Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention.
Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.
University of North Carolina Project-China, Guangzhou, China; Institute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, USA. Electronic address: jdtucker@med.unc.edu.
Joseph D
JD
Tucker
University of North Carolina Project-China, Guangzhou, China. Electronic address: ltso@umich.edu.
Lai Sze
LS
Tso
Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA. Electronic address: brianhall@umac.mo.
Brian
B
Hall
University of North Carolina Project-China, Guangzhou, China. Electronic address: qingyan_ma@med.unc.edu.
Qingyan
Q
Ma
HIV Department, World Health Organization, Geneva, Switzerland. Electronic address: beanlandr@who.int.
Rachel
R
Beanland
School of Medicine, University of California, San Francisco, San Francisco, USA. Electronic address: John.Best@ucsf.edu.
John
J
Best
University of North Carolina Project-China, Guangzhou, China.
Haochu
H
Li
Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA. Electronic address: mellanye.lackey@utah.edu.
Mellanye
M
Lackey
University of North Carolina Project-China, Guangzhou, China. Electronic address: giftatluck@yahoo.com.
Gifty
G
Marley
University of North Carolina Project-China, Guangzhou, China. Electronic address: zackrich@gmail.com.
Zachary C
ZC
Rich
University of North Carolina Project-China, Guangzhou, China. Electronic address: soukalon19920126@gmail.com.
Ka-Lon
KL
Sou
HIV Department, World Health Organization, Geneva, Switzerland. Electronic address: dohertym@who.int.
Meg
M
Doherty
D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D011787:Quality of Health Care / Q000592:standards*; D012959:Socioeconomic Factors
HIV; Intervention; Public health; Qualitative; Systematic review