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

Abstract

Background: Adherence 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. Methods: We 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. Results: In 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.

Qualidade de vida e fatores associados em pessoas vivendo com HIV/AIDS

“…Given the changes in morbidity and mortality, studies have shown the positive impact of adherence to antiretroviral therapy on the quality of life. (5,13,14) Permeated by feelings of guilt, loneliness and fear of death, participants who exercised spirituality by means of faith or religious beliefs achieved better coping with the HIV serostatus, encouragement and ability to work. Spirituality and religion improve health, quality of life, and help people living with HIV to cope with stress from stigma and discriminatory practices.…”

Barriers to Antiretroviral Therapy Adherence and Plasma HIV RNA Suppression Among AIDS Clinical Trials Group Study Participants

“…We conducted a secondary analysis of data collected for other purposes and which contained a substantial number of research participants with missing data. We relied on self-reported adherence barriers, which may be prone to recall and social desirability bias and may not have fully captured all adherence barriers (e.g., substance use, 47 trust in HIV care provider, pregnancy, 36,48 etc.). We examined adherence barriers at only one time point early in the ART course.…”

Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013

“…Previous studies have identified several factors as potentially contributing to late presentation, poor HAART uptake and low retention in HIV care. These factors include stigma, fear of status disclosure, complexity of treatment regimens and lack of psychosocial support (48); lack of confidentiality and fear of discrimination at health facilities, workplace and community (49); poor staff-patient relationships and underestimation of the need for HAART (50); and active drug use (43,46). Stigma and fear of disclosure are particularly important among females living in a conservative society.…”