Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies.
The success of potent antiretroviral treatment for HIV infection is primarily determined by adherence. We systematically review the evidence of effectiveness of interventions to increase adherence to antiretroviral treatment in sub-Saharan Africa. We identified 27 relevant reports from 26 studies of behavioural, cognitive, biological, structural, and combination interventions done between 2003 and 2010. Despite study diversity and limitations, evidence suggests that treatment supporters, directly observed therapy, mobile-phone text messages, diary cards, and food rations can effectively increase adherence in sub-Saharan Africa. However, some interventions are unlikely to have large or lasting effects, and others are effective only in specific settings. These findings emphasise the need for more research, particularly for randomised controlled trials, to examine the effect of context and specific features of intervention content on effectiveness. Future work should assess intervention targeting and selection of interventions based on behavioural theories relevant to sub-Saharan Africa.
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa. tbaernig@hsph.harvard.edu
Till
T
Bärnighausen
Krisda
K
Chaiyachati
Natsayi
N
Chimbindi
Ashleigh
A
Peoples
Jessica
J
Haberer
Marie-Louise
ML
Newell
D017954:Africa South of the Sahara; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D017063:Outcome Assessment, Health Care; D016903:Drug Monitoring