title: Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence.
abstract: OBJECTIVE
  This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy.
  
  
  BACKGROUND
  Evidence on efficacy must be supplemented with evidence on how interventions were implemented in practice and on how that implementation varied across populations and settings.
  
  
  METHODS
  Sixty-one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Fifty-two reports were included in the final analysis: 37 reporting the effects of interventions and 15 reporting intervention feasibility, acceptability, or fidelity.
  
  
  METHODS
  An adaptation of Pawson's realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. This model is successively refined to the point at which it best explains empirical findings from the reports reviewed.
  
  
  RESULTS
  The final explanatory model suggests that individuals with HIV will be more likely to enroll in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one-to-one relationship with the intervener. Participants who have limited prior experience with antiretroviral therapy will be more likely to continue with an intervention than those who are more experienced. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand-alone interventions.
  
  
  CONCLUSIONS
  The explanatory model developed in this study is intended to provide guidance to clinicians and researchers on the points in the implementation chain that require strengthening.
authors: School of Nursing, University of North Carolina, Chapel Hill, USA. jleeman@email.unc.edu
authors: Jennifer
authors: J
authors: Leeman
authors: Yun Kyung
authors: YK
authors: Chang
authors: Eun Jeong
authors: EJ
authors: Lee
authors: Corrine I
authors: CI
authors: Voils
authors: Jamie
authors: J
authors: Crandell
authors: Margarete
authors: M
authors: Sandelowski
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003219:Confidentiality; D005069:Evaluation Studies as Topic; D055317:Evidence-Based Practice; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000451:nursing; D015438:Health Behavior; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D009723:Nurse-Patient Relations; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D014481:United States; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents