Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis.
OBJECTIVE
We aimed to estimate the odds of engagement in HIV care and treatment among HIV-positive women reporting intimate partner violence (IPV).


METHODS
We systematically reviewed the literature on the association between IPV and engagement in care. Data sources included searches of electronic databases (PubMed, Web of Science, CINAHL and PsychoInfo), hand searches and citation tracking.


METHODS
Two reviewers screened 757 full-text articles, extracted data and independently appraised study quality. Included studies were peer-reviewed and assessed IPV alongside engagement in care outcomes: antiretroviral treatment (ART) use; self-reported ART adherence; viral suppression; retention in HIV care. Odds ratios (ORs) were pooled using random effects meta-analysis.


RESULTS
Thirteen cross-sectional studies among HIV-positive women were included. Measurement of IPV varied, with most studies defining a 'case' as any history of physical and/or sexual IPV. Meta-analysis of five studies showed IPV to be significantly associated with lower ART use [OR 0.79, 95% confidence interval (95% CI) 0.64-0.97]. IPV was associated with poorer self-reported ART adherence in six studies (OR 0.48, 95% CI 0.30-0.75) and lower odds of viral load suppression in seven studies (OR 0.64, 95% CI 0.46-0.90). Lack of longitudinal data and measurement considerations should temper interpretation of these results.


CONCLUSIONS
IPV is associated with lower ART use, half the odds of self-reported ART adherence and significantly worsened viral suppression among women. To ensure the health of HIV-positive women, it is essential for clinical programmes to address conditions that impact engagement in care and treatment. IPV is one such condition, and its association with declines in ART use and adherence requires urgent attention.
aWits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa bUniversity of California, San Francisco, San Francisco, California, USA cLondon School of Hygiene and Tropical Medicine, London, UK dUniversity of Alabama at Birmingham, Birmingham, Alabama, USA.
Abigail M
AM
Hatcher
Elizabeth M
EM
Smout
Janet M
JM
Turan
Nicola
N
Christofides
Heidi
H
Stöckl
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology*; D055118:Medication Adherence; D019562:Viral Load
D019380:Anti-HIV Agents