Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom

Abstract

International focus on reducing onward HIV transmission emphasizes the need for routine HIV testing and early uptake of antiretroviral treatment (ART). Strategic targets have been set for 2020 to achieve the goal of 90% of people infected with HIV diagnosed, 90% of identified cases on treatment, and 90% of persons on treatment virally suppressed (90-90-90). It is vital to understand the complexity of factors influencing a person's treatment decisions over time and the context which may enable better adherence. In this paper we present findings from the review of published and gray literature (2003-2013) on the documented factors associated with treatment initiation and adherence in the general adult population of Australia, Canada, and the UK. A framework developed by Begley, McLaws, Ross, and Gold [2008. Cognitive and behavioural correlates of non-adherence to HIV anti-retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology. Clinical Psychologist, 12(1), 9-17] in Australia was adapted to summarize the findings. A systematic database search using keywords and a set of inclusion criteria yielded 17 studies (Australia = 6; Canada = 8; UK = 3). In addition 11 reports were included in the review. We found that a person's abilities and motivations (intrapersonal factors, reported in 7 studies) to start and continue ART are influenced by a host of interconnected factors spanning relationship (interpersonal, 3 studies) and broader structural (extrapersonal, 15 studies) factors that are situated within social determinants of health. People therefore evaluate various costs and benefits of starting and staying on treatment, in which biomedical concerns play an important yet often subsidiary role. In this review the economic barriers to care were found to be significant and under-reported, highlighting the persistent health inequities in terms of access to services. Our understanding of the context around people's use of ART remains poor. Qualitative social research within HIV-positive communities is urgently needed to capture people's lived experiences and may address some of this deficit in understanding.

Factor Influencing HIV Care Continuum among People Living with HIV in Western Kenya

“…This may be due to the fact that HIV testing uptake for both males and females in Kenya is highest between the ages of 25-29 years and mostly take place in VCT hence increased linkage to HIV care and management among this age group [28]. Of note are that these findings are in contrast with previous studies in indicating that found that young age is associated with low uptake of ART [29,30], suggesting that that there may be context-specific barriers to ART uptake that may persist despite changes to clinical guidelines encouraging early uptake.…”

Factors Influencing Adherence to Antiretroviral Therapy among People Living with HIV in Coastal South India

“…7,8 From the available evidence, an average rate of 24.8% of nonadherence to medication has been reported in most of the patients having chronic diseases 9 ; however, the level of ART adherence among PLHIV is higher compared to most of the other chronic diseases. 10 Previously published studies reported multiple barriers for optimal adherence to ART in both developed and developing countries, [11][12][13][14] which could be categorized into patient-related, medication-related, and health system-related factors. 15 As these barriers vary across settings, identification of the factors responsible for nonadherence to ART and contextualization of these factors will be helpful in designing and developing intervention strategies to improve adherence to ART.…”

Speaker Abstracts

“…However, symptoms like fatigue, cognitive failure and sleep disorders should also be considered as variables related to low compliance. Therefore, we investigated the frequency of symptoms associated with depression, self-reported psychosocial and treatment-related factors, in a sample of patients with failure to the first line of HAART [1–4]. …”