Understanding treatment discontinuation among latent tuberculosis infection: A scoping review integrating evidence within the COM-B framework

Objective: To identify tuberculosis preventive treatment nonadherence mechanisms via the Capability, Opportunity, Motivation, and Behavior (COM-B) framework for latent tuberculosis infection patients. Methods: This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Relevant literature reporting factors associated with tuberculosis preventive treatment discontinuation or completion was included. Identified determinants were synthesized and mapped across the COM-B domains. Results: Twenty-seven studies were included. Treatment discontinuation rates varied widely (2.0%-66.8%), with consistently higher rates observed in longer regimens (6 months of isoniazid, and 9 months of isoniazid) compared with shorter regimens (3 months of isoniazid plus rifapentine, 3 months of isoniazid plus rifampin, and 4 months of rifampin). Adverse drug reactions, particularly hepatotoxicity, emerged as the most consistent predictor of discontinuation, reflecting impaired physical capability. Opportunity-related factors included healthcare system fragmentation, transportation challenges, and limited access to services. Reduced motivation was associated with stigma, low risk perception, and negative treatment beliefs. Interventions such as shorter regimens, patient-centered care, healthcare worker supervision, and digital adherence technologies were associated with improved treatment completion. These findings suggest that treatment discontinuation results from dynamic interactions between treatment-related burden, healthcare accessibility, and patient motivation. Conclusions: Clinical tolerance, structural and behavioral factors interact to cause latent tuberculosis infection discontinuation. COM-B guides targeted interventions: shorter regimens, adverse drug reaction management, and improved access and motivation.