Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis

Kanters, Steve; Park, Jay; Chan, Keith C. C.; Socías, María Eugenia; Ford, Nathan; Forrest, Jamie I; Thorlund, Kristian; Nachega, Jean B.; Mills, Edward J.

doi:10.1016/s2352-3018(16)30206-5

Cited by 199 publications

(160 citation statements)

References 100 publications

(13 reference statements)

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…Most barriers to adherence are amenable to interventions that have been evaluated in randomized trials (Table 2) [12,21–30]. Notably, forgetting was the most frequently cited barrier to adherence across all age groups.…”

Section: Discussionmentioning

confidence: 99%

“…Several interventions have been found to improve adherence in randomized trials, including adherence counselling, text messaging, and reminder devices [12], and these are recommended by the WHO [13]. However, there remains a need to understand the relative importance of different barriers to adherence in order to inform the targeting of different interventions and inform future research.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Mills²,

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundMaintaining high levels of adherence to antiretroviral therapy (ART) is a challenge across settings and populations. Understanding the relative importance of different barriers to adherence will help inform the targeting of different interventions and future research priorities.Methods and FindingsWe searched MEDLINE via PubMed, Embase, Web of Science, and PsychINFO from 01 January 1997 to 31 March 2016 for studies reporting barriers to adherence to ART. We calculated pooled proportions of reported barriers to adherence per age group (adults, adolescents, and children). We included data from 125 studies that provided information about adherence barriers for 17,061 adults, 1,099 children, and 856 adolescents. We assessed differences according to geographical location and level of economic development. The most frequently reported individual barriers included forgetting (adults 41.4%, 95% CI 37.3%–45.4%; adolescents 63.1%, 95% CI 46.3%–80.0%; children/caregivers 29.2%, 95% CI 20.1%–38.4%), being away from home (adults 30.4%, 95% CI 25.5%–35.2%; adolescents 40.7%, 95% CI 25.7%–55.6%; children/caregivers 18.5%, 95% CI 10.3%–26.8%), and a change to daily routine (adults 28.0%, 95% CI 20.9%–35.0%; adolescents 32.4%, 95% CI 0%–75.0%; children/caregivers 26.3%, 95% CI 15.3%–37.4%). Depression was reported as a barrier to adherence by more than 15% of patients across all age categories (adults 15.5%, 95% CI 12.8%–18.3%; adolescents 25.7%, 95% CI 17.7%–33.6%; children 15.1%, 95% CI 3.9%–26.3%), while alcohol/substance misuse was commonly reported by adults (12.9%, 95% CI 9.7%–16.1%) and adolescents (28.8%, 95% CI 11.8%–45.8%). Secrecy/stigma was a commonly cited barrier to adherence, reported by more than 10% of adults and children across all regions (adults 13.6%, 95% CI 11.9%–15.3%; children/caregivers 22.3%, 95% CI 10.2%–34.5%). Among adults, feeling sick (15.9%, 95% CI 13.0%–18.8%) was a more commonly cited barrier to adherence than feeling well (9.3%, 95% CI 7.2%–11.4%). Health service–related barriers, including distance to clinic (adults 17.5%, 95% CI 13.0%–21.9%) and stock outs (adults 16.1%, 95% CI 11.7%–20.4%), were also frequently reported. Limitations of this review relate to the fact that included studies differed in approaches to assessing adherence barriers and included variable durations of follow up. Studies that report self-reported adherence will likely underestimate the frequency of non-adherence. For children, barriers were mainly reported by caregivers, which may not correspond to the most important barriers faced by children.ConclusionsPatients on ART face multiple barriers to adherence, and no single intervention will be sufficient to ensure that high levels of adherence to treatment and virological suppression are sustained. For maximum efficacy, health providers should consider a more triaged approach that first identifies patients at risk of poor adherence and then seeks to establish the support that is needed to overcome the most important barriers to adherence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Mills²,

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Text messages are generally shown to be effective at improving medication adherence across a variety of populations and settings [29**, 38**] (with some exceptions [39]). Further, short weekly text messages have been shown to perform better than daily messages in reducing non-adherence [30, 40, 41].…”

Section: What Core Features Should Be Included In An Art Adherence Mhmentioning

confidence: 99%

“…All interventions identified in this review included at least some component of text message reminders, reflecting this as a current core feature in adherence support interventions. A 2017 meta-analysis of ART adherence interventions found multiple interventions achieved better results than single interventions [38**]. As suggested by the studies reviewed above, interventions testing text messages in combination with other features (e.g.…”

Section: What Core Features Should Be Included In An Art Adherence Mhmentioning

confidence: 99%

Recent mobile health interventions to support medication adherence among HIV-positive MSM

Muessig

LeGrand

Horvath

et al. 2017

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

Purpose of Review We describe recent mHealth interventions supporting antiretroviral (ART) medication adherence among HIV-positive men who have sex with men (MSM). Recent Findings Keyword searches (1/1/2016 to 5/13/2017) identified 721 citations. Seven publications reporting on six studies met inclusion criteria. Five studies focused on MSM. Interventions primarily employed text messaging (n=4), while two focused on smartphone apps and one on social media. Three studies measured intervention impact on adherence and found increased ART use intentions (n=1), self-reported adherence (n=1), and viral suppression (n=1, no control group). Other mHealth interventions for HIV-positive MSM focused on status disclosure and reducing sexual risk. Summary mHealth interventions to support ART adherence among MSM show acceptability, feasibility, and preliminary efficacy. No recent mHealth interventions for MSM measured impact on viral suppression compared to a control condition despite earlier (pre-2015) evidence for efficacy. Studies are underway that include multiple features designed to improve adherence within complex smartphone or internet-based platforms. Areas for future growth include overcoming measurement and engagement challenges, developing tools for coordinating patient and provider adherence data, testing combination interventions, and adapting efficacious interventions for new languages and geographic settings.

show abstract

“…There is sufficient evidence on the need for and potential of technologies in improving retention in HIV care and PrEP studies, and sustaining ART/PrEP adherence [43, 83–86]. However, delayed linkage into HIV care and late initiation of ART remains a persistent challenge confronting HIV treatment programmes [87].…”

Section: The Way Forwardmentioning

confidence: 99%

Online-to-offline models in HIV service delivery

Anand

Nitpolprasert²,

Phanuphak³

2017

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

Purpose of review Half the world’s population has access to Internet and technologies, and utilization is near-ubiquitous among providers and key populations. Despite being so well connected; identifying, reaching and linking vulnerable populations to HIV clinical services remains a global challenge. This review highlights the emerging online-to-offline (O2O) models, their potential in scaling-up services, and evaluating impact, and implications for future research. Recent findings Globally, four major types of O2O models have been implemented, primarily in the West and Asia, especially among men who have sex with men (MSM) and transgender women (TG). These models have varying levels of impact in terms of reach, engagement, participation, linkage, and ability to track and monitor participants, and assess outcomes. Those integrated with offline sites enable seamless transition, dramatically reduce the O2O linkage time and demonstrate high linkage success (>73%). O2O models are ideal for at-risk, stigmatized, criminalized populations and for scaling-up biomedical prevention interventions such as pre- and post-exposure prophylaxis. Summary O2O models represent novel and powerful solutions to reverse the pandemic, and could help fill significant programmatic gaps in tracking individuals through HIV cascades. Providers, especially in resource-limited settings could choose between a variety of current approaches highlighted in this review, and employ no-cost or cost-effective technologies to transform their traditional models and leverage O2O models.

show abstract

Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis

Abstract: WHO.

Cited by 199 publications

References 100 publications

Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Recent mobile health interventions to support medication adherence among HIV-positive MSM

Online-to-offline models in HIV service delivery

Contact Info

Product

Resources

About