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Moderators of Adherence & Retention and GHDonline staff

Context Adherence to antiretroviral therapy is a powerful predictor of survival for
individuals living with human immunodeficiency virus (HIV) and AIDS. Concerns about
incomplete adherence among patients living in poverty have been an important consideration
in expanding the access to antiretroviral therapy in sub-Saharan Africa.
Objective To evaluate estimates of antiretroviral therapy adherence in sub-Saharan
Africa and North America.
Data Sources Eleven electronic databases were searched along with major conference
abstract databases (inclusion dates: inception of database up until April 18, 2006)
for all English-language articles and abstracts; and researchers and treatment advocacy
groups were contacted.
Study Selection and Data Abstraction To best reflect the general population,
studies of mixed populations in both North America and Africa were selected. Studies
evaluating specific populations such as men only, homeless individuals, or drug users,
were excluded. The data were abstracted in duplicate on study adherence outcomes,
thresholds used to determine adherence, and characteristics of the populations.Arandomeffects
meta-analysis was performed in which heterogeneity was examined using multivariable
random-effects logistic regression. A sensitivity analysis was performed using
Bayesian methods.
Data Synthesis Thirty-one studies from North America (28 full-text articles and 3
abstracts) and 27 studies (9 full-text articles and 18 abstracts) from sub-Saharan Africa
were included. African studies represented 12 sub-Saharan countries. Of the North
American studies, 71% used patient self-report to assess adherence; this was true of
66% of the African assessments. Studies reported similar thresholds for adherence monitoring
(eg, 100%, 95%, 90%, 80%). A pooled analysis of the North American
studies (17 573 patients total) indicated a pooled estimate of 55% (95% confidence
interval, 49%-62%; I2, 98.6%) of the populations achieving adequate levels of adherence.
Our pooled analysis of African studies (12 116 patients total) indicated a pooled
estimate of 77% (95% confidence interval, 68%-85%; I2, 98.4%). Study continent,
adherence thresholds, and study quality were significant predictors of heterogeneity.
Bayesian analysis was used as an alternative statistical method for combining adherence
rates and provided similar findings.
Conclusion Our findings indicate that favorable levels of adherence, much of which
was assessed via patient self-report, can be achieved in sub-Saharan African settings
and that adherence remains a concern in North America.

Attached resource:

Summary: Context Adherence to antiretroviral therapy is a powerful predictor of survival for
individuals living with human immunodeficiency virus (HIV) and AIDS. Concerns about
incomplete adherence among patients living in poverty have been an important consideration
in expanding the access to antiretroviral therapy in sub-Saharan Africa.
Objective To evaluate estimates of antiretroviral therapy adherence in sub-Saharan
Africa and North America.
Data Sources Eleven electronic databases were searched along with major conference
abstract databases (inclusion dates: inception of database up until April 18, 2006)
for all English-language articles and abstracts; and researchers and treatment advocacy
groups were contacted.
Study Selection and Data Abstraction To best reflect the general population,
studies of mixed populations in both North America and Africa were selected. Studies
evaluating specific populations such as men only, homeless individuals, or drug users,
were excluded. The data were abstracted in duplicate on study adherence outcomes,
thresholds used to determine adherence, and characteristics of the populations.Arandomeffects
meta-analysis was performed in which heterogeneity was examined using multivariable
random-effects logistic regression. A sensitivity analysis was performed using
Bayesian methods.
Data Synthesis Thirty-one studies from North America (28 full-text articles and 3
abstracts) and 27 studies (9 full-text articles and 18 abstracts) from sub-Saharan Africa
were included. African studies represented 12 sub-Saharan countries. Of the North
American studies, 71% used patient self-report to assess adherence; this was true of
66% of the African assessments. Studies reported similar thresholds for adherence monitoring
(eg, 100%, 95%, 90%, 80%). A pooled analysis of the North American
studies (17 573 patients total) indicated a pooled estimate of 55% (95% confidence
interval, 49%-62%; I2, 98.6%) of the populations achieving adequate levels of adherence.
Our pooled analysis of African studies (12 116 patients total) indicated a pooled
estimate of 77% (95% confidence interval, 68%-85%; I2, 98.4%). Study continent,
adherence thresholds, and study quality were significant predictors of heterogeneity.
Bayesian analysis was used as an alternative statistical method for combining adherence
rates and provided similar findings.
Conclusion Our findings indicate that favorable levels of adherence, much of which
was assessed via patient self-report, can be achieved in sub-Saharan African settings
and that adherence remains a concern in North America.

Source: Journal of General Internal Medicine

Publication Date: August 9, 2006

 

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Adherence & Retention and GHDonline staff