33R
9 Wigger GW, Bouton TC, Jacobson KR, Auld SC, Yeligar SM, Staitieh BS. The impact of alcohol use disorder on tuberculosis: a review of the epidemiology and potential immunologic mechanisms. Front Immunol. 2022;13:864817. DOI: https://doi.org/10.3389/fimmu.2022.864817
10 Messias I de PCL de, Wyszomirska RM de AF. Fatores associados ao abandono do tratamento da tuberculose: uma revisão integrativa. Rev JRG Est Acadêmicos. 2024;7(14):e14922. DOI: https://doi.org/10.55892/jrg.v7i14.922
11 Bezerra T de M, Matos CC. Tuberculose: principais fatores associados ao abandono do tratamento. Arq. Ciênc. Saúde Unipar. 2023;27(5):2699-715. DOI: https://doi.org/10.25110/arqsaude.v27i5.2023-036
12 Damasceno JPL, Farias LMD, Cavalcanti SB, Pachu CO. Consumo de drogas lícitas e o direito à saúde: uma revisão narrativa. In: Coelho ACM, Almeida FA de, organizadores. Direito e Políticas Públicas: desafios, perspectivas e possibilidades. São Paulo: Editora Científica Digital. 2022;10:150-162. DOI: https://dx.doi.org/10.37885/220709374
13 Nascimento VF do, Silva F da, Hattori TY, Lemes AG, Lourenção LG, Trettel ACP, et al. Fatores associados ao abandono do tratamento de tuberculose entre usuários de tabaco e drogas ilícitas. Salud, Arte y Cuidado. 2023;16(1):15-22. DOI: https://doi.org/10.5281/zenodo.7573211
14 Soares AK de A. Revisões da Literatura: Diferenças, métodos e aplicações. Braz. J. Implantol. Health Sci. 2025;7(11):982-1005. DOI: https://doi.org/10.36557/2674-8169.2025v7n11p982-1005
15 Sousa MNA de, Silva AMM da, Alves PRF, Fausto PF, Dias TR, Suarez L de AB. Fatores de risco e tuberculose: alerta para os profissionais de saúde. CIS - Conjecturas Inter Studies. 2021;21(4), 785–796. DOI: https://doi.org/10.53660/CONJ-289-315
16 Flor TO, Gonçalves AJ da S, Vinholi Júnior AJ, Trajano VS. Revisões de literatura como métodos de pesquisa: aproximações e divergências. In: Anais do VI Congresso Nacional de Pesquisa e Ensino em Ciências. Campina Grande: Realize Editora; 2022.
17 Dantas HL de L, Costa CRB, Costa L de MC, Lúcio IML, Comassetto I. Como elaborar uma revisão integrativa: sistematização do método científico. Revista Recien. 2022;12(37):334-345. DOI: https://doi.org/10.24276/rrecien2022.12.37.334-345
18 Biruel EP, Pinto R. Bibliotecário: um profissional a serviço da pesquisa. In: Anais do XXIV Congresso Brasileiro de Biblioteconomia, Documentação e Ciência da Informação. Maceió, AL: Universidade Federal de Alagoas; 2011. p. 330-3.
19 Kaliner E, Bornstein S, Kabha D, Lidji M, Sheffer R, Mor Z. A retrospective cohort analysis of treatment outcomes of patients with tuberculosis who used substances in Tel Aviv, Israel. Alcohol and Alcoholism. 2023;59(2):agad073. DOI: https://doi.org/10.1093/alcalc/agad073
20 Nowiński A, Wesołowski S, Korzeniewska-Koseła M. The impact of comorbidities on tuberculosis treatment outcomes in Poland: a national cohort study. Front Public Health. 2023;11:1253615. DOI: https://doi.org/10.3389/fpubh.2023.1253615
21 Sharani ZZ, Ismail N, Yasin SM, Zakaria Y, Razali A, Demong NAR, et al. Characteristics and determinants of loss to follow-up among tuberculosis (TB) patients who smoke in an industrial state of Malaysia: a registry-based study of the years 2013-2017. BMC Public Health. 2022;22(1):638. DOI: https://doi.org/10.1186/s12889-022-13020-3
22 Wekunda PW, Aduda DS, Guyah B. Determinants of tuberculosis treatment interruption among patients in Vihiga County, Kenya. PLOS ONE. 2021;16(12):e0260669. DOI: https://doi.org/10.1371/journal.pone.0260669
23 Lima SVM, Araújo KCGM, Nunes MAP, Nunes C. Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalized hierarchical analysis. Heliyon. 2021;7(4):e06788. DOI: https://doi.org/10.1016/j.heliyon.2021.e06788
24 Plokhykh V, Duka M, Cassidy L, Chen C-Y, Malakyan K, Isaakidis P, et al. Mental health interventions for rifampicin-resistant tuberculosis patients with alcohol use disorders, Zhytomyr, Ukraine. J Infect Dev Ctries. 2021;15(9.1):25S-33S. DOI: https://doi.org/10.3855/jidc.13827
25 Vargas KR, Freitas AA, Azeredo ACV, Silva DR. Smoking prevalence and effects on treatment outcomes in patients with tuberculosis. Rev Assoc Med Bras. 2021;67(3):406-410. DOI: https://doi.org/10.1590/1806-9282.20200825
26 Khan AH, Sulaiman SAS, Hassali MA, Khan KU, Ming LC, Mateen O, et al. Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study. BMC Public Health. 2020;20(1):854. DOI: https://doi.org/10.1186/s12889-020-08856-6
27 Gupta A, Kumar V, Mahajan A, Goel S. Effect of smoking on treatment outcomes among newly diagnosed Tuberculosis patients in Shimla. Indian J Community Health. 2019;31(2):193-199. DOI: https://doi.org/10.47203/IJCH.2019.v31i02.007
28 Thomas BE, Thiruvengadam K, Rani S, Kadam D, Ovung S, Sivakumar S, et al. Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored. PLOS ONE. 2019;14(7):e0220507. DOI: https://doi.org/10.1371/journal.pone.0220507
29 Ma Y, Che NY, Liu YH, Shu W, Du J, Xie SH, et al. The joint impact of smoking plus alcohol drinking on treatment of pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis. 2019;38(4):651-657. DOI: https://doi.org/10.1007/s10096-019-03489-z
30 Espírito Santo SSS do, Abreu AMM, Portela LF, Mattos LR, Paixao LAR da, Brites RMR, et al. Consumo de substâncias psicoativas em pacientes com tuberculose: adesão ao tratamento e interface com Intervenção Breve. Rev Enferm Referência. 2020;5(1):e19093. DOI: https://doi.org/10.12707/RIV19093
31 Souza DCS, Oliveira KS de, Andrade RL de P, Scatena LM, Silva-Sobrinho RA. Aspects related to the outcomes of the treatment, in international borders, of cases of tuberculosis as associated to comorbidities. Rev Gaúcha Enferm. 2019;40:e20190050. DOI: https://doi.org/10.1590/1983-1447.2019.20190050
32 David JC, Fonte D, Sutter-Dallay AL, Auriacombe M, Serre F, Rascle N, et al. The stigma of smoking among women: a systematic review. Soc Sci Med. 2024;340:116491. DOI: https://doi.org/10.1016/j.socscimed.2023.116491
33 Terra AAA, Silva GA da, Giarola LTP. Acesso ao diagnóstico da tuberculose na perspectiva das pessoas acometidas pela doença: um estudo transversal. HU Rev. 2026;51:1-9. DOI: 10.34019/1982-8047.2025.v51.48431
34 Guidoni LM, Negri L dos SA, Carlesso GF, Zandonade E, Maciel ELN. Custos catastróficos em pacientes com tuberculose no Brasil: estudo em cinco capitais. Esc Anna Nery. 2021;25(5):e20200546. DOI: https://doi.org/10.1590/2177-9465-EAN-2020-0546
35 Santos ACE dos, Brunfentrinker C, Pena L da S, Saraiva S dos S, Boing AF. Analysis and comparison of tuberculosis treatment outcomes in the homeless population and in the general population of Brazil. J bras pneumol. 2021;47(2):e20200178. DOI: https://doi.org/10.36416/1806-3756/e20200178
36 Pavinati G, Lima LV de, Ferreira MRL, Zanatta STP, Magnabosco GT. Trends and clusters of tuberculosis treatment interruption among people experiencing homelessness in Brazil: influence of individual, social and programmatic factors. Rev Bras Epidemiol. 2025;28:e250041. DOI: https://doi.org/10.1590/1980-549720250041.2
37 Mitouso VS, Lozano AW, Melo KGF de, Justi VD de O, Rodrigues VAV, Ballaris A de L, et al. Directly observed treatment for tuberculosis in brazil: an integrative review focused on primary health care and the sus. REMUNOM. 2026;13(09):1-28. DOI: https://doi.org/10.66104/4t76ks71
38 Grigorio IG, Glória KMS, Simões M de O, Rodrigues KC, Pereira FR. Tratamento Diretamente Observado para a Tuberculose na Atenção Primária à Saúde: discursos e práticas. Rev. Enf. UFJF. 2025;11(1). DOI: https://doi.org/10.34019/2446-5739.2025.v11.42990
39 Barbosa TMS, Silva MEW de B, Bazante GT, Martins C das G de A, Tavares BT de L, Feijão LEA, et al. Abordagem dos profissionais de saúde frente aos casos de tuberculose na atenção primária à saúde. Rev. Contemp. 2023;3(9):14662-74. DOI: https://doi.org/10.56083/RCV3N9-065
40 Silva VRV da, Mantey JMC, Oliveira JJ de, Silva ENR da, Souza CP de, Araújo VM da S, et al. Challenges in care for patients with tuberculosis in primary care. RSD. 2023;12(8):e13612842974. DOI: https://doi.org/10.33448/rsd-v12i8.42974
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Denise Taquini, Rebeca Sousa Braga, Sônia Maria Dias de Lima, Nathalia Halax Orfão
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
