Interventions to increase antiretroviral adherence in sub-Saharan Africa: A systematic review of evaluation studies

Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
The Lancet Infectious Diseases (Impact Factor: 22.43). 12/2011; 11(12):942-51. DOI: 10.1016/S1473-3099(11)70181-5
Source: PubMed


The success of potent antiretroviral treatment for HIV infection is primarily determined by adherence. We systematically review the evidence of effectiveness of interventions to increase adherence to antiretroviral treatment in sub-Saharan Africa. We identified 27 relevant reports from 26 studies of behavioural, cognitive, biological, structural, and combination interventions done between 2003 and 2010. Despite study diversity and limitations, evidence suggests that treatment supporters, directly observed therapy, mobile-phone text messages, diary cards, and food rations can effectively increase adherence in sub-Saharan Africa. However, some interventions are unlikely to have large or lasting effects, and others are effective only in specific settings. These findings emphasise the need for more research, particularly for randomised controlled trials, to examine the effect of context and specific features of intervention content on effectiveness. Future work should assess intervention targeting and selection of interventions based on behavioural theories relevant to sub-Saharan Africa.

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    • "Second, the study has a two-year drop-out rate of about 24%, which is substantially higher than the primary endpoint event rate of about 14% and therefore may compromise the Kaplan-Meier-analysis. This drop-out rate (which is equivalent to an annual 12% loss-to follow-up ) is comparable to the loss-to-follow-up rates reported in many other clinical trials on HIV drug adherence in Sub-Saharan Africa[29]. As the drop-out rate in the prednisolone arm was similar to the drop-out rate in the placebo arm (22.09% versus 25.15%, respectively) we suggest that there is reason to assume that the dropout rate may not have had a big distorting effect on the results of the trial and we found no evidence that the drop-outs were related to HIV infection., 2016Third, stratification according to sex was a post-hoc analysis, and only in this post-hoc analysis we observed a statistically significant benefit for prednisolone in attenuation of disease progression in female study participants. "
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    Full-text · Article · Jan 2016 · PLoS ONE
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    • "The health of PLWH and the sustained success of ART programmes depend not only on the health care available but also on PLWH's motivation and ability to self-manage the condition , including daily adherence to drugs. Although there is a growing body of evidence about ART adherence and its influences in resource-limited settings4567, there is still relatively limited research on the range of PLWH's self-management processes on ART in resource-limited settings[2,8,9]. This paper aims to enhance knowledge and understanding of HIV self-management processes in one particular resource-limited setting, Uganda. "
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    ABSTRACT: The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new 'self': they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "Small sample sized pilot studies expressing mHealth remain in the early stages [5], despite an urgency to achieve better understanding, utilization and promotion of mobile phone technology in this discipline and a need to achieve more effective and measurable results. It is observed that all of the RCT studies showed influencer outcomes in observational studies [13]. Some of these studies focused on mobile operating training programs for community health workers as they supervise and communicate with rural patients about their medication and treatment. "

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