Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis

Abstract

Structured Summary Background Adherence to antiretroviral therapy (ART) is a necessary condition to the improvement of HIV patient health and public health through ART. This study sought to determine the comparative effectiveness of different interventions for improving ART adherence among HIV-infected persons living in Africa. Methods We searched for randomized trials that evaluated an intervention to promote antiretroviral adherence within Africa. We created a network of the differing interventions by pooling the published and individual patient data for comparable treatments and comparing them across the individual interventions using Bayesian network meta-analyses. Outcomes included self-reported adherence and viral suppression. Findings We obtained data on 14 randomized controlled trials, involving 7,110 patients. Interventions included daily and weekly short message service (SMS) messaging, calendars, peer supporters, alarms, counseling, and basic and enhanced standard of care (SOC). For self-reported adherence, we found distinguishable improvement in adherence compared to SOC with enhanced SOC (odds ratio [OR]: 1.46, 95% credibility interval [CrI]: 1.06–1.98), weekly SMS messages (OR:1.65; 95% CrI: 1.25–2.18), counseling and SMS combined (OR:2.07; 95% CrI: 1.22–3.53), and treatment supporters (OR:1.83; 95% CrI:1.36–2.45). We found no compelling evidence for the remaining interventions. Results were similar when using viral suppression as an outcome, although the network of evidence was sparser. Treatment supporters with enhanced SOC (OR:1.46; 95% CrI: 1.09–1.97) and weekly SMS messages (OR:1.55; 95% CrI: 1.00–2.39) were significantly superior to basic SOC. Interpretation Several recommendations for improving adherence are unsupported by the available evidence. These findings should influence guidance documents on improving ART adherence in poor settings.

SMSaúde: Evaluating Mobile Phone Text Reminders to Improve Retention in HIV Care for Patients on Antiretroviral Therapy in Mozambique

“…11 A recent US study among adolescents and young adults found that self-reported ART adherence was higher among those who received personalized daily text message messages. 12 Further, a systematic review found that text message reminders can help improve adherence in other chronic diseases such as diabetes, or infectious diseases such as tuberculosis.…”

Rheumatic Heart Disease Treatment Cascade in Uganda

“…Since there are no tested interventions known to improve treatment cascade metrics for RHD in Africa, initial efforts might focus on strategies proven to work for HIV care. Specific interventions that appear to be most effective in HIV include weekly SMS reminders, treatment supporters, and enhanced counseling 27 . A large meta-analysis has also highlighted the benefits of decentralizing care and task shifting, demonstrating a more favorable effect for community-based vs. clinic-based ART programs on engagement in care in low- and middle-income countries 28 .…”

Current concepts for PrEP adherence in the PrEP revolution

“…Many lessons may be learned from the large literature exploring ART adherence interventions (49, 50); however, relevant factors may differ significantly for prevention (e.g., motivations, tolerance of side effects, availability of support). Formative work among US MSM suggest key components of a behavior adherence intervention for PrEP should be motivations to use PrEP, barriers to PrEP use, facilitators of PrEP use, sexual decision-making in the context of PrEP, prospective PrEP education content, and perceived effective characteristics of PrEP delivery personnel (51).…”