ABSTRACT

Objective:

To analyze actions promoting adherence to tuberculosis treatment that are being carried out by nurses in different countries.

Method:

Scoping review with selection of articles on the subject in LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases.

Results:

Forty studies, published between 2009 and 2020, allowed the identification of nursing actions in two thematic categories. In the category “Nursing care: TB patients’ specific needs to promote adherence to treatment”, actions involving clinical aspects, professionals’ knowledge and skills, educational and relational processes were identified. In the category “The role of nursing in coping with the social determinants of health to promote adherence to treatment”, interventions related to the strengthening of family and community support, the inclusion of socioeconomic issues in care plans, and respect for cultural differences were highlighted.

Conclusion:

Nursing work directed to the adherence to disease treatment requires the development of technical, ethical and, above all, political skills, aiming to increase the success of the actions carried out by these professionals.

DESCRIPTORS
Tuberculosis; Medication Adherence; Public Health Nursing; Health Policy; Review

RESUMEN

Objetivo:

Analizar las acciones de promoción de la adhesión al tratamiento de la tuberculosis que han sido realizadas pela enfermería en diferentes países.

Método:

Revisión de alcance con selección de artículos sobre el tema en las bases LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science y Scopus.

Resultados:

Cuarenta estudios, publicados entre 2009 y 2020 viabilizaron identificar acciones de enfermería en dos clases temáticas. En la clase- Cuidado de enfermería: necesidades específicas de la persona con tuberculosis para la promoción de la adhesión al tratamiento-, se identificaron acciones que involucran los aspectos clínicos, el conocimiento y habilidades de los profesionales, los procesos educativos y relacionales. En la clase- La actuación de la enfermería en el enfrentamiento de los determinantes sociales de la salud para la promoción de la adhesión al tratamiento, se destacaron intervenciones que se relacionan al fortalecimiento del apoyo familiar y comunitario, a la inclusión de las cuestiones socioeconómicas en los planes de cuidado y el respeto a las diferencias culturales.

Consideraciones Finales:

La actuación de la enfermería con énfasis a la adhesión al tratamiento de la enfermedad exige el desarrollo de competencias técnicas, éticas y, sobretodo, políticas, con el objetivo de ampliar el éxito de las acciones realizadas por esos profesionales.

DESCRIPTORES
Tuberculosis; Cumplimiento de la Medicación; Enfermería en Salud Pública; Política de Salud; Revisión

RESUMO

Objetivo:

Analisar as ações de promoção da adesão ao tratamento da tuberculose que vêm sendo realizadas pela enfermagem em diferentes países.

Método:

Revisão de escopo com seleção de artigos sobre o tema nas bases LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science e Scopus.

Resultados:

Quarenta estudos, publicados entre 2009 e 2020 possibilitaram identificar ações de enfermagem em duas categorias temáticas. Na categoria “Cuidado de enfermagem: necessidades específicas da pessoa com TB para a promoção da adesão ao tratamento” foram identificadas ações que envolvem os aspectos clínicos, o conhecimento e habilidades dos profissionais, os processos educativos e relacionais. Na categoria “A atuação da enfermagem no enfrentamento dos determinantes sociais da saúde para a promoção da adesão ao tratamento”, destacaram-se intervenções que se relacionam ao fortalecimento do apoio familiar e comunitário, à inclusão das questões socioeconômicas nos planos de cuidado e o respeito às diferenças culturais.

Conclusão:

A atuação da enfermagem voltada à adesão ao tratamento da doença exige o desenvolvimento de competências técnicas, éticas e, sobretudo, políticas, com vistas a ampliar o êxito das ações realizadas por esses profissionais.

DESCRITORES
Tuberculose; Adesão à Medicação; Enfermagem em Saúde Pública; Política de Saúde; Revisão

INTRODUCTION

Tuberculosis (TB), an airborne infectious and contagious disease of high mortality, has a high chance of cure when drug treatment is universally available and the indicated therapeutic regimen is maintained with no interruption until its conclusion(¹1. World Health Organization. Global Tuberculosis Report [Internet]. Geneva: WHO; 2020 [cited 2020 Dec 10]. Available from: https://www.who.int/publications/i/item/9789240013131
https://www.who.int/publications/i/item/... ). Adherence is defined by the collaborative acceptance by the person with TB of the treatment instituted by the health professional(²2. Brasil. Ministério da Saúde; Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica. Manual de recomendações para o controle da tuberculose no Brasil [Internet]. Brasília; 2018 [citado 2019 out. 22]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ). Non-adherence to treatment results in an increase in the clinical complexity of cases, with the development of resistance to tuberculostatic drugs, as well as an epidemiological impact with the persistence of sources of disease transmission(¹1. World Health Organization. Global Tuberculosis Report [Internet]. Geneva: WHO; 2020 [cited 2020 Dec 10]. Available from: https://www.who.int/publications/i/item/9789240013131
https://www.who.int/publications/i/item/... ).

Several aspects lead to complications in the process of adherence to TB treatment, including unfavorable socioeconomic conditions, insufficient supply/quality of health services, clinical complications of the disease, as well as subjective and cultural characteristics of the person undergoing treatment(³3. Viana PV, Redner P, Ramos JP. Factors associated with loss to follow-up and death in cases of drug-resistant tuberculosis (DR-TB) treated at a reference center in Rio de Janeiro, Brazil. Cad Saúde Pública. 2018;34(5):e00048217. https://doi.org/10.1590/0102-311X00048217
https://doi.org/10.1590/0102-311X0004821... ,⁴4. Fang XH, Shen HH, Hu WQ, Xu QQ, Jun L, Zhang ZP, et al. Prevalence of and factors influencing anti-tuberculosis treatment non-adherence among patients with pulmonary tuberculosis: a cross-sectional study in Anhui province, Eastern China. Med Sci Monit. 2019;25:1928-35. http://doi.org/10.12659/MSM.913510
http://doi.org/10.12659/MSM.913510... ,⁵5. Zegeye A, Dessie G, Wagnew F, Gebrie A, Islam SMS, Tesfaye B, Kiross D. Prevalence and determinants of anti-tuberculosis treatment non-adherence in Ethiopia: a systematic review and meta-analysis. PLoS One. 2019;14(1):e0210422. https://doi.org/10.1371/journal.pone.0210422
https://doi.org/10.1371/journal.pone.021... ). These aspects are associated with social determinants in the health and disease process, knowledge that gave new meaning to the problem of illness and refounded the Health Promotion movement, with new perspectives of interdisciplinary health work linked to the knowledge and values of individuals and communities. In the debate regarding TB, it is worth emphasizing the concept of Vulnerability and Human Rights that, incorporating the ideas of the social determinants of health and the New Health Promotion, expands the potential of this fusion of expertise and knowledge by assuming that collective and sympathetic construction of care actions can only thrive in contexts favorable to human rights and where the principles of social justice, equity, and human dignity(⁶6. Ayres JR, Paiva V, França-Júnior I. Conceitos e práticas de prevenção: da história natural da doença ao quadro da vulnerabilidade e direitos humanos. In: Paiva V, Ayres JR, Buchalla CM, editores. Vulnerabilidade e direitos humanos: prevenção e promoção da saúde: da doença à cidadania. Curitiba: Juruá, 2012. p. 43-94.) are followed.

In the poorest regions, especially in Latin American, African and Asian countries, the highest burdens of the disease and the highest burdens of co-infection (TB-HIV) are recorded(¹1. World Health Organization. Global Tuberculosis Report [Internet]. Geneva: WHO; 2020 [cited 2020 Dec 10]. Available from: https://www.who.int/publications/i/item/9789240013131
https://www.who.int/publications/i/item/... ). Brazil, a country with one of the highest income inequalities in the world(⁷7. Souza PHG, Medeiros M. The concentration of income at the top in Brazil, 2006-2014 [Internet]. Brasília: International Policy Centre for Inclusive Growth; 2017 [cited 2019 Oct 23]. Available from: http://ipcig.org/pub/eng/WP163_The_concentration_of_income_at_the_top_in_Brazil.pdf
http://ipcig.org/pub/eng/WP163_The_conce... ), has a high burden of TB and cases of co-infection (TB/HIV), an unsatisfactory cure rate (71.4%), and high treatment dropout (10.8%)(¹1. World Health Organization. Global Tuberculosis Report [Internet]. Geneva: WHO; 2020 [cited 2020 Dec 10]. Available from: https://www.who.int/publications/i/item/9789240013131
https://www.who.int/publications/i/item/... ,⁸8. Boletim Epidemiológico. Brasília: Ministério da Saúde, Secretaria de Vigilância em Saúde. Brasil livre da tuberculose: evolução dos cenários epidemiológicos e operacionais da doença [Internet]. 2019 [citado 2019 out. 23];50(9). Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2019/marco/22/2019-009.pdf
https://portalarquivos2.saude.gov.br/ima... ). In European countries, the disease is concentrated among immigrants who live in precarious living conditions generated in political contexts of denial of citizenship rights(⁹9. Kruczak K, Augustynowicz-Kopeć E, Kozińska M, Passak-Stańda G, Niżankowska-Mogilnicka E, Sładek K. Tuberculosis transmission in the population of patients from the Krakow Region (Poland) based on the epidemiological and molecular methods. Int J Mycobacteriol. 2019;8(1):60-9. https://doi.org/10.4103/ijmy.ijmy_11_19
https://doi.org/10.4103/ijmy.ijmy_11_19... –¹⁰10. Bonvicini F, Cilloni S, Fornaciari R, Casoni C, Marchesi C, Greci M, et al. Compliance with tuberculosis screening in irregular immigrants. Int J Environ Res Public Health. 2018;16(1):E28. https://doi.org/10.3390/ijerph16010028
https://doi.org/10.3390/ijerph16010028... ).

As a response to this epidemiological scenario, the World Health Organization (WHO)/United Nations Fund and the signatory countries of their recommendations have been formulating strategies focused on promoting adherence to TB treatment(²2. Brasil. Ministério da Saúde; Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica. Manual de recomendações para o controle da tuberculose no Brasil [Internet]. Brasília; 2018 [citado 2019 out. 22]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ,¹¹11. World Health Organization. The stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals [Internet]. Geneva: WHO; 2006. [cited 2020 June 19]. Available from: https://apps.who.int/iris/handle/10665/69241
https://apps.who.int/iris/handle/10665/6... –¹²12. World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015 [Internet]. Geneva: WHO; 2013 [cited 2020 June 19]. Available from: https://www.who.int/tb/post_2015_tb_presentation.pdf
https://www.who.int/tb/post_2015_tb_pres... ) and facing the social determinants associated with the disease. Currently, the “End TB Strategy” aims to eradicate TB, with programmatic actions emphasizing the implementation of multisectoral actions, as well as the prevention and person-centered care(²2. Brasil. Ministério da Saúde; Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica. Manual de recomendações para o controle da tuberculose no Brasil [Internet]. Brasília; 2018 [citado 2019 out. 22]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ). Such actions are structured in the context of universal access to health and the expansion of Primary Health Care (PHC) services. With regard to the enhancement of therapeutic adherence, the recommendations emphasize the role of nursing professionals in the elaboration of care plans that include not only help for diagnosis but also operationalization of directly observed therapy (DOT)(²2. Brasil. Ministério da Saúde; Secretaria de Vigilância em Saúde, Departamento de Vigilância Epidemiológica. Manual de recomendações para o controle da tuberculose no Brasil [Internet]. Brasília; 2018 [citado 2019 out. 22]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ,¹³13. Peruhype RC, Mitano F, Hoffmann JF, Surniche CA, Palha PF. Planning pathways in the transfer of directly observed treatment of tuberculosis. Rev Latino Am Enfermagem. 2018;26:e3015. http://dx.doi.org/10.1590/1518-8345.2213.3015
http://dx.doi.org/10.1590/1518-8345.2213... –¹⁴14. International Union Against Tuberculosis and Lung Disease. Best practice for the care of patients with tuberculosis: a guide for low-income countries. 2nd ed. Paris; 2017.).

Considering the analyses of the global epidemiological situation of TB and the importance of adherence to treatment in disease control actions, some questions shall be answered about the role of nursing in the various geopolitical and sanitary contexts in which the disease is highlighted on the agenda of health problems. Most of the available literature on the subject results from investigations on therapeutic adherence, focusing on factors related to TB treatment dropout(⁵5. Zegeye A, Dessie G, Wagnew F, Gebrie A, Islam SMS, Tesfaye B, Kiross D. Prevalence and determinants of anti-tuberculosis treatment non-adherence in Ethiopia: a systematic review and meta-analysis. PLoS One. 2019;14(1):e0210422. https://doi.org/10.1371/journal.pone.0210422
https://doi.org/10.1371/journal.pone.021... ,¹⁵15. Maffacciolli R, Oliveira DLLC, Brand EM. Vulnerability and human rights in the understanding of trajectories of tuberculosis hospitalization. Saúde Soc. 2017;26(1):286-99. http://dx.doi.org/10.1590/s0104-12902017168038
http://dx.doi.org/10.1590/s0104-12902017... ,¹⁶16. Casals M, Rodrigo T, Camprubí E, Orcau A, Caylà JA. Tuberculosis and immigration in Spain: scoping review. Rev Esp Salud Publica. 2014;88(6):803-9. http://dx.doi.org/10.4321/S1135-57272014000600011
http://dx.doi.org/10.4321/S1135-57272014... ,¹⁷17. Pinheiro de Souza E, Souza Barbosa EC, Ataide Rodrigues I, Vidal Nogueira LM. Prevention and control of tuberculosis: integrative literature review. Rev CuidArte. 2015;6(2):1094-102. http://dx.doi.org/10.15649/cuidarte.v6i2.178
http://dx.doi.org/10.15649/cuidarte.v6i2... ,¹⁸18. Valença MS, Possuelo LG, Cezar-Vaz MR, Silva PEA. Tuberculosis in Brazilian prisons: an integrative review of the literature. Ciênc Saúde Coletiva. 2016;21(7):2147-60. http://dx.doi.org/10.1590/1413-81232015217.16172015
http://dx.doi.org/10.1590/1413-812320152... ,¹⁹19. Floyd K, Glaziou P, Zumla A, Raviglione M. The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. Lancet Respir Med. 2018;6(4):299-314. https://doi.org/10.1016/S2213-2600(18)30057-2
https://doi.org/10.1016/S2213-2600(18)30... ,²⁰20. Rabahi MF, Silva Junior JLR, Ferreira ACG, Tannus-Silva DGS, Conde MB. Tuberculosis treatment. J Bras Pneumol. 2017;43(6):472-86. http://dex.doi.org/10.1590/S1806-37562016000000388
http://dex.doi.org/10.1590/S1806-3756201... ). Many of these studies, even though they signal the importance of nursing in this process, do not show which actions are feasible in different health services and in different contexts, which constituted an important knowledge gap to be explored.

In this regard, the objective of this study was to analyze the actions promoting adherence to tuberculosis treatment that are being carried out by nurses in different countries.

METHOD

Type of Study

The scoping review(²¹21. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616
https://doi.org/10.1080/1364557032000119... –²²22. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69
https://doi.org/10.1186/1748-5908-5-69... ) was used as a method that aims to obtain broad and comprehensive results in the review of the scientific literature(²³23. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
https://doi.org/10.1111/j.1471-1842.2009... –²⁴24. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2020. https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ).

The five methodological steps followed in this scoping review include: (1) identification of the research question, (2) identification of relevant studies, (3) selection of studies, (4) data mapping, and (5) collection, summary and reporting of results(²²22. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69
https://doi.org/10.1186/1748-5908-5-69... ).

The question elaborated for this review is based on the PCC (population, concept and context) mnemonic strategy(²⁴24. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2020. https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ), namely: what actions to promote adherence to TB treatment are being carried out by nurses to control the disease in the world?

Data Collection

The studies were selected from different portals and databases: Latin American and Caribbean Literature on Health Sciences (LILACS); Spanish Bibliographic Index of Health Sciences (IBECS); Nursing Database (BDENF); Scientific Electronic Library Online (SciELO); Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed; Embase; Web of Science, and Scopus.

The inclusion criteria were original articles published in English, Portuguese and Spanish, whose objects addressed actions of the nursing team that promote adherence to TB treatment. Thus, studies with quantitative, qualitative, and mixed designs were included. Studies that had as participants professionals of the nursing team involved in the care of TB and/or sick people who were undergoing treatment, or who had already obtained a cure for the disease, attended in public or private health services, were listed. To obtain the most scientifically robust evidence on the topic, review studies, case studies, dissertations, theses, or theoretical articles were not included. Due to the large volume of publications found in the databases, it was also decided that gray literature would not be included.

For the literature search, the time limit of studies published from January 2009 to November 2020 was established. The time limit of 2009 corresponds to the period from which TB is treated as a serious public health problem, a fact that guided the main disease control strategies(¹¹11. World Health Organization. The stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals [Internet]. Geneva: WHO; 2006. [cited 2020 June 19]. Available from: https://apps.who.int/iris/handle/10665/69241
https://apps.who.int/iris/handle/10665/6... –¹²12. World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015 [Internet]. Geneva: WHO; 2013 [cited 2020 June 19]. Available from: https://www.who.int/tb/post_2015_tb_presentation.pdf
https://www.who.int/tb/post_2015_tb_pres... ) for coping with its social determinants.

The research team defined a search strategy for each database, considering the selected Health Sciences Descriptors (DeCS) and/or Medical Subject Headings (MeSH) and keeping the Boolean operator AND (Chart 1). When many results appeared, the descriptors and/or MeSH were expanded using 3 terms, and they were combined using the operator AND to increase the level of search specificity. The search strategy was also carried out in Portuguese and Spanish.

The selection of studies took place in three consecutive steps: reading of the title, abstract, and full article. This process was carried out by two researchers, and use of consensus by a third researcher in case of disagreement regarding findings.

Data systematization was performed using a structured instrument that allowed the following information to be synthesized: year of publication, journal, place of study, type of service, research participants, type of data collection, method used, type analysis, theme addressed, and main results (adherence actions with the involvement of the nursing team).

Figure 1 shows the search, exclusion, and selection process of the studies found according to PRISMA recommendations(²⁵25. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169(7):467-73. https://doi.org/doi/10.7326/M18-0850
https://doi.org/doi/10.7326/M18-0850... ).

Data Analysis and Treatment

At this step, the compilation and communication of results was carried out, to present an overview of all the material. These results are presented through a numerical and thematic synthesis(²⁴24. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2020. https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12... ). In the numerical synthesis, the characteristics of the studies included were described, such as the total number of studies, method, year of publication, characteristics of the studied population and countries where the studies were developed. The thematic synthesis, on the other hand, was organized according to the nature of the actions to promote adherence to TB treatment that have been carried out by the nursing team, generating a broad presentation of the scoping review on the topic.

RESULTS

The application of search strategies in portals and databases allowed the identification of 1,568 articles. In the selection step, 90 articles were obtained, which were analyzed in full. In the eligibility step, 40 studies were selected, the results of which answered the research question.

The period of publication of the reports covered the years 2009 to 2020, with 22 publications referring to the period from 2015 to 2018. The 40 articles report studies developed in Latin American countries: 13 in Brazil(²⁶26. Rodrigues DCS, Oliveira AAV, Andrade SLE, Araújo EMNF, Lopes AMC, Sá LD. The discourse of people taken ill by tuberculosis about the treatment adhesion. Ciênc Enferm. 2017;23(1):67-76. http://dx.doi.org/10.4067/S0717-95532017000100067
http://dx.doi.org/10.4067/S0717-95532017... –³⁸38. Orlandi GM, Pereira EG, Biagolini, REM, França FOS, Bertolozzi MR. Incentivos sociais na adesão ao tratamento da tuberculose. Rev Bras Enferm. 2020;72(5):1182-8. https://doi.org/10.1590/0034-7167-2017-0654
https://doi.org/10.1590/0034-7167-2017-0... ) and three in Peru(³⁹39. Castañeda-Navarrete A, Sánchez-León D, Manchego-Quispe M, Musayón-Oblitas Y. Efectividad de la consejería en enfermería en la adherencia al tratamiento farmacológico en pacientes con tuberculosis de la micro red de salud Jaime Zubieta Calderón en San Juan de Lurigancho, Lima, Perú. Rev Enferm Herediana. 2016;9(1):10-6. https://doi.org/10.20453/renh.v9i1.2857
https://doi.org/10.20453/renh.v9i1.2857... –⁴¹41. Chirinos NC, Meirelles BHS, Bousfield AB. Relationship between the social representations of health professionals and people with tuberculosis and treatment abandonment. Texto Contexto Enferm. 2017;26(1):e5650015. http://dx.doi.org/10.1590/0104-07072017005650015
http://dx.doi.org/10.1590/0104-070720170... ). On the African continent, nine studies were developed, namely: six in South Africa(⁴²42. Serapelwane MG, Davhana-Maselesele M, Masilo GM. Experiences of patients having tuberculosis (TB) regarding the use of directly observed treatment short-course (DOTS) in the North West Province, South Africa. Curationis. 2016;39(1):e1-9. http://dx.doi.org/10.4102/curationis.v39i1.1629
http://dx.doi.org/10.4102/curationis.v39... –⁴⁷47. Mabunda JT, Khoza LB, Van den Borne HB, Lebese RT. Needs assessment for adapting TB directly observed treatment intervention Programme in Limpopo Province, South Africa: a community-based participatory research approach. Afr J Prim Health Care Fam Med. 2016;8(2):e1-7. http://dx.doi.org/10.4102/phcfm.v8i2.981
http://dx.doi.org/10.4102/phcfm.v8i2.981... ), one in Kenya(⁴⁸48. Braitstein P, Siika A, Hogan J, Kosgei R, Sang E, Sidle J, et al. A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment. J Int AIDS Soc. 2012;15:7. http://dx.doi.org/10.1186/1758-2652-15-7
http://dx.doi.org/10.1186/1758-2652-15-7... ), one in Nigeria(⁴⁹49. Ibrahim LM, Hadjia IS, Nguku P, Waziri NE, Akhimien MO, Patrobas P, et al. Health care workers’ knowledge and attitude towards TB patients under direct observation of treatment in Plateau state Nigeria, 2011. Pan Afr Med J. 2014;18 Suppl 1:8. http://dx.doi.org/10.11694/pamj.supp.2014.18.1.3408
http://dx.doi.org/10.11694/pamj.supp.201... ) and one in Namibia(⁵⁰50. Zvavamwe Z, Ehlers VJ. Experiences of a community-based tuberculosis treatment programme in Namibia: a comparative cohort study. Int J Nurs Stud. 2009;46(3):302-9. http://dx.doi.org/10.1016/j.ijnurstu.2008.09.013
http://dx.doi.org/10.1016/j.ijnurstu.200... ). In Europe, six studies were carried out: two in Spain(⁵¹51. Guix-Comellas EM, Rozas-Quesada L, Velasco-Arnaiz EV, Ferrés-Canals A, Estrada-Masllorens JM, Force-Sanmartín E, et al. Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: a nonrandomized controlled trial. J Adv Nurs. 2018;74(8):1819-30. http://dx.doi.org/10.1111/jan.13692
http://dx.doi.org/10.1111/jan.13692... –⁵²52. Guix-Comellas EM, Rozas-Quesada L, Force-Sanmartín E, Estrada-Masllorens JM, Galimany-Masclans J, Noguera-Julian A. Influence of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: research protocol. J Adv Nurs. 2015;71(9):2189-99. http://dx.doi.org/10.1111/jan.12656
http://dx.doi.org/10.1111/jan.12656... ), two in the United Kingdom(⁵³53. Boudioni M, McLaren S, Belling R, Woods L. Listening to those on the frontline: service users’ experiences of London tuberculosis services. Patient Prefer Adherence. 2011;5:267-77. https://doi.org/10.2147/ppa.s20361
https://doi.org/10.2147/ppa.s20361... –⁵⁴54. Gerrish K, Naisby A, Ismail M. Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK. J Adv Nurs. 2013;69(10):2285-94. http://dx.doi.org/10.1111/jan.12112
http://dx.doi.org/10.1111/jan.12112... ), one in Macedonia(⁵⁵55. Ilievska-Poposka B, Zakoska M, Mitreski V. Evaluation of the directly observed treatment’s acceptance by tuberculosis patients in the Republic of Macedonia. Open Access Maced J Med Sci. 2018;6(5):896-900. http://dx.doi.org/10.3889/oamjms.2018.204
http://dx.doi.org/10.3889/oamjms.2018.20... ), and one in Ukraine(⁵⁶56. Charyeva Z, Curtis S, Mullen S, Senik T, Zaliznyak, O. What works best for ensuring treatment adherence. Lessons from a social support program for people treated for tuberculosis in Ukraine. PloS One. 2019;14(8):e0221688. http://dx.doi.org/10.1371/journal.pone.0221688
http://dx.doi.org/10.1371/journal.pone.0... ). In Asia, there were five studies: two in Japan(⁵⁷57. Shimamura T, Taguchi A, Kobayashi S, Nagata S, Magilvy JK, Murashima S. The strategies of Japanese public health nurses in medication support for high-risk tuberculosis patients. Public Health Nurs. 2012;30(4):370-8. http://dx.doi.org/10.1111/phn.12010
http://dx.doi.org/10.1111/phn.12010... –⁵⁸58. Shiratani KN. Psychological changes and associated factors among patients with tuberculosis who received directly observed treatment short-course in metropolitan areas of Japan: quantitative and qualitative perspectives. BMC Public Health. 2019;19(1):1642. https://doi.org/10.1186/s12889-019-8001-9
https://doi.org/10.1186/s12889-019-8001-... ), one in Indonesia(⁵⁹59. Prasetyo YA, Preechawong S, Yunibhand J. Effect of a tuberculosis health promotion program on medication adherence among tuberculosis patients. J Health Res. 2015;29(1):47-53.), one in Singapore(⁶⁰60. Lee HK, Teo SSH, Barbier S, Tang SC, Yeo GH, Tan NC. The impact of direct observed therapy on daily living activities, quality of life and socioeconomic burden on patients with tuberculosis in primary care in Singapore. Proc Singap Healthc. 2016;25(4):235-42. http://dx.doi.org/10.1177/2010105816652148
http://dx.doi.org/10.1177/20101058166521... ), and one in Thailand(⁶¹61. Suwannakeeree W, Lertwatthanawilat WPW, Unahalekhaka A. A medication adherence enhancement program for persons with pulmonary tuberculosis: a randomized controlled trial study. Pac Rim Int J Nurs Res [Internet]. 2015 [cited 2019 Oct 23];19(4):311-29. Available from: https://www.tci-thaijo.org/index.php/PRIJNR/article/view/21104
https://www.tci-thaijo.org/index.php/PRI... ). In Oceania, two studies were carried out, in Australia and Malawi(⁶²62. Mukasa, JP, Glass N, Mnatzaganian G. Ethnicity and patient satisfaction with tuberculosis care: a cross-sectional study. Nurs Health Sci. 2015;17(3):395-401. https://doi.org/10.1111/nhs.12202
https://doi.org/10.1111/nhs.12202... –⁶³63. Wade VA, Karnon J, Eliott JA, Hiller JE. Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation. PLoS One. 2012;7(11):e50155. http://dx.doi.org/10.1371/journal.pone.0050155
http://dx.doi.org/10.1371/journal.pone.0... ). In North America, two studies were identified in the United States of America(⁶⁴64. Ailinger, RL, Martyn D, Lasus H, Lima Garcia N. The effect of a cultural intervention on adherence to latent tuberculosis infection therapy in Latino immigrants. Public Health Nurs. 2010;27(2):115-20. https://doi.org/10.1111/j.1525-1446.2010.00834.x
https://doi.org/10.1111/j.1525-1446.2010... –⁶⁵65. Salém BE, Klansek E, Morisky DE, Shin SS, Yadav K, Chang AH, et al. Acceptability and feasibility of a nurse-led, community health worker partnered latent tuberculosis medication adherence model for homeless adults. Int J Environ Res Public Health. 2020;17(22):8342. http://dx.doi.org/10.3390/ijerph17228342.
http://dx.doi.org/10.3390/ijerph17228342... ).

The distribution of studies according to the method used was 23 (57.5%) qualitative(²⁶26. Rodrigues DCS, Oliveira AAV, Andrade SLE, Araújo EMNF, Lopes AMC, Sá LD. The discourse of people taken ill by tuberculosis about the treatment adhesion. Ciênc Enferm. 2017;23(1):67-76. http://dx.doi.org/10.4067/S0717-95532017000100067
http://dx.doi.org/10.4067/S0717-95532017... ,²⁸28. Sousa LO, Mitano F, Lima MCRAA, Sicsú AN, Silva LMC, Palha PF. Hort-course therapy for tuberculosis: a discourse analysis. Rev Bras Enferm. 2016;69(6):1154-63. http://dx.doi.org/10.1590/0034-7167-2016-0330
http://dx.doi.org/10.1590/0034-7167-2016... ,²⁹29. Dias AAL, Oliveira DMF, Ramdohr Sobrinho EC, Palha PF, Figueiredo RM. Tratamento da tuberculose na visão do usuário. Rev Rene [Internet]. 2013 [citado 2019 out. 23];14(6):1133-40. Disponível em: http://www.periodicos.ufc.br/rene/article/view/3726/2946
http://www.periodicos.ufc.br/rene/articl... ,³⁰30. Queiroz EM, Guanilo MCTU, Ferreira KR, Bertolozzi MR. Tuberculosis: limitations and strengths of directly observed treatment short-course. Rev Latino Am Enfermagem. 2012;20(2):369-77. http://dx.doi.org/10.1590/S0104-11692012000200021
http://dx.doi.org/10.1590/S0104-11692012... ,³¹31. Guimarães TMR, Amorim CT, Barbosa EFF, Silva FM, Farias CML, Lopes BS. Cuidados de enfermagem a um paciente portador de tuberculose pulmonar e comorbidades: relato de caso. Rev Online Pesq Cuid Fundam. 2018;10(3):683-9. http://dx.doi.org/10.9789/2175-5361.2018.v10i3.683-689
http://dx.doi.org/10.9789/2175-5361.2018... ,³²32. Souza KMJ, Sá LD, Palha PF, Nogueira JA, Villa TCS, Figueiredo DA. Abandono do tratamento de tuberculose e relações de vínculo com a equipe de saúde da família. Rev Esc Enferm USP. 2010;44(4):904-10. http://dx.doi.org/10.1590/S0080-62342010000400007
http://dx.doi.org/10.1590/S0080-62342010... ,³³33. Ferreira KR, Orlandi GM, Silva TC, Bertolozzi MR, França FOS, Bender A. Representations on adherence to the treatment of multidrug-resistant tuberculosis. Rev Esc Enferm USP. 2018;52:e03412. http://dx.doi.org/10.1590/s1980-220x2018010303412
http://dx.doi.org/10.1590/s1980-220x2018... ,³⁴34. Queiroz EM, Bertolozzi MR. Tuberculose: tratamento supervisionado nas coordenadorias de saúde Norte, Oeste e Leste do município de São Paulo. Rev Esc Enferm USP. 2010;44(2):453-61. http://dx.doi.org/10.1590/S0080-62342010000200030
http://dx.doi.org/10.1590/S0080-62342010... ,³⁵35. Souza SS, Silva DMGV. Passando pela experiência do tratamento para tuberculose. Texto Contexto Enferm. 2010;19(4):636-43. http://dx.doi.org/10.1590/S0104-07072010000400005
http://dx.doi.org/10.1590/S0104-07072010... ,³⁷37. Freire APVS, Normann KAS, Nakata PT, Cicolella DA. Percepção da enfermagem sobre a adesão e o abandono do tratamento da tuberculose. Rev Enf UFSM. 2020;37(10):1-18. 10.5902/2179769239456
https://doi.org/10.5902/2179769239456... –³⁸38. Orlandi GM, Pereira EG, Biagolini, REM, França FOS, Bertolozzi MR. Incentivos sociais na adesão ao tratamento da tuberculose. Rev Bras Enferm. 2020;72(5):1182-8. https://doi.org/10.1590/0034-7167-2017-0654
https://doi.org/10.1590/0034-7167-2017-0... ,⁴⁰40. Chirinos NEC, Meirelles BHS, Bousfield ABS. Social representations of TB patients on treatment discontinuation. Rev Gaúcha Enferm. 2015;36(esp):207-14. http://dx.doi.org/10.1590/1983-1447.2015.esp.56723
http://dx.doi.org/10.1590/1983-1447.2015... –⁴²42. Serapelwane MG, Davhana-Maselesele M, Masilo GM. Experiences of patients having tuberculosis (TB) regarding the use of directly observed treatment short-course (DOTS) in the North West Province, South Africa. Curationis. 2016;39(1):e1-9. http://dx.doi.org/10.4102/curationis.v39i1.1629
http://dx.doi.org/10.4102/curationis.v39... ,⁴⁴44. Makhado L, Davhana-Maselesele M, Farley JE. Barriers to tuberculosis and human immunodeficiency virus treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy in KwaZulu-Natal and North West provinces. Curationis. 2018;41(1):e1-8. https://doi.org/10.4102/curationis.v41i1.1808
https://doi.org/10.4102/curationis.v41i1... ,⁴⁵45. Dixon J, Tameris M. A disease beyond reach: nurse perspectives on the past and present of tuberculosis control in South Africa. Anthropol South Africa. 2018;41(4):257-69. https://doi.org/10.1080/23323256.2018.1526096
https://doi.org/10.1080/23323256.2018.15... ,⁴⁶46. Akeju OO, Wright SCD, Maja TM. Lived experience of patients on tuberculosis treatment in Tshwane, Gauteng province. Health SA Gesondheid. 2017;22:259-67. https://doi.org/10.1016/j.hsag.2017.03.001
https://doi.org/10.1016/j.hsag.2017.03.0... ,⁴⁷47. Mabunda JT, Khoza LB, Van den Borne HB, Lebese RT. Needs assessment for adapting TB directly observed treatment intervention Programme in Limpopo Province, South Africa: a community-based participatory research approach. Afr J Prim Health Care Fam Med. 2016;8(2):e1-7. http://dx.doi.org/10.4102/phcfm.v8i2.981
http://dx.doi.org/10.4102/phcfm.v8i2.981... ,⁵³53. Boudioni M, McLaren S, Belling R, Woods L. Listening to those on the frontline: service users’ experiences of London tuberculosis services. Patient Prefer Adherence. 2011;5:267-77. https://doi.org/10.2147/ppa.s20361
https://doi.org/10.2147/ppa.s20361... –⁵⁴54. Gerrish K, Naisby A, Ismail M. Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK. J Adv Nurs. 2013;69(10):2285-94. http://dx.doi.org/10.1111/jan.12112
http://dx.doi.org/10.1111/jan.12112... ,⁵⁶56. Charyeva Z, Curtis S, Mullen S, Senik T, Zaliznyak, O. What works best for ensuring treatment adherence. Lessons from a social support program for people treated for tuberculosis in Ukraine. PloS One. 2019;14(8):e0221688. http://dx.doi.org/10.1371/journal.pone.0221688
http://dx.doi.org/10.1371/journal.pone.0... –⁵⁷57. Shimamura T, Taguchi A, Kobayashi S, Nagata S, Magilvy JK, Murashima S. The strategies of Japanese public health nurses in medication support for high-risk tuberculosis patients. Public Health Nurs. 2012;30(4):370-8. http://dx.doi.org/10.1111/phn.12010
http://dx.doi.org/10.1111/phn.12010... ,⁶⁵65. Salém BE, Klansek E, Morisky DE, Shin SS, Yadav K, Chang AH, et al. Acceptability and feasibility of a nurse-led, community health worker partnered latent tuberculosis medication adherence model for homeless adults. Int J Environ Res Public Health. 2020;17(22):8342. http://dx.doi.org/10.3390/ijerph17228342.
http://dx.doi.org/10.3390/ijerph17228342... ); 14 (35%) quantitative(²⁷27. Beraldo AA, Andrade RLP, Orfão NH, Silva-Sobrinho RA, Pinto ESG, Wysocki AD, et al. Adherence to tuberculosis treatment in Primary Health Care: perception of patients and professionals in a large municipality. Esc Anna Nery. 2017;21(4):e20170075. http://dx.doi.org/10.1590/2177-9465-ean-2017-0075
http://dx.doi.org/10.1590/2177-9465-ean-... ,³⁶36. Crepaldi NY, Lima IB, Vicentine FB, Rodrigues LML, Sanches TLM, Ruffino-Netto A, et al. Towards a clinical trial protocol to evaluate health information systems: evaluation of a computerized system for monitoring tuberculosis from a patient perspective in Brazil. J Med Syst. 2018;42(6):113. https://doi.org/10.1007/s10916-018-0968-8
https://doi.org/10.1007/s10916-018-0968-... ,³⁹39. Castañeda-Navarrete A, Sánchez-León D, Manchego-Quispe M, Musayón-Oblitas Y. Efectividad de la consejería en enfermería en la adherencia al tratamiento farmacológico en pacientes con tuberculosis de la micro red de salud Jaime Zubieta Calderón en San Juan de Lurigancho, Lima, Perú. Rev Enferm Herediana. 2016;9(1):10-6. https://doi.org/10.20453/renh.v9i1.2857
https://doi.org/10.20453/renh.v9i1.2857... ,⁴³43. Nunu WN, Munyewende PO. Patient satisfaction with nurse-delivery primary health care services in Free State and Gauteng provinces, South Africa: a comparative study. Afr J Prim Health Care Fam Med. 2017;9(1):e1-8. https://doi.org/10.4102/phcfm.v9i1.1262
https://doi.org/10.4102/phcfm.v9i1.1262... ,⁴⁸48. Braitstein P, Siika A, Hogan J, Kosgei R, Sang E, Sidle J, et al. A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment. J Int AIDS Soc. 2012;15:7. http://dx.doi.org/10.1186/1758-2652-15-7
http://dx.doi.org/10.1186/1758-2652-15-7... ,⁵⁰50. Zvavamwe Z, Ehlers VJ. Experiences of a community-based tuberculosis treatment programme in Namibia: a comparative cohort study. Int J Nurs Stud. 2009;46(3):302-9. http://dx.doi.org/10.1016/j.ijnurstu.2008.09.013
http://dx.doi.org/10.1016/j.ijnurstu.200... –⁵²52. Guix-Comellas EM, Rozas-Quesada L, Force-Sanmartín E, Estrada-Masllorens JM, Galimany-Masclans J, Noguera-Julian A. Influence of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: research protocol. J Adv Nurs. 2015;71(9):2189-99. http://dx.doi.org/10.1111/jan.12656
http://dx.doi.org/10.1111/jan.12656... ,⁵⁵55. Ilievska-Poposka B, Zakoska M, Mitreski V. Evaluation of the directly observed treatment’s acceptance by tuberculosis patients in the Republic of Macedonia. Open Access Maced J Med Sci. 2018;6(5):896-900. http://dx.doi.org/10.3889/oamjms.2018.204
http://dx.doi.org/10.3889/oamjms.2018.20... ,⁵⁹59. Prasetyo YA, Preechawong S, Yunibhand J. Effect of a tuberculosis health promotion program on medication adherence among tuberculosis patients. J Health Res. 2015;29(1):47-53.,⁶⁰60. Lee HK, Teo SSH, Barbier S, Tang SC, Yeo GH, Tan NC. The impact of direct observed therapy on daily living activities, quality of life and socioeconomic burden on patients with tuberculosis in primary care in Singapore. Proc Singap Healthc. 2016;25(4):235-42. http://dx.doi.org/10.1177/2010105816652148
http://dx.doi.org/10.1177/20101058166521... –⁶²62. Mukasa, JP, Glass N, Mnatzaganian G. Ethnicity and patient satisfaction with tuberculosis care: a cross-sectional study. Nurs Health Sci. 2015;17(3):395-401. https://doi.org/10.1111/nhs.12202
https://doi.org/10.1111/nhs.12202... ,⁶⁴64. Ailinger, RL, Martyn D, Lasus H, Lima Garcia N. The effect of a cultural intervention on adherence to latent tuberculosis infection therapy in Latino immigrants. Public Health Nurs. 2010;27(2):115-20. https://doi.org/10.1111/j.1525-1446.2010.00834.x
https://doi.org/10.1111/j.1525-1446.2010... ), and 3 (7.5%) mixed studies(⁵⁸58. Shiratani KN. Psychological changes and associated factors among patients with tuberculosis who received directly observed treatment short-course in metropolitan areas of Japan: quantitative and qualitative perspectives. BMC Public Health. 2019;19(1):1642. https://doi.org/10.1186/s12889-019-8001-9
https://doi.org/10.1186/s12889-019-8001-... ,⁶¹61. Suwannakeeree W, Lertwatthanawilat WPW, Unahalekhaka A. A medication adherence enhancement program for persons with pulmonary tuberculosis: a randomized controlled trial study. Pac Rim Int J Nurs Res [Internet]. 2015 [cited 2019 Oct 23];19(4):311-29. Available from: https://www.tci-thaijo.org/index.php/PRIJNR/article/view/21104
https://www.tci-thaijo.org/index.php/PRI... ,⁶³63. Wade VA, Karnon J, Eliott JA, Hiller JE. Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation. PLoS One. 2012;7(11):e50155. http://dx.doi.org/10.1371/journal.pone.0050155
http://dx.doi.org/10.1371/journal.pone.0... ).

The analysis of the articles allowed the organization of two main thematic categories: 1) Nursing care: TB patients’ specific needs to promote adherence to treatment and 2) The role of nursing in coping with social determinants of health to promote adherence to treatment.

The first category addresses actions required for the promotion of adherence to the disease treatment, based on the clinical aspects inherent to the occurrence of TB; of educational health actions; of the construction of bonds and incentive to autonomy of the sick person; of embracement and humanization of care; and of professionals’ knowledge and skills. Such care actions are those carried out in the daily service, aimed at TB patients and their families (Chart 2).

The second category encompasses the collective nature of nursing interventions capable of strengthening treatment adherence based on acting in contexts with unfavorable socioeconomic and cultural conditions. These actions refer to social protection: food, housing, transport, income, and work; family and community support; addressing socioeconomic aspects in care plans and respecting the culture of people with TB (Chart 3). In addition to being associated with the work of professionals from other areas, these actions also rely on social protection policies being elaborated by different sectors of the government. In the first category, we identified actions in which nursing has more autonomy and their performance occurs in the encounter with individuals and families affected by TB. In the second category, how the actions dialogue with collective demands in contexts of social vulnerability is highlighted, and the perspectives of nursing practice in the face of social protection policies aimed at people with TB are evidenced.

DISCUSSION

Given the specificities of the results systematized in the category “Nursing care: TB patients’ specific needs to promote adherence to treatment”, the designation of nursing care considered actions that cover the technical-scientific, educational, ethical and political dimensions of professional performance(⁶⁶66. Wilson L, Moran L, Zarate R, Warren N, Ventura CAA, Tamí-Maury I, et al. Qualitative description of global health nursing competencies by Nursing Faculty in Africa and the Americas. Rev Latino Am Enfermagem. 2016;24:e2697. http://dx.doi.org/10.1590/1518-8345.0772.2697
http://dx.doi.org/10.1590/1518-8345.0772... ). This was the category with the highest density of mentions on the topic presented in the studies. Studies(¹⁶16. Casals M, Rodrigo T, Camprubí E, Orcau A, Caylà JA. Tuberculosis and immigration in Spain: scoping review. Rev Esp Salud Publica. 2014;88(6):803-9. http://dx.doi.org/10.4321/S1135-57272014000600011
http://dx.doi.org/10.4321/S1135-57272014... ,¹⁷17. Pinheiro de Souza E, Souza Barbosa EC, Ataide Rodrigues I, Vidal Nogueira LM. Prevention and control of tuberculosis: integrative literature review. Rev CuidArte. 2015;6(2):1094-102. http://dx.doi.org/10.15649/cuidarte.v6i2.178
http://dx.doi.org/10.15649/cuidarte.v6i2... ,¹⁸18. Valença MS, Possuelo LG, Cezar-Vaz MR, Silva PEA. Tuberculosis in Brazilian prisons: an integrative review of the literature. Ciênc Saúde Coletiva. 2016;21(7):2147-60. http://dx.doi.org/10.1590/1413-81232015217.16172015
http://dx.doi.org/10.1590/1413-812320152... ,⁶⁶66. Wilson L, Moran L, Zarate R, Warren N, Ventura CAA, Tamí-Maury I, et al. Qualitative description of global health nursing competencies by Nursing Faculty in Africa and the Americas. Rev Latino Am Enfermagem. 2016;24:e2697. http://dx.doi.org/10.1590/1518-8345.0772.2697
http://dx.doi.org/10.1590/1518-8345.0772... –⁶⁷67. Van de Berg S, Jansen-Aaldring N, Vries G, Van den Hof S. Patient support for tuberculosis patients in low-incidence countries: a systematic review. PLoS One. 2018;13(10):e0205433. https://doi.org/10.1371/journal.pone.0205433
https://doi.org/10.1371/journal.pone.020... ) report that over the last ten years, even in different contexts, the success of treatment is consistent with nursing care capable of impacting the conditions related to treatment dropout, of expanding support for the person affected by the disease and ensure treatment maintenance.

The dimension of clinical aspects that influence the care provided by nursing, which explores early diagnosis of TB, attention to adverse events, supervision and guidance on treatment, gained prominence among the studies. In this regard, there is evidence that keeping nursing care offered continuously is highly promising for achieving improvement in adherence behavior, as well as better cure rates, greater satisfaction with the work of professionals, greater acquisition of knowledge about the disease, and improved quality of life(⁶⁸68. Wan C, Zhou Y. Effect of continuous nursing intervention on the therapeutic outcome, compliance behavior and quality of life of patients with pulmonary tuberculosis. Int J Clin Exp Med [Internet]. 2020 [cited 2020 June 12];13(3):1528-36. Available from: http://www.ijcem.com/files/ijcem0104211.pdfIssn:1940-5901/IJCEM0104211
http://www.ijcem.com/files/ijcem0104211.... ).

Regarding the effectiveness of DOT, in regions with a high burden of TB and HIV in sub-Saharan Africa(⁶⁹69. Pascual-Pareja JF, Carrillo-Gómez R, Hontañón-Antoñana V, Martínez-Prieto M. Treatment of pulmonar and extrapulmonary tuberculosis. Enferm Infecc Microbiol Clin. 2018;36(8):507-16. https://doi.org/10.1016/j.eimc.2017.10.018
https://doi.org/10.1016/j.eimc.2017.10.0... ) there are still difficulties to operationalize this practice. In the Brazilian context, for example, despite the recommendation to adopt DOT(²⁰20. Rabahi MF, Silva Junior JLR, Ferreira ACG, Tannus-Silva DGS, Conde MB. Tuberculosis treatment. J Bras Pneumol. 2017;43(6):472-86. http://dex.doi.org/10.1590/S1806-37562016000000388
http://dex.doi.org/10.1590/S1806-3756201... ), it is observed that its implementation process relies on the transfer of this practice to Primary Health Care (PHC), which took place from the year 2000 on, being in charge of nursing professionals(¹³13. Peruhype RC, Mitano F, Hoffmann JF, Surniche CA, Palha PF. Planning pathways in the transfer of directly observed treatment of tuberculosis. Rev Latino Am Enfermagem. 2018;26:e3015. http://dx.doi.org/10.1590/1518-8345.2213.3015
http://dx.doi.org/10.1590/1518-8345.2213... ,⁷⁰70. Adejumo OA, Daniel OJ, Otesanya AF, Salisu-Olatunj SO, Abdur-Razzag HA. Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos state, Nigeria. Niger Med J. 2017;58(1):44-9. https://doi.org/10.4103/0300-1652.218417
https://doi.org/10.4103/0300-1652.218417... ). However, it is understood that, to prevent nursing actions from becoming isolated activities and restricted to making people with TB aware of taking medication, the implementation of more robust technical approaches is required. Therefore, management qualification and intersectoral articulation, ensured in public policies, should provide conditions for the operationalization of DOT. Moreover, ensuring qualified and sufficient human resources for the work demand and improving the environment in the health units would be more successful in contributing to actions that promote adherence(⁷¹71. Souza KMJ, Sá LD, Silva LMC, Palha PF. Nursing performance in the policy transfer of directly observed treatment of tuberculosis. Rev Esc Enferm USP. 2014;48(5):874-82. http://dx.doi.org/10.1590/S0080-6234201400005000014
http://dx.doi.org/10.1590/S0080-62342014... ).

Among the findings, nursing actions from the monitoring of people undergoing TB treatment were highlighted, with the use of various technologies such as the internet, video calls, and the use of software in the form of applications for smartphones. This fact does not necessarily reflect the maintenance of adherence to treatment, as these strategies effectiveness is dependent on access and training to use the technologies chosen for this purpose. This depends on the mobilization of health service managers and coordinators to plan actions that contemplate the implementation of these resources, making them viable with the respective monitoring of their results(¹³13. Peruhype RC, Mitano F, Hoffmann JF, Surniche CA, Palha PF. Planning pathways in the transfer of directly observed treatment of tuberculosis. Rev Latino Am Enfermagem. 2018;26:e3015. http://dx.doi.org/10.1590/1518-8345.2213.3015
http://dx.doi.org/10.1590/1518-8345.2213... ).

Among the health educational actions highlighted, those that mobilize assertive communication during consultations and counseling were successful. These actions were linked to the supply of printed material, provision of written information, and use of the internet. The importance of these initiatives has also been recognized in the improvement of early diagnosis of TB in studies that draw attention to the fact that people’s psychosocial singularities are taken into account in educational interactions(⁷²72. Wahab FA, Abdullah S, Abdullah JM, Jaafar H, Noor SSM, Wan Mohammad WMZ, et al. Updates on knowledge, attitude and preventive practices on tuberculosis among healthcare workers. Malays J Med Sci. 2016;23(6):25-34. http://dx.doi.org/10.21315/mjms2016.23.6.3
http://dx.doi.org/10.21315/mjms2016.23.6... –⁷³73. Muñoz-Sanchez AI, Rubiano-Mesa YL, Saavedra-Cantor CJ. Measuring instrument: knowledge, attitudes and practices of people with pulmonary tuberculosis. Rev Latino Am Enfermagem. 2019;27:e3086. http://dx.doi.org/10.1590/1518-8345.2608.3086
http://dx.doi.org/10.1590/1518-8345.2608... ).

The use of educational approaches in health by nursing has been consolidated in the history of the profession and there is no doubt about the value of these strategies in care actions. The reflection on these experiences, however, shall be done to identify which pedagogical strands support the best practices. For instance, non-dialogue-based approaches, which emphasize individual responsibility for the disease or even blame the person for the failure of treatment, give low contribution to health-favorable habits being incorporated into their routine of life. Thus, it is understood that health education actions, in the context of adherence to TB treatment, find the best conditions to be effective when there is an interaction between the technical-scientific knowledge of professionals and the practical knowledge of people, generating understanding and support for self-care(⁷⁴74. Castellanos MEP, Baptista TWF. Entrevista com José Ricardo Ayres. Saude Soc. 2018;27(1):51-60. http://dx.doi.org/10.1590/s0104-12902018000002
http://dx.doi.org/10.1590/s0104-12902018... ).

Bonding and incentive to autonomy, embracement, and humanization of care were mentioned as relational components that can be incorporated into the nursing care process, favoring treatment adherence and access to the health service. This aspect is highlighted when it comes to populations in situations of extreme social vulnerability, such as the homeless population, as bonding and humanization are prerequisites for meeting the basic needs of these specific populations, whose risk of getting TB is higher(⁷⁵75. Hino P, Monroe AA, Takahashi RF, Souza KMJ, Figueiredo TMM, Bertolozzi MR. Tuberculosis control from the perspective of health professionals working in street clinics. Rev Latino Am Enfermagem. 2018;26:e3095. http://dx.doi.org/10.1590/1518-8345.2691.3095
http://dx.doi.org/10.1590/1518-8345.2691... ). The promotion of adherence in these populations benefits from projects capable of breaking with the essentially instrumental professional training, to encourage the use of relational and socio-affective technologies for the qualification of care for people in these conditions(⁷⁶76. Tesser CD, Norman AH, Vidal TB. Access to care in Primary Health Care in Brazil: situation, problems and coping strategies. Saúde Debate. 2018;42(1):361-78. http://dx.doi.org/10.1590/0103-11042018S125
http://dx.doi.org/10.1590/0103-11042018S... ). Regarding the qualification of nursing care, professionals’ values and beliefs regarding social differences should be analyzed, as respect for human diversity leads to relationships based on equal rights and mitigation of vulnerabilities(⁷⁷77. Maffacciolli R, Oliveira DLLC. Challenges and perspectives of nursing care to vulnerable populations. Rev Gaúcha Enferm. 2018;39:e20170189. http://dx.doi.org/10.1590/1983-1447.2018.20170189
http://dx.doi.org/10.1590/1983-1447.2018... ).

The professionals’ knowledge and skills were aspects less addressed in the studies included in the review. Those carried out in some regions of South Africa, with a high incidence of TB and HIV, highlight the professional’s ability to build motivational strategies for treatment, in situations in which the lack of information and certain beliefs and attitudes about the illness are configured as barriers to care. In the context of some countries on the African continent(⁷⁸78. Mitano F, Ventura CAA, Palha PF. Health and development in Sub-Saharan Africa: a reflection focusing on Mozambique. Physis. 2016;26(3):901-15. http://dx.doi.org/10.1590/s0103-73312016000300010
http://dx.doi.org/10.1590/s0103-73312016... ), the various aggravating factors, such as armed conflicts, extreme poverty and deprivation of access to school, appear as limiting the improvement of health conditions, preventing economic growth from being accompanied by investments in the area. Such factors can hinder interventions by the nursing team, which, lacking the minimum human and material resources necessary for a multidisciplinary and networked work, is restricted to specific motivational actions between the professional and the person undergoing treatment.

The analysis that supported the construction of the second category called “The role of nursing in coping with the social determinants of health to promote adherence to treatment” allowed us to identify a set of socioeconomic, cultural, and political-institutional elements as social determinants of disease treatment adherence(⁷⁹79. Muñoz del Carpio-Toia AM, Sánchez-Pérez H, Verges de López C, López-Dávila LM, Sotomayor-Saavedra MA, Sorokin P. Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética. Pers Bioet. 2018;22(2):331-57. https://doi.org/10.5294/pebi.2018.22.2.10
https://doi.org/10.5294/pebi.2018.22.2.1... ), with repercussions on nursing actions.

The dimension of social protection, which covers food, housing, transport, income, and work and the need for family and community support, was evidenced in the findings. A study(⁸⁰80. Oliosi JGN, Reis-Santos B, Locatelli RL, Sales CMM, Silva Filho WG, Silva KC, et al. Effect of the Bolsa Familia Programme on the outcome of tuberculosis treatment: a prospective cohort study. Lancet Respir Med. 2019;7(2):e219-26. https://doi.org/10.1016/S2214-109X(18)30478-9
https://doi.org/10.1016/S2214-109X(18)30... ) carried out in 42 TB treatment centers in Brazil showed that cash transfer programs, such as the Bolsa Família program, had a direct positive effect on the treatment outcome, with the potential to contribute to disease control in the country.

Likewise, the findings refer to the importance of a social protection network for the care of TB patients, especially among immigrants and in community centers. The need for articulation of social protection devices capable of providing support to the family and communities, especially in countries with precarious health networks and a shortage of professionals in the services, can have different impacts on nursing actions. When these devices are not supported, there is a risk of overload and/or limitation in nursing work. On the other hand, this contribution can be mobilized if there is cohesion among the various professionals who make up the health teams and if they take on the responsibility of carrying out intersectoral articulations that address the demands of the territory(⁸¹81. Broch D, Riquinho DL, Vieira LB, Ramos AR, Gasparin VA. Social determinants of health and community health agent work. Rev Esc Enferm USP. 2020;54:e03558. https://doi.org/10.1590/S1980-220X2018031403558
https://doi.org/10.1590/S1980-220X201803... ) where individuals, families, and TB-affected communities live.

This debate strains the critical capacity and political positioning of nurses in actions to promote adherence to TB treatment, as there are no conditions to achieve success in these actions, reproducing the technocratic tradition of nursing work, focused on prescriptive procedures and guidelines(⁸²82. Fortuna CM, Matumoto S, Mishima SM, Rodríguez AMMM. Enfermagem em saúde coletiva: desejos e práticas. Rev Bras Enferm. 2019;72 Supl. 1:336-40. https://doi.org/10.1590/0034-7167-2017-0632.
https://doi.org/10.1590/0034-7167-2017-0... ). If reality imposes the analysis of social determinants of health and disease process and of vulnerabilities, critical reflections on social policies and on the social and technical organization of health practices belong to the scope of this analysis, and this implies opening to new ways of acting in the field of health and in an ethical-political horizon favorable to solidarity and social justice(⁶6. Ayres JR, Paiva V, França-Júnior I. Conceitos e práticas de prevenção: da história natural da doença ao quadro da vulnerabilidade e direitos humanos. In: Paiva V, Ayres JR, Buchalla CM, editores. Vulnerabilidade e direitos humanos: prevenção e promoção da saúde: da doença à cidadania. Curitiba: Juruá, 2012. p. 43-94.).

The approach to the social determinants of health and disease process, which covers psychosocial and socioeconomic aspects in care plans, was also highlighted in the results. As a way of including social determinants in care planning, it was observed that several action fronts should be activated, which range from social protection by State policies, operated by different sectors, to the incentive to the maintenance of good family and community relationships, mutual support and emotional support for people with TB(⁷⁷77. Maffacciolli R, Oliveira DLLC. Challenges and perspectives of nursing care to vulnerable populations. Rev Gaúcha Enferm. 2018;39:e20170189. http://dx.doi.org/10.1590/1983-1447.2018.20170189
http://dx.doi.org/10.1590/1983-1447.2018... ). It is noteworthy that action based on public policies requires, from health professionals and managers, skills related to the local planning of actions. The understanding and operationalization of the various stages and technical and political elements of local health planning expand the effectiveness of programmatic actions developed at the macro-structural level of management(¹¹11. World Health Organization. The stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals [Internet]. Geneva: WHO; 2006. [cited 2020 June 19]. Available from: https://apps.who.int/iris/handle/10665/69241
https://apps.who.int/iris/handle/10665/6... ).

Respect for the culture of people with TB was highlighted as essential for nursing commitment to subjective uniqueness. Such commitment requires professionals to establish relationships that allow them to understand the main intersubjective components expressed in the conduct of people with TB and their importance for treatment adherence and success. The understanding that the person has about the disease, the degree of involvement and expectations regarding the prescribed treatment, as well as the assessment of the risk of not being treated, both for him/her and for his/her family(⁸³83. Serrano Gallardo MP. Intersectorality, key to address social health inequalities. Rev Latino Am Enfermagem. 2019;27:e3124. http://dx.doi.org/10.1590/1518-8345.0000-3124
http://dx.doi.org/10.1590/1518-8345.0000... ), are valuable information for the care plans, which are only obtained when relationships are based on respect and acceptance of differences.

Still on cultural aspects, the findings point to the situation of immigrants. Understanding the different ethno-cultural characteristics is the way to refute xenophobic attitudes associated with people’s distancing from health services or low adherence to TB treatment. A study carried out in Spain warns that the concomitance between the increase in growing migratory flows and the change observed in the profile of the individual affected by the disease in the country signals the need for adaptations in the technical and attitudinal preparation of health professionals(¹⁶16. Casals M, Rodrigo T, Camprubí E, Orcau A, Caylà JA. Tuberculosis and immigration in Spain: scoping review. Rev Esp Salud Publica. 2014;88(6):803-9. http://dx.doi.org/10.4321/S1135-57272014000600011
http://dx.doi.org/10.4321/S1135-57272014... ).

There was a predominance of studies with a qualitative methodological approach, which may have contributed to increasing the visibility of the subjective and social aspects associated with therapeutic adherence. Investigations aimed at understanding these aspects can favor comprehensive care, built from the bond produced in the relationships between professionals and people undergoing treatment and focused on the determinants of the health and disease process. Care, which includes these characteristics, preserves people’s dignity, respects their perceptions about the treatment, and mobilizes awareness about which interventions have the greatest potential to reduce social and health vulnerabilities(⁸⁴84. Diderichsen F, Hallqvist J, Whitehead M. Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities. Int J Epidemiol. 2019;48(1):268-74. https://doi.org/10.1093/ije/dyy167
https://doi.org/10.1093/ije/dyy167... ).

It is worth pointing out some limitations of the study, such as the non-inclusion of texts published in other languages and in other indexing bases. Likewise, the authors acknowledge that important published research may have been omitted due to the use of our search strategy. However, it should be noted that this scoping review allowed identifying the role of nursing actions in adherence to TB treatment on several fronts and in different contexts. In addition, it made it visible that such actions cover aspects related to coping with the social determinants of health, which are strongly related to the occurrence of TB in populations in vulnerable situations.

CONCLUSION

The results of this review allowed the analysis of actions to promote adherence to TB treatment carried out by nurses in different countries. Such actions are distributed between two strands. The first covers characteristics of nursing care for people with TB and involves clinical interventions, health education actions, development of bonds, and incentive to autonomy, welcoming and humanized relationships, and knowledge and skills of professionals providing this care. The second one contemplates nursing actions, considering scenarios in which social determinants of health and disease process negatively influence adherence to TB treatment. In this aspect, there are social protection actions, family and community support, approach to socioeconomic issues in care plans, and respect for the cultural differences of people undergoing treatment.

The implications of this study for practice may include strengthening the role of nursing actions in adherence to TB treatment in contexts that require adaptations according to different social, economic, cultural, and epidemiological aspects. These actions should not be structured in isolation, as the cases of the disease are concentrated in contexts of vulnerability and violation of human rights, in which social protection and intersectoral actions are identified as a way of confronting the social determinants of health.

It is believed that this study, by giving visibility to nursing care actions that promote adherence to TB treatment, can motivate or support the implementation of new health interventions, as well as qualify existing actions towards the consolidation of programmatic strategies aimed at TB control.

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