title: Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis.
abstract: BACKGROUND
  Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa.
  
  
  METHODS
  We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms "HIV", "ART", "adherence", and "Africa". We created a network of the interventions by pooling the published and individual patients' data for comparable treatments and comparing them across the individual interventions with Bayesian network meta-analyses. The primary outcome was adherence defined as the proportion of patients meeting trial defined criteria; the secondary endpoint was viral suppression.
  
  
  RESULTS
  We obtained data for 14 randomised controlled trials, with 7110 patients. Interventions included daily and weekly short message service (SMS; text message) messaging, calendars, peer supporters, alarms, counselling, and basic and enhanced standard of care (SOC). Compared with SOC, we found distinguishable improvement in self-reported adherence with enhanced SOC (odds ratio [OR] 1·46, 95% credibility interval [CrI] 1·06-1·98), weekly SMS messages (1·65, 1·25-2·18), counselling and SMS combined (2·07, 1·22-3·53), and treatment supporters (1·83, 1·36-2·45). We found no compelling evidence for the remaining interventions. Results were similar when using viral suppression as an outcome, although the network contained less evidence than that for adherence. Treatment supporters with enhanced SOC (1·46, 1·09-1·97) and weekly SMS messages (1·55, 1·01-2·38) were significantly better than basic SOC.
  
  
  CONCLUSIONS
  Several recommendations for improving adherence are unsupported by the available evidence. These findings can inform future intervention choices for improving ART adherence in low-income settings.
  
  
  BACKGROUND
  None.
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, CA, USA. Electronic address: millsej@stanford.edu.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Lester
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, CA, USA; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorlund
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Lorenzi
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Muldoon
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Kanters
authors.affiliation: RAND Corp, Los Angeles, CA, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Linnemayr
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.affiliation: Department of Emergency Medicine, Albert Einstein University, New York, NY, USA.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Calderon
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: School of Social Work, University of Washington, Seattle, WA, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pearson
authors.affiliation: HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Department of Global Health, School of Medicine and Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
authors.affiliation: Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.affiliation: Center for AIDS Research, UCSF, San Francisco, CA, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Liu
authors.affiliation: Centre for Applied Health Research & Delivery, Warwick University, Coventry, UK.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Simoni
authors.affiliation: Harvard School of Public Health, Harvard, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bangsberg
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Sanni
authors.initials: S
authors.lastname: Yaya
authors.affiliation: Harvard School of Public Health, Harvard, Boston, MA, USA; Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.affiliation: Department of HIV/AIDS, WHO, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Center for Infectious Diseases, Stellenbosch University, Cape Town, Western Cape, South Africa.
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega