title: Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom.
abstract: International focus on reducing onward HIV transmission emphasizes the need for routine HIV testing and early uptake of antiretroviral treatment (ART). Strategic targets have been set for 2020 to achieve the goal of 90% of people infected with HIV diagnosed, 90% of identified cases on treatment, and 90% of persons on treatment virally suppressed (90-90-90). It is vital to understand the complexity of factors influencing a person's treatment decisions over time and the context which may enable better adherence. In this paper we present findings from the review of published and gray literature (2003-2013) on the documented factors associated with treatment initiation and adherence in the general adult population of Australia, Canada, and the UK. A framework developed by Begley, McLaws, Ross, and Gold [2008. Cognitive and behavioural correlates of non-adherence to HIV anti-retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology. Clinical Psychologist, 12(1), 9-17] in Australia was adapted to summarize the findings. A systematic database search using keywords and a set of inclusion criteria yielded 17 studies (Australia = 6; Canada = 8; UK = 3). In addition 11 reports were included in the review. We found that a person's abilities and motivations (intrapersonal factors, reported in 7 studies) to start and continue ART are influenced by a host of interconnected factors spanning relationship (interpersonal, 3 studies) and broader structural (extrapersonal, 15 studies) factors that are situated within social determinants of health. People therefore evaluate various costs and benefits of starting and staying on treatment, in which biomedical concerns play an important yet often subsidiary role. In this review the economic barriers to care were found to be significant and under-reported, highlighting the persistent health inequities in terms of access to services. Our understanding of the context around people's use of ART remains poor. Qualitative social research within HIV-positive communities is urgently needed to capture people's lived experiences and may address some of this deficit in understanding.
authors.affiliation: a School of Public Health, University of Queensland , Herston , Australia.
authors.forename: K
authors.initials: K
authors.lastname: Bolsewicz
authors.affiliation: b Metro North Public Health Unit, Metro North Hospital & Health Service , Windsor , Australia.
authors.forename: J
authors.initials: J
authors.lastname: Debattista
authors.affiliation: c Public Health Interventions Research Group, The Kirby Institute, UNSW.|d Australian Institute of Tropical Health & Medicine, James Cook University , Cairns , Australia.
authors.forename: A
authors.initials: A
authors.lastname: Vallely
authors.affiliation: e School of Social Science, Faculty of Arts , Monash University , Melbourne , Victoria , Australia.
authors.forename: A
authors.initials: A
authors.lastname: Whittaker
authors.affiliation: a School of Public Health, University of Queensland , Herston , Australia.
authors.forename: L
authors.initials: L
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001315:Australia; D002170:Canada; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D020377:Self Efficacy; D012944:Social Support; D012959:Socioeconomic Factors; D006113:United Kingdom; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: ART; ART: antiretroviral treatment; the UK: United Kingdom; HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; PLHIV: people living with HIV; the USA: United States of America; IDU: injecting drug user; PBS: Pharmaceutical Benefits Sc; Australia; Canada; UK; factors; review