Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies.
Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies.
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DOI：
10.1016/s1473-3099(11)70181-5
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发表时间：
2011-12
影响因子：
56.3
通讯作者：
Newell, Marie-Louise
中科院分区：
文献类型：
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作者：
Baernighausen, Till;Chaiyachati, Krisda;Chimbindi, Natsayi;Peoples, Ashleigh;Haberer, Jessica;Newell, Marie-Louise
艾滋病毒感染强效抗逆转录病毒治疗（ART）的成功主要取决于药物依从性水平。我们系统地回顾了撒哈拉以南非洲（SSA）提高抗逆转录病毒治疗依从性的干预措施有效性的证据，该地区500多万接受抗逆转录病毒治疗的人中有五分之四生活在那里。我们确定了2003年至2010年间进行的关于行为、认知、生物、结构和组合干预的25项研究的26篇相关出版物。大多数（16项）研究是在城市医院门诊设施进行的。研究在设计、样本量、随访时间和结果测量方面存在很大差异。尽管研究存在多样性和局限性，但迄今为止的证据表明，治疗支持者，直接观察治疗，手机短信服务，日记卡和食物配给，可以有效地增加SSA某些环境中的依从性。然而，我们的综合研究也表明，一些干预措施不太可能产生大的或持久的影响，而其他干预措施在某些情况下有效，但在其他情况下无效，强调需要更多的研究，特别是随机对照试验，以便检查环境和干预内容的特定特征对有效性的影响。未来工作的重要途径包括基于与SSA相关的行为理论的干预目标和干预选择。
The success of potent antiretroviral treatment (ART) for HIV infection is primarily determined by the level of medication adherence. We systematically review the evidence on effectiveness of interventions to enhance ART adherence in sub-Saharan Africa (SSA), where four fifths of the more than five million people receiving ART live. We identified 26 relevant publications reporting on 25 studies, conducted between 2003 and 2010, of behavioural, cognitive, biological, structural, and combination interventions. The majority (16) of the studies took place in hospital outpatient facilities in urban settings. Studies differed widely in design, sample size, length of follow-up, and outcome measurement. Despite study diversity and limitations, the evidence to date suggest that treatment supporters, directly observed therapy, cell phone short message services, diary cards and food rations and can be effective in increasing adherence in some settings in SSA. However, our synthesis of studies also shows that some interventions are unlikely to produce large or lasting effects, while other interventions are effective in some but not in other settings, emphasizing the need for more research, in particular, RCTs, to allow examination of the influence of context and particular features of intervention content on effectiveness. Important avenues for future work include intervention targeting and selection of interventions based on behavioural theories relevant to SSA.