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Author Notes:

Cherie R. Rooks-Peck, PhD, RD Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road NE, Mailstop F-62 Atlanta, GA 30329, Email: crookspeck@cdc.gov

We thank members of the Prevention Research Synthesis team for their contribution to the PRS database, including Jeff Becasen, Mary Mullins, and Emiko Kamitani.

No competing financial interests exist.

Subject:

Research Funding:

The work of Leslie W. Ross was supported by the Emory University Rollins Earn and Learn (REAL) internship program.

Keywords:

  • medication adherence
  • HIV
  • systematic review
  • intervention

Analysis of Systematic Reviews of Medication Adherence Interventions for Persons with HIV, 1996–2017

Journal Title:

AIDS PATIENT CARE AND STDS

Volume:

Volume 33, Number 12

Publisher:

, Pages 528-537

Type of Work:

Article | Post-print: After Peer Review

Abstract:

This overview of reviews summarizes the evidence from systematic reviews (SR) on the effectiveness of antiretroviral therapy (ART) adherence interventions for people with HIV (PWH) and descriptively compares adherence interventions among key populations. Relevant articles published during 1996–2017 were identified by comprehensive searches of CDC’s HIV/acquired immunodeficiency syndrome (AIDS) Prevention Research Synthesis Database and manual searches. Included SRs examined primary interventions intended to improve ART adherence, focused on PWH, and assessed medication adherence or biologic outcomes (e.g., viral load). We synthesized the qualitative data and used the Assessment of Multiple Systematic Reviews (AMSTAR) for quality assessment. Forty-one SRs met inclusion criteria. Average quality was high. SRs that evaluated text-messaging interventions (n = 9) consistently reported statistically significant improvements in adherence and biologic outcomes. Other ART adherence strategies [e.g., behavioral, directly administered antiretroviral therapy (DAART)] reported improvements, but did not report significant effects for both outcomes, or intervention effects that did not persist postintervention. In the review focused on people who inject drugs (n = 1), DAART alone or in combination with medication-assisted therapy improved both outcomes. In SRs focused on children or adolescents aged <18 years (n = 5), regimen-related and hospital-based DAART improved biologic outcomes. ART adherence interventions (e.g., text-messaging) improved adherence and biologic outcomes; however, results differed for other intervention strategies, populations, and outcomes. Because few SRs reported evidence for populations at high risk (e.g., men who have sex with men), the results are not generalizable to all PWH. Future implementation studies are needed to examine medication adherence interventions in specific populations and address the identified gaps.
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