Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies

Abstract

We sought to review the effectiveness of interventions designed to improve adherence to antiretroviral therapy (ART) from studies included in a recent Cochrane review that reported a clinical and an adherence outcome, with at least 80% follow-up for 6 months or more. Data were extracted independently and in duplicate, with an adjudicator for disagreements. Risk of bias was assessed using the Cochrane Risk of Bias tool. Of 182 relevant studies in the Cochrane review, 49 were related to ART. Statistical pooling was not warranted due to heterogeneity in interventions, participants, treatments, adherence measures and outcomes. Many studies had high risk of bias in elements of design and outcome ascertainment. Only 10 studies improved both adherence and clinical outcomes. These used the following interventions: adherence counselling (two studies); a once-daily regimen (compared to twice daily); text messaging; web-based cognitive behavioral intervention; face-to-face multi-session intensive behavioral interventions (two studies); contingency management; modified directly observed therapy; and nurse-delivered home visits combined with telephone calls. Patient-related adherence interventions were the most frequently tested. Uniform adherence measures and higher quality studies of younger populations are encouraged.

Relationship between Adherence to Oral Antibiotics and Postdischarge Clinical Outcomes among Patients Hospitalized with Staphylococcus aureus Skin Infections

“…In other chronic and acute infections, medication adherence is frequently suboptimal and associated with worse clinical outcomes (11)(12)(13). However, there are no studies to date evaluating antibiotic adherence, or the relationship between adherence and clinical outcome, among patients experiencing skin infections.…”

Cognitive behavioral therapy improves adherence to antiretroviral therapy in HIV-infected patients: a prospective randomized controlled trial from eastern India

“…The intervention effect for 95% adherence was significantly stronger in studies that used recall periods of 2 or 4 weeks (vs. < 7 days) [26]. Taken together, all the evidence suggests that various ART adherence intervention strategies can be successful, but more research is needed to identify the most efficacious intervention [27]. Recently several studies have looked at the effectiveness of CBT in the improvement of adherence in HIV patients, with or without concomitant depression.…”

Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention (Preprint)

“…SMS text-based strategies [14] [15], that are not yoked to monitoring but are systematically sent, require a response from participants, and also seem to suggest that an interactive component is particularly beneficial. [16] [17] Garofalo and colleagues recent work in this area with 105 adolescents and young adults where two-way daily SMS texts were provided to non-adherent youth demonstrated a significant improvement in self-reported adherence and high satisfaction scores. [18] Furthermore, a pilot study using personalized, interactive, daily SMS text messages demonstrated significant improvement among 14-to-29 year olds living with HIV with poor self-reported adherence rates.…”