BackgroundThe efficacy of antiretroviral therapy depends on patient adherence to a daily medication regimen, yet many patients fail to adhere at high enough rates to maintain health and reduce the risk of transmitting HIV. Given the explosive global growth of cellular-mobile phone use, text-messaging interventions to promote adherence are especially appropriate. This meta-analysis synthesized available text messaging interventions to promote antiretroviral therapy adherence in people living with HIV.MethodsWe performed Boolean searches of electronic databases, hand searches of recent year conference abstracts and reverse searches. Included studies (1) targeted antiretroviral therapy adherence in a sample of people living with HIV, (2) used a randomized-controlled trial design to examine a text messaging intervention, and (3) reported at least one adherence measurement or clinical outcome.ResultsEight studies, including 9 interventions, met inclusion criteria. Text-messaging interventions yielded significantly higher adherence than control conditions (OR = 1.39; 95% CI = 1.18, 1.64). Sensitivity analyses of intervention characteristics suggested that studies had larger effects when interventions (1) were sent less frequently than daily, (2) supported bidirectional communication, (3) included personalized message content, and (4) were matched to participants’ antiretroviral therapy dosing schedule. Interventions were also associated with improved viral load and/or CD4+ count (k = 3; OR = 1.56; 95% CI = 1.11, 2.20).ConclusionsText-messaging can support antiretroviral therapy adherence. Researchers should consider the adoption of less frequent messaging interventions with content and timing that is individually tailored and designed to evoke a reply from the recipient. Future research is needed in order to determine how best to optimize efficacy.
Objective: Adjuvant endocrine therapy (AET) significantly reduces risk of breast cancer recurrence in those patients whose tumor tests hormone (estrogen and/or progesterone) receptor positive. Many who are prescribed AET do not adhere adequately. Studies have sought to examine the effects of interventions to enhance patients' AET adherence, with strikingly mixed results. In order to reconcile a disparate literature, this paper aims to (1) quantitatively review the aggregate effect of interventions designed to optimize AET adherence within the current literature and(2) meta-analyze these effects across studies' by intervention design.Methods: Duplicate searches were conducted using multiple electronic databases as well as hand searches of recent year conference abstracts. Studies were included that (1) tested an intervention to promote AET adherence; (2) reported at least one measure of medication adherence; and (3) reported (or provided upon request) data sufficient to calculate effect size. Effect sizes were calculated using random effects models. Results: Seven studies representing eight unique interventions were included. We observed an overall null effect across all interventions (k = 8; d [95% CI] = 0.28 [−0.05, 0.61]); however, sensitivity analyses showed that interventions that used bi-directional communication showed statistically significant effects relative to control groups within each study (k = 4; d [95% CI] = 0.59 [0.23, 0.95]) while those relying only on providing information to the patient (one-way communication) did not (k = 4; d [95% CI] = −0.03 [−0.27, 0.20]). Conclusions:Interventions that promote patient self-report may improve AET adherence through enhancing patient engagement. Investigators and clinicians who wish to optimize medication adherence in this population can consider this approach.
Effective treatment of HIV hinges upon maintaining adequate antiretroviral therapy adherence. Accurate, cost-effective measurement of medication adherence is needed to best respond to the HIV pandemic. The visual analogue scale (VAS) appears to be a simple and easy to use measure of adherence but the current literature on its use is mixed. This meta-analysis (1) describes VAS concordance with other measures of medication adherence and viral load; and (2) examines how research methods moderate the reported strength of the VAS-viral load relationship. Literature searches were conducted electronically and by hand with a total of 20 studies included in the present study. The VAS showed large strength associations with most other measures of adherence and a smaller association with viral load. More rigorous methodological quality significantly improved the VAS-viral load effect size. We conclude with optimization recommendations for VAS use in clinical practice and research design.
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