Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: a systematic review of the literature

Abstract

Objectives: It has been shown that socioeconomic status (SES) is associated with adherence to treatment of patients with several chronic diseases. However, there is a controversy regarding the impact of SES on adherence among patients with the human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). Thus, we sought to perform a systematic review of the evidence regarding the association of SES with adherence to treatment of patients with HIV/ AIDS. Methods:We searched the PubMed database to identify studies concerning SES and HIV/AIDS and collected data regarding the association between various determinants of SES (income, education, occupation) and adherence. Findings:We initially identified 116 potentially relevant articles and reviewed in detail 17 original studies, which contained data that were helpful in evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. No original research study has specifically focused on the possible association between SES and adherence to treatment of patients with HIV/ AIDS. Among the reviewed studies that examined the impact of income and education on adherence to antiretroviral treatment, only half and less than a third, respectively, found a statistically significant association between these main determinants of SES and adherence of patients infected with HIV/AIDS. Conclusion:Our systematic review of the available evidence does not provide conclusive support for existence of a clear association between SES and adherence among patients infected with HIV/ AIDS. There seemed to be a positive trend among components of SES (income, education, occupation) and adherence to antiretroviral treatment in many of the reviewed studies, however most of the studies did not establish a statistically significant association between determinants of SES and adherence.

Social Position as a Structural Determinant of Adherence to Treatment in Women Living with HIV/AIDS

“…Although the relationship between the poverty of women and HIV/AIDS has been recognized as an essential determinant of the dynamics of the epidemic (Farmer, 1996;Herrera & Campero, 2002;Rao, 2004;Wingood & Diclemente, 2000), adherence among this population is a topic on which there has been little research and the results are not consistent. A systematic literature review of 116 studies presents the conclusion that even though there is a positive trend in relation to adherence in various chronic illnesses and some areas of socioeconomic status, for example income, education and occupation, there is insufficient evidence about statistically significant associations between socioeconomic status and adherence among patients with HIV/AIDS (Falagas, 2008). On the contrary, other studies carried out with men and women reveal associations between a deficient financial situation and non-adherence (Carballo et al, 2004;Castro, 2005;Chesney, Chesney et al, 2000;Gifford et al, 2000;Glass, et al, 2006;Gordillo, 1999;Ickovics & Meade, 2002;Kleeberger et al, 2001).…”

Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review

“…Persons with different risk factors (e.g. injection drug use) may have therapy adherence problems due to their behavioral and decision-making characteristics that may have grounds in low education, low incomes, unemployment, and low occupational status [18]. It has been documented that the relative survival estimates by transmission category are significantly better for males exposed through male-to-male sexual contact as compared with other transmission groups [84].…”

“…AIDS diagnosis and CD4 cell counts point out HIV progression and, therefore, they should always be adjusted for in the survival analysis if available. In the post-HAART period, treatment variables, such as access to care and HAART adherence [18,93,94] affecting disease progression must be considered along with clinical variables in relation to the patients' SES. The recent trend of an increasing proportion of older adults with more advanced HIV disease compared to younger individuals at first presentation for care [13,16] also highlights the importance of adjusting measures of association for age and AIDS diagnosis in the analysis of the effects of SES on mortality and morbidity due to HIV/AIDS.…”

Adherence to antiretroviral therapy: factors independently associated with reported difficulty taking antiretroviral therapy in a national sample of HIV-positive Australians

“…Gender, a history of injecting drug use, risk factor(s) for HIV infection and marital status have generally not been associated with nonadherence to cART [9,10]. Socioeconomic factors have generally not been found to be associated with nonadherence to cART, although a lack of social support and unstable housing have been associated with nonadherence [9,11]. Of those treatment-related factors investigated, a greater number of doses per day and certain adverse events, typically physical symptoms, have been associated with nonadherence [4,9,[12][13][14][15][16].…”