Strategies to improve adherence to antiretroviral therapy and retention in care for people living with HIV in high-income countries: a protocol for an overview of systematic reviews

Mbuagbaw, Lawrence; Mertz, Dominik; Lawson, Daeria O.; Śmieja, Marek; Benoit, Anita C.; Álvarez, Elizabeth; Ritchie, Lisa Puchalski; Rachlis, Beth; Logie, Carmen H.; Husbands, Winston; Margolese, Shari; Thabane, Lehana

doi:10.1136/bmjopen-2018-022982

Cited by 12 publications

(15 citation statements)

References 42 publications

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“…Novel models of integrated care for HIV and AUD, either by specialty referral or care for AUD within HIV clinics (Edelman et al, 2016;Edelman et al, 2017) and communitybased settings may provide insights on optimal strategies for improving AUD care for this population, and should be adaptable to the needs of less complex facilities. The low prevalence of retention on medications suggests that strategies that promote retention are needed, and these strategies may draw from those used to promote retention on ART such as through technology-based interventions or peer navigators (Mbuagbaw et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV

Oldfield

McGinnis

Edelman

et al. 2020

Journal of Substance Abuse Treatment

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Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status.Methods: From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient-and facility-level predictors of AUD medication initiation across HIV status.Results: Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51-0.85). Older age (for PLWH: AOR 0.78, 95% CI 0.61-0.99; for uninfected: AOR 0.70, 95% CI 0.61-0.80) and black race (for PLWH: AOR 0.63, 95% CI 0.0.49-0.1.00; for uninfected: AOR 0.63, 95% CI 0.48-0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. Conclusions:For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).

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Section: Discussionmentioning

confidence: 99%

Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV

Oldfield

McGinnis

Edelman

et al. 2020

Journal of Substance Abuse Treatment

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“…This study established that structural violence embedded within social structures such as laws, policies and institutional practices, and manifest through systemic inequities constrain Black people's retention in care and ART adherence, and ability to achieve and maintain undetectability, optimal health outcomes, and quality of life (12,76), leading to structural violation of their human rights (35). The manifestation of structural violence and violation of the human rights of Black people materialize from how laws and policy frameworks regulating public systems constrain Black people's agency to the extent that they could not equitably access health determinants.…”

Section: Discussionmentioning

confidence: 99%

“…Achieving and maintaining an undetectable viral load for people aware of their HIV-positive status requires consistent ART adherence (7)(8)(9)(10). At the same time, adherence to ART requires people living with HIV to remain engaged in continuous care, have routine follow-up services to monitor treatment e cacy, and take medication without interruption and discontinuation following diagnosis and treatment initiation (11)(12)(13). Studies have associated low retention in care and non-adherence to ART with suboptimal health outcomes and high mortality rates (7,(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Structural Violence and the Uncertainty of Viral Undetectability for African, Caribbean and Black People Living with HIV in Canada: An Institutional Ethnography

Odhiambo

O’Campo

Nelson

et al. 2022

Preprint

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Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of ‘structural violence’ to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n=20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n=15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada’s social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered “bad” patients while privileged individuals who achieve undetectability are considered “good” people. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.

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“… 23 The protocol for this overview has been published elsewhere. 24 Key features of our methods are outlined below.…”

Section: Methodsmentioning

confidence: 99%

Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1

et al. 2020

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ObjectivesWe sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care.MethodsWe conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis.ResultsWe identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care.ConclusionsInterventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.

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Strategies to improve adherence to antiretroviral therapy and retention in care for people living with HIV in high-income countries: a protocol for an overview of systematic reviews

Cited by 12 publications

References 42 publications

Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV

Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV

Structural Violence and the Uncertainty of Viral Undetectability for African, Caribbean and Black People Living with HIV in Canada: An Institutional Ethnography

Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1

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