Improving antiretroviral therapy adherence in resource-limited settings at scale: A discussion of interventions and recommendations
JournalJournal of the International AIDS Society
MetadataShow full item record
AbstractIntroduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-Analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low-And middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS. Copyright 2017 Haberer JE et al.
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85020608553&doi=10.7448%2fIAS.20.1.21371&partnerID=40&md5=78d6185412a70a4f08a263d26ed6e73f; http://hdl.handle.net/10713/10011
- Optimal monitoring strategies for guiding when to switch first-line antiretroviral therapy regimens for treatment failure in adults and adolescents living with HIV in low-resource settings.
- Authors: Chang LW, Harris J, Humphreys E
- Issue date: 2010 Apr 14
- Effectiveness of short message services and voice call interventions for antiretroviral therapy adherence and other outcomes: A systematic review and meta-analysis.
- Authors: Amankwaa I, Boateng D, Quansah DY, Akuoko CP, Evans C
- Issue date: 2018
- Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection.
- Authors: Horvath T, Azman H, Kennedy GE, Rutherford GW
- Issue date: 2012 Mar 14
- Factors Affecting the Implementation of Electronic Antiretroviral Therapy Adherence Monitoring and Associated Interventions for Routine HIV Care in Uganda: Qualitative Study.
- Authors: Haberer JE, Garrison L, Tumuhairwe JB, Baijuka R, Tindimwebwa E, Tinkamanyire J, Burns BF, Asiimwe S
- Issue date: 2020 Sep 10
- Antiretroviral therapy (ART) for treating HIV infection in ART-eligible pregnant women.
- Authors: Sturt AS, Dokubo EK, Sint TT
- Issue date: 2010 Mar 17