Antiretroviral Therapy Adherence Enhancing Interventions for Adolescents and Young Adults 13–24 Years of Age: A Review of the Evidence Base

Abstract

Introduction:Youth living with HIV are highly under-represented in the evidence base for adherence interventions, despite their diverse and unique needs and barriers.Objective:This systematic review aimed to identify antiretroviral therapy (ART) adherence interventions specifically targeting adolescents and young adults (defined as ages 13–24) with the goal of characterizing the evidence base.Methods:Articles were identified using the PubMed database and cover work published through September 14, 2015. Inclusion criteria: (1) average age 13 to 24, (2) HIV positive, (3) on or beginning ART, (4) intervention targeted ART adherence in full or in part, (5) reported adherence, viral load, and/or CD4 count outcomes. Strength of evidence was defined as level 1 [randomized controlled trial (RCT) with significance testing on outcomes], 2 (within group studies with statistical testing on outcomes), 3 (RCTs with descriptive results), or 4 (within group studies with descriptive results).Results:Of 151 articles, 10 met inclusion criteria. Published between 2003 and 2014, these studies evaluated diverse intervention approaches. Most were conducted in the US and were small pilots that have yet to be replicated despite promising results. Only 3 studies met criteria for highest level strength of evidence; 2 supported a phone-based counseling approach with adherence monitors and 1 for weekly individual and family counseling.Conclusions:Despite nearly 20 years passing since the wide-scale availability of ART, and clear recognition that adolescents and youth adults fair worse on the cascade of HIV care, the evidence base remains sparse and underdeveloped. Promising approaches need replication and more rigorous studies are desperately needed.

Health Technology-Enabled Interventions for Adherence Support and Retention in Care Among US HIV-Infected Adolescents and Young Adults: An Integrative Review

“…Yet the sample size in all but two studies [54, 59] was less than or equal to 37 participants, a trend consistent with other reviews reporting on HIV-infected youth [35] and distinct from adherence interventions conducted with HIV-infected adults [62, 63]. Clearly larger and adequately powered clinical trials are needed, but we will first need to identify improved mechanisms for recruitment outside of clinical settings including peer-led, and community based strategies.…”

“…Technology-enabled interventions for adherence support have only recently been tested in HIV-infected adolescents and young adults, and although promising, synthesis of the findings from the nine identified primary studies reflects a paucity of published peer-reviewed evidence in the US during the past decade. In fact, the evidence base for adherence interventions and recent trends of intervention research are disproportionate to the needs of this population [23, 35, 36]. Hence, the ability to generate broad recommendations from this review is limited.…”

“…Recent literature reviews including cohorts of HIV-in-fected youth provide evidence on interventions for ART adherence [35], service delivery for linkage, retention and ART adherence [36], and trends in technology use [25]. However, individual studies within each of these reviews represent a broad range of outcomes and populations [25], domestic and international settings [25, 35, 36], and a range of delivery modes with and without technological platforms [35]. Therefore, critical appraisal and synthesis of data extracted from a more homogenous body of evidence is a vital first step to inform the development of effective health technology-enabled interventions for support of HIV-infected youth progressing through the HIV care cascade.…”

Feasibility and Acceptability of Digital Gaming to Improve Adherence among Adolescents and Young Adults Living with HIV (Preprint)

“…These findings are not surprising considering the interplay during these complex developmental periods of adolescence and young adulthood of altered levels of identification, self-regulation, and influence from peers [11]. As adolescents mature into young adults, strategies and messages to support adherence, self-management and well-being should arguably reflect shifts from concrete to abstract thinking and from an invulnerable to self-preserving mindset [12].…”

“…Autonomy also differs between AYA and adults living with HIV as younger persons must frequently rely on parents or caregivers for treatment [12,13]. Furthermore, AYA living with HIV may experience a higher frequency of cognitive deficits, depression, and substance abuse issues compared to general populations [14].…”