Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention

Abstract

Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.

A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi

“…The 6-month interval did not incentivize selling or sharing. Although the literature indicates that financial stress can influence ART adherence due to lack of money for transport to clinic or inability to step away from incomegenerating activities for refill visits, 2,18,21 there is scarce published evidence of selling ART for economic improvement. As clients and providers mentioned, there is a limited market for selling ART because medications are provided for free in most settings.…”

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

“…A systematic review focused on adolescents, given high attrition in this group, identified education and counseling, financial incentives, increasing clinic accessibility, and adolescent-specific services as promising to improve linkage and retention [ 39 ]. Finally, a systematic review of studies to increase linkage, adherence, and retention noted key themes including poverty, food insecurity, transportation and housing constraints, and unmet mental health needs as factors limiting the success of public health HIV interventions [ 40 ]. To maximize the impact of health systems strengthening activities, all of these factors must be addressed.…”

Interactive Two-Way mHealth Interventions for Improving Medication Adherence: An Evaluation Using The Behaviour Change Wheel Framework

“…A systematic review examining various ART adherence interventions have concluded that behavioral interventions producing a positive impact in one setting may not translate to other populations because of differences in economic, social, and behavioral barriers to adherence [ 33 ]. Such barriers including poverty and mental health comorbidities commonly co-exist in various contexts, and addressing these issues through respective integrative services alongside public health HIV interventions may increase implementation success of the latter [ 34 ].…”