Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature

Abstract

Background: Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients. Methods: The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age). Findings: From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%). Conclusion: The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.

What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study

“…Although some study eligible women declined to participate in the study, their baseline characteristics did not vary from those who participated except for the categories of casual worker and housewife under the variable “Occupation”. Although some earlier studies found a positive association between occupation/employment and adherence [ 53 ], similar to our study, other studies reported no association between socio- demographic and economic variables and adherence to ART [ 54 , 55 ]. Therefore, our study findings can be generalizable to women in settings similar to where the study was conducted such as regional referral hospitals, general hospitals and HC IIIs.…”

Viral suppression and associated factors among children tested for HIV viral load at Amhara Public Health Institute, Dessie Branch, Ethiopia: a cross-sectional study

“…Similarly, in Bahir Dar, Ethiopia, 71% of the HIV viral load was suppressed 6. But in the current study, there was a higher viral suppression rate than in the study conducted in southern Ghana and Niger 17 18. The difference might be due to differences in the study design, study area and methods used to measure viral suppression rate, as well as the sociodemographic characteristics of the study participants.…”

Determinants of Antiretroviral Treatment Success and Adherence in People With Human Immunodeficiency Virus Treated for Tuberculosis

“…Adherence to ART is a main driver of virologic efficacy and suboptimal adherence is associated to virologic failure [ 9–12 ]. Various indirect measures of adherence have been used, including patients’ self-reports, pill count adherence or medication possession ratio, pharmacy refill, physician evaluation, or electronic measures [ 13–17 ].…”

“…The threshold to define optimal adherence has been largely debated, but it is accepted that an adherence equal to or above 95% can be considered an optimal adherence level enabling to achieve virologic control [ 22 , 23 ]. A further understanding of the determinants of adherence and measuring their influence on virologic efficacy is challenging because socio-demographic and economic factors are also involved [ 9–12 ].…”