title: Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies.
abstract: We sought to review the effectiveness of interventions designed to improve adherence to antiretroviral therapy (ART) from studies included in a recent Cochrane review that reported a clinical and an adherence outcome, with at least 80% follow-up for 6 months or more. Data were extracted independently and in duplicate, with an adjudicator for disagreements. Risk of bias was assessed using the Cochrane Risk of Bias tool. Of 182 relevant studies in the Cochrane review, 49 were related to ART. Statistical pooling was not warranted due to heterogeneity in interventions, participants, treatments, adherence measures and outcomes. Many studies had high risk of bias in elements of design and outcome ascertainment. Only 10 studies improved both adherence and clinical outcomes. These used the following interventions: adherence counselling (two studies); a once-daily regimen (compared to twice daily); text messaging; web-based cognitive behavioral intervention; face-to-face multi-session intensive behavioral interventions (two studies); contingency management; modified directly observed therapy; and nurse-delivered home visits combined with telephone calls. Patient-related adherence interventions were the most frequently tested. Uniform adherence measures and higher quality studies of younger populations are encouraged.
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.forename: Bhairavi
authors.initials: B
authors.lastname: Sivaramalingam
authors.forename: Tamara
authors.initials: T
authors.lastname: Navarro
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hobson
authors.forename: Arun
authors.initials: A
authors.lastname: Keepanasseril
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Wilczynski
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D055118:Medication Adherence; D016032:Randomized Controlled Trials as Topic; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
references.citation: Confl Health. 2012 Oct 31;6(1):9
references.pmid: 23110782
references.citation: Ann Behav Med. 2011 Feb;41(1):83-91
references.pmid: 20922510
references.citation: Am J Public Health. 2013 Feb;103(2):308-15
references.pmid: 22720766
references.citation: AIDS Behav. 2013 Oct;17(8):2816-29
references.pmid: 23812892
references.citation: J Pediatr Psychol. 2013 Jul;38(6):638-48
references.pmid: 23359664
references.citation: HIV Med. 2008 Oct;9(8):667-72
references.pmid: 18631255
references.citation: J Acquir Immune Defic Syndr. 2009 Jun 1;51(2):163-74
references.pmid: 19357529
references.citation: Cochrane Database Syst Rev. 2011;(12):CD009513
references.pmid: 22161452
references.citation: Sex Health. 2014 Jul;11(3):230-9
references.pmid: 24966025
references.citation: Curr HIV/AIDS Rep. 2011 Dec;8(4):223-34
references.pmid: 21858414
references.citation: J Acquir Immune Defic Syndr. 2007 Oct 1;46(2):238-44
references.pmid: 17693890
references.citation: Clin Infect Dis. 2001 Sep 15;33(6):865-72
references.pmid: 11512092
references.citation: Drug Alcohol Depend. 2007 Apr 17;88(1):54-63
references.pmid: 17056206
references.citation: J Clin Epidemiol. 2009 Oct;62(10):1006-12
references.pmid: 19631508
references.citation: Drugs Aging. 2013 Oct;30(10):809-19
references.pmid: 23959913
references.citation: Enferm Infecc Microbiol Clin. 1999 Feb;17(2):78-81
references.pmid: 10193067
references.citation: Antivir Ther. 2005;10(1):83-93
references.pmid: 15751766
references.citation: J Acquir Immune Defic Syndr. 2003 Oct 1;34(2):174-83
references.pmid: 14526206
references.citation: AIDS. 2005 Aug 12;19(12):1243-9
references.pmid: 16052078
references.citation: JAMA. 1999 Sep 22-29;282(12):1135-41
references.pmid: 10501116
references.citation: HIV Med. 2013 Nov;14(10):583-95
references.pmid: 23773654
references.citation: Cochrane Database Syst Rev. 2014;11:CD000011
references.pmid: 25412402
references.citation: AIDS. 2005 May 20;19(8):807-14
references.pmid: 15867495
references.citation: HIV Clin Trials. 2003 Mar-Apr;4(2):121-31
references.pmid: 12671780
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: AIDS Care. 2008 Mar;20(3):273-83
references.pmid: 18351473
references.citation: J Acquir Immune Defic Syndr. 2009 Dec 1;52(4):465-473
references.pmid: 19911481
references.citation: AIDS. 2007 Oct 18;21(16):2217-22
references.pmid: 18090049
references.citation: J Acquir Immune Defic Syndr. 2010 May 1;54(1):85-92
references.pmid: 20418724
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 15;48(5):611-9
references.pmid: 18645509
references.citation: AIDS Care. 2010 Oct;22(10):1173-81
references.pmid: 20640949
references.citation: Clin Infect Dis. 2010 Jul 1;51(1):115-7
references.pmid: 20518676
references.citation: AIDS Patient Care STDS. 2007 Jan;21(1):30-40
references.pmid: 17263651
references.citation: Lancet. 2010 Nov 27;376(9755):1838-45
references.pmid: 21071074
references.citation: J Acquir Immune Defic Syndr. 2013 May 1;63(1):42-50
references.pmid: 23337369
references.citation: Int J STD AIDS. 2013 Jun;24(6):427-32
references.pmid: 23970743
references.citation: PLoS Med. 2011 Mar;8(3):e1000422
references.pmid: 21390262
references.citation: AIDS Behav. 2011 Jul;15(5):919-29
references.pmid: 20957423
references.citation: Arch Intern Med. 2011 Jan 10;171(1):23-31
references.pmid: 21220657
references.citation: J Acquir Immune Defic Syndr. 2007 Dec 1;46(4):443-50
references.pmid: 18077833
references.citation: J Infect Dis. 2005 Oct 15;192(8):1398-406
references.pmid: 16170757
references.citation: AIDS Behav. 2013 Jul;17(6):1992-2001
references.pmid: 23568228
references.citation: N Engl J Med. 1998 Jul 30;339(5):307-11
references.pmid: 9682043
references.citation: Drug Alcohol Depend. 2010 Dec 1;112(3):178-93
references.pmid: 20705402
references.citation: Lancet Infect Dis. 2011 Dec;11(12):942-51
references.pmid: 22030332
references.citation: AIDS Behav. 2011 Jul;15(5):885-96
references.pmid: 21165692
references.citation: AIDS Patient Care STDS. 2012 Jan;26(1):36-52
references.pmid: 22070609
references.citation: AIDS Patient Care STDS. 2004 Jun;18(6):355-63
references.pmid: 15294086
references.citation: AIDS Behav. 2011 Oct;15(7):1381-96
references.pmid: 21468660
references.citation: Clin Infect Dis. 2000 Jun;30 Suppl 2:S171-6
references.pmid: 10860902
references.citation: AIDS Behav. 2013 Nov;17(9):3059-65
references.pmid: 23904145
references.citation: AIDS Behav. 2011 Nov;15(8):1635-46
references.pmid: 21452051
references.citation: J Pain Symptom Manage. 2012 Feb;43(2):161-71
references.pmid: 21925831
references.citation: AIDS. 2001 Jun 15;15(9):1181-3
references.pmid: 11416722
references.citation: J Acquir Immune Defic Syndr. 2002 May 1;30(1):105-10
references.pmid: 12048370
references.citation: Cochrane Database Syst Rev. 2012;3:CD009756
references.pmid: 22419345
references.citation: JAMA. 1998 Mar 25;279(12):930-7
references.pmid: 9544767
references.citation: AIDS Behav. 2010 Jun;14(3):580-9
references.pmid: 19771504
references.citation: Ann Intern Med. 2000 Jul 4;133(1):21-30
references.pmid: 10877736
references.citation: BMJ Open. 2013 Dec 17;3(12):e003950
references.pmid: 24345901
references.citation: J Acquir Immune Defic Syndr. 2010 Mar;53(3):369-77
references.pmid: 20087195
references.citation: AIDS Behav. 2014 Apr;18(4):646-60
references.pmid: 24043269
references.citation: J Clin Nurs. 2010 Feb;19(3-4):380-8
references.pmid: 20500277
references.citation: Cochrane Database Syst Rev. 2012;9:CD009748
references.pmid: 22972147
references.citation: AIDS Care. 2012;24(5):583-92
references.pmid: 22292452
references.citation: AIDS Behav. 2013 Nov;17(9):2963-76
references.pmid: 23760634
references.citation: Clin Infect Dis. 2006 Oct 1;43(7):939-41
references.pmid: 16941380
references.citation: Enferm Infecc Microbiol Clin. 2000 Jan;18(1):27-39
references.pmid: 10721560
references.citation: Antivir Ther. 2004 Feb;9(1):85-95
references.pmid: 15040540
references.citation: J Acquir Immune Defic Syndr. 2000 Nov 1;25(3):221-8
references.pmid: 11115952
references.citation: Health Psychol. 2007 Jul;26(4):488-95
references.pmid: 17605569
references.citation: Am J Public Health. 2011 Mar;101(3):531-8
references.pmid: 21233431
references.citation: Ann Behav Med. 2014 Jun;47(3):259-69
references.pmid: 24234601
references.citation: AIDS Care. 2011 Nov;23(11):1360-5
references.pmid: 22022846
references.citation: Clin Infect Dis. 2002 Apr 15;34(8):1115-21
references.pmid: 11915001
references.citation: AIDS Care. 2013;25(4):507-14
references.pmid: 22909294
references.citation: J Acquir Immune Defic Syndr. 2007 Nov 1;46 Suppl 2:S35-47
references.pmid: 18089983
references.citation: AIDS Behav. 2013 Jan;17(1):181-92
references.pmid: 22527264
references.citation: Clin Infect Dis. 2005 Sep 15;41(6):875-82
references.pmid: 16107989
references.citation: AIDS. 2014 Mar;28 Suppl 2:S187-204
references.pmid: 24849479
references.citation: HIV Med. 2005 May;6(3):185-90
references.pmid: 15876285
references.citation: AIDS Behav. 2011 Nov;15(8):1795-802
references.pmid: 21424272
references.citation: HIV Clin Trials. 2013 Sep-Oct;14(5):235-53
references.pmid: 24144900
references.citation: AIDS. 1999 Jun 18;13(9):1099-107
references.pmid: 10397541