Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis

Abstract

BackgroundAdherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence.MethodsWe searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression.ResultsIn total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries.ConclusionsThese findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

“…This could have contributed to the poorer adherence seen in men than women in our study. The majority of studies have reported no sex difference with respect to adherence [22][23][24][25][26][27], with one metaanalysis reporting a marginal association of male sex with higher adherence [16].…”

“…In the final multivariable analysis, we adjusted for potential confounders commonly cited in the literature [15,16]. We tested for interactions between CD4 count and trial arm, CD4 count and time in trial, and CD4 count and sex, to assess whether the effect of CD4 count on adherence depended on trial arm, time or on sex.…”

“…Adherence at each visit was plotted over the first 12 months after ART initiation; during this period, adherence was expected to be documented at 13 visits (2,4,8,12,16,20,24,28,32,36,40,44, 48 weeks post ART initiation). Random effects logistic regression was used to examine the association between CD4 count at initiation and sub-optimal adherence at each visit.…”

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

“…The current study found that social support was related to adherence in this sample. Previous studies reported mixed outcomes with social support and ART adherence (Kovarth et al, 2015;Langebeek et al, 2014;Kagee et al, 2010;Beng et al, 2011;Rivero-Mendez et al, 2010;Harris et al, 2011;Tabatabai et al, 2014;Kalichman et al, 2011;Haberer et al, 2013;Kagee et al, 2011). Previous studies among Caribbean women that examined social support generally found a relationship between social support and adherence to regimen (Beng et al, 2011;Rivero-Mendez et al, 2010;Harris et al, 2011).…”

“…With regard to depression, a majority of previous studies found a relationship between depression and ART adherence, with higher depression being associated with less adherence (Blashill, Gordon, & Safren, 2014;Langebeek et al, 2014;Sheth et al, 2015;Beer & Skarbinski, 2014;Ghose et al, 2013;King et al, 2012). However, some have shown an association with viral suppression, but not with adherence (Beck-Sague et al, 2014).…”