Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings.
TLDR
There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers, and recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation.Abstract:
The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency virus (HIV)-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a compelling case for more data to guide strategies to improve access and adherence to treatment in resource-limited settings.read more
Citations
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Journal Article
True Outcomes for Patients on Antiretroviral Therapy Who Are "Lost to Follow-Up" in Malawi/Veritables Issues Du Traitement Antiretroviral Pour Les Patients Consideres Comme « Perdus De Vue » Au Malawi/Evolucion Real De Los Pacientes Sometidos a Terapia Antirretroviral Y Perdidos En El Seguimiento En Malawi
Joseph Kwong-Leung Yu,Solomon Chih-Cheng Chen,Kuo-Yang Wang,Chao-Sung Chang,Simon D Makombe,Erik J Schouten,Anthony D. Harries +6 more
TL;DR: The authors in this paper found that 15% of the patients who were lost to follow-up may have died in the first year of ART, with the average being 12% in programmes with active followup and 19% in those with no active follow up.
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Health Behavior Change Models for HIV Prevention and AIDS Care: Practical Recommendations for a Multi-Level Approach
TL;DR: A comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice.
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Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review.
Carly Hudelson,Lucie Cluver +1 more
TL;DR: More research using longitudinal designs and rigorous measures of adherence is required in order to identify the range of factors influencing ART adherence as adolescents living with HIV/AIDS in LMICs grow into adulthood.
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Contemporary issues on the epidemiology and antiretroviral adherence of HIV‐infected adolescents in sub‐Saharan Africa: a narrative review
TL;DR: The epidemiology of HIV among sub‐Saharan African adolescents and their adherence to ART is summarized, emphasizing the unique challenges and factors associated with adherence behaviour.
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A Systematic Review of Health System Barriers and Enablers for Antiretroviral Therapy (ART) for HIV-Infected Pregnant and Postpartum Women
Christopher J. Colvin,Konopka S,John Chalker,Edna Jonas,Jennifer Albertini,Anouk Amzel,Karen P. Fogg +6 more
TL;DR: There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women, and supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps.
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