The IMPACT study: Intervening with a Manualised Package to Achieve treatment adherence in people with Tuberculosis 

January 2018 – December 2021

Compared to the rest of the UK and Western Europe, England has a major problem with the infectious disease tuberculosis (TB). The large amount of TB in the country has led Public Health England (PHE) and NHS England to develop a national TB control plan. Treatment lasts a long time (at least six months, and even more in people with drug resistant TB). Finding ways to make sure that people are able to take all of their medication as prescribed is one of the plan’s priorities. If people miss doses (described as being ‘non-adherent or poorly adherent to treatment), their TB can develop resistance to the usual drugs, risking both their health and that of others.

In the UK, treatment completion and adherence among TB patients is variable. Unfortunately, current methods of treatment support often fail to adequately identify individuals struggling to adhere to treatment or to respond to the important underlying reasons for non-adherence. This project aims to develop, pilot, and evaluate process and interim outcomes for a manualised intervention package that improves adherence to treatment for TB among NHS patients at risk of poor adherence due to social and cultural factors.

Karina Kielmann (Reader, IGHD) is a co-investigator on the UCL-lead project, responsible for oversight and guidance on the qualitative research components of the project.  Aaron Karat, Research Fellow, has been involved in data collection, management, analysis and writing.

The IMPACT Study at

  • Project objectives
  • Partners
  • Funding
  • Papers
  1. Synthesise current knowledge on (a) determinants of adherence to treatment for TB, and (b) interventions that can support adherence, with particular emphasis on social and cultural barriers.
  2. Apply a conceptual framework of adherence endorsed by NICE Guidelines to elucidate and address the personal, socio-cultural, and health systems context, mechanisms, and pathways of poor adherence among NHS patients with TB.
  3. Develop a manualised intervention package with multiple components that can identify (a) NHS patients most at risk of non-adherence, (b) the salient modifiable barriers; and (c) tailor support mechanisms to meet individual needs by matching appropriate interventions to specific barriers
  4. Pilot the intervention package in people at risk of poor adherence to define how the components work in combination and separately.
  5. Evaluate the process of implementation by describing the challenges and facilitators in delivering the package as intended (fidelity, reach) and assessing the impact of the intervention through evaluation of adherence indicators.
  6. Use findings from the pilot study to assess the costs of delivering the manualised intervention in an NHS setting, and guide development of a proposal for a full randomised controlled trial (RCT).


  • Professor Marc Lipman, Centre for Respiratory Medicine, University College London (lead)
  • The UCL School of Pharmacy

Partner sites

  • The Royal Free Hospital
  • London and Barts Health NHS Trust, London
  • Royal Infirmary of Edinburgh
  • University Hospital Southampton
  • The Whittington NHS Trust

This work was supported by the National Institute for Health Research (NIHR) Health Technology Assessment Programme, UK grant number 16/88/06. The views expressed are those of the author(s) and not necessarily those of the National Health Service, UK, the NIHR or the Department of Health and Social Care.

NIHR and UCL logos

"Tuberculosis Research" by USAID Asia is licensed under CC BY-NC 2.0

Dr Karina Kielmann

Reader - IGHD