TY - JOUR
T1 - Barriers and facilitators of interventions for improving antiretroviral therapy adherence
T2 - A systematic review of global qualitative evidence: A
AU - Ma, Qingyan
AU - Tso, Lai Sze
AU - Rich, Zachary C.
AU - Hall, Brian J.
AU - Beanland, Rachel
AU - Li, Haochu
AU - Lackey, Mellanye
AU - Hu, Fengyu
AU - Cai, Weiping
AU - Doherty, Meg
AU - Tucker, Joseph D.
N1 - Funding Information:
We want to thank the Guangzhou Eighth People's Hospital and UNC Project-China for providing administrative support. We also want to extend our appreciation to Yang Bin and Zhang Ye at the Guangdong Center for Skin Disease and STI Control for help. This work was commissioned by the World Health Organization and supported by the South China-UNC STD Research Training Center, UNC Project-China and NIH Fogarty International Center (1D43TW009532-01, NIAID 1R01AI114310-01).
Funding Information:
Health Organization and supported by the South China-UNC STD Research Training Center, UNC Project-China and NIH Fogarty International Center (1D43TW009532-01, NIAID 1R01AI114310-01).
Publisher Copyright:
© 2016 Ma Q et al; licensee International AIDS Society.
PY - 2016/1
Y1 - 2016/1
N2 - Introduction: Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. Methods: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings. Results: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025), children living with HIV (two studies, n=46), adolescents living with HIV (four studies, n=70) and pregnant women living with HIV (one study, n=79). Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay health workers and inadvertent disclosure of serostatus by participating in the intervention. Conclusions: Our study evaluated adherence interventions based on qualitative data from PLHIV and health providers. The study underlines the importance of incorporating social and cultural factors into the design and implementation of interventions. Further qualitative research is needed to evaluate ART adherence interventions.
AB - Introduction: Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. Methods: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings. Results: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025), children living with HIV (two studies, n=46), adolescents living with HIV (four studies, n=70) and pregnant women living with HIV (one study, n=79). Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay health workers and inadvertent disclosure of serostatus by participating in the intervention. Conclusions: Our study evaluated adherence interventions based on qualitative data from PLHIV and health providers. The study underlines the importance of incorporating social and cultural factors into the design and implementation of interventions. Further qualitative research is needed to evaluate ART adherence interventions.
KW - ART adherence
KW - health policy
KW - intervention
KW - qualitative research
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85015788116&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015788116&partnerID=8YFLogxK
U2 - 10.7448/IAS.19.1.21166
DO - 10.7448/IAS.19.1.21166
M3 - Review article
C2 - 27756450
AN - SCOPUS:85015788116
VL - 19
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
SN - 1758-2652
IS - 1
M1 - 21166
ER -