Interventions to improve adherence to antiretroviral therapy: a rapid systematic review
Interventions to improve adherence to antiretroviral therapy: a rapid systematic review
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DOI：
10.1097/qad.0000000000000252
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发表时间：
2014-03-01
期刊：
影响因子：
3.8
通讯作者：
Baernighausen, Till
中科院分区：
文献类型：
--
作者：
Chaiyachati, Krisda H.;Ogbuoji, Osondu;Baernighausen, Till
导言：在过去的十年中，获得抗逆转录病毒治疗(ART)的机会有了很大的改善。在艾滋病毒作为一种慢性病的新时代，抗逆转录病毒治疗的持续成功将关键取决于对抗逆转录病毒药物的持续高度坚持。这篇综述的目的是系统地评价可以改善对抗逆转录病毒疗法依从性的干预措施，包括个体水平的干预措施和对抗逆转录病毒疗法交付结构的改变，为2013年世卫组织抗逆转录病毒综合指南提供证据基础。设计：快速系统综述。方法：我们对全球关于干预措施改善对抗逆转录病毒疗法依从性的证据进行了快速系统审查，利用先前存在的系统审查来确定相关的研究证据，并对过去两年发表的关于随机对照试验(RCT)证据的文章进行数据库筛选。我们在五个数据库中搜索系统评价和初步随机对照试验研究(Cochrane图书馆、EMBASE、MEDLINE、科学网和世界卫生组织全球卫生图书馆)；此外，我们还在ClinicalTrials.gov上搜索随机对照试验研究。我们根据不同的研究特征，特别是接受干预的特定人群来检验干预的有效性。结果：共有124项研究符合我们的选择标准。86项研究为随机对照试验。20多项研究测试了以下每一种干预措施的有效性，无论是单独进行还是与其他干预措施结合使用：认知-行为干预、教育、治疗支持者、直接观察治疗和主动遵守提醒设备(如手机短信)。虽然有强有力的证据表明，在某些情况下，所有这五种干预措施都可以显著提高对ART的依从性，但在几项研究中，每一种干预措施也被发现没有产生显著的效果。在124项研究中，近一半(55项)调查了联合干预的有效性。联合干预措施的效果往往与单一干预措施的效果相似。除了对注射吸毒者的干预外，对重点人群的干预的证据基础薄弱。结论：在常规方案和护理环境中，应越来越多地实施经过检验的、有效的依从性增强干预措施，同时对实施效果和绩效进行严格评估。关于加强遵守干预措施的主要证据差距仍然存在，特别是在不同环境中干预措施的成本效益、长期有效性以及干预措施在特定人群中的有效性方面，例如孕妇和哺乳期妇女。(C)2014沃尔特斯·克鲁沃健康垂直酒吧Lippincott Williams&Wilkins
Introduction:Access to antiretroviral treatment (ART) has substantially improved over the past decade. In this new era of HIV as a chronic disease, the continued success of ART will depend critically on sustained high ART adherence. The objective of this review was to systematically review interventions that can improve adherence to ART, including individual-level interventions and changes to the structure of ART delivery, to inform the evidence base for the 2013 WHO consolidated antiretroviral guidelines.Design:A rapid systematic review.Methods:We conducted a rapid systematic review of the global evidence on interventions to improve adherence to ART, utilizing pre-existing systematic reviews to identify relevant research evidence complemented by screening of databases for articles published over the past 2 years on evidence from randomized controlled trials (RCTs). We searched five databases for both systematic reviews and primary RCT studies (Cochrane Library, EMBASE, MEDLINE, Web of Science, and WHO Global Health Library); we additionally searched ClinicalTrials.gov for RCT studies. We examined intervention effectiveness by different study characteristics, in particular, the specific populations who received the intervention.Results:A total of 124 studies met our selection criteria. Eighty-six studies were RCTs. More than 20 studies have tested the effectiveness of each of the following interventions, either singly or in combination with other interventions: cognitive-behavioural interventions, education, treatment supporters, directly observed therapy, and active adherence reminder devices (such as mobile phone text messages). Although there is strong evidence that all five of these interventions can significantly increase ART adherence in some settings, each intervention has also been found not to produce significant effects in several studies. Almost half (55) of the 124 studies investigated the effectiveness of combination interventions. Combination interventions tended to have effects that were similar to those of single interventions. The evidence base on interventions in key populations was weak, with the exception of interventions for people who inject drugs.Conclusion:Tested and effective adherence-enhancing interventions should be increasingly moved into implementation in routine programme and care settings, accompanied by rigorous evaluation of implementation impact and performance. Major evidence gaps on adherence-enhancing interventions remain, in particular, on the cost-effectiveness of interventions in different settings, long-term effectiveness, and effectiveness of interventions in specific populations, such as pregnant and breastfeeding women. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins