Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review.
Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review.
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DOI：
10.1136/bmjgh-2016-000125
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发表时间：
2016
影响因子：
8.1
通讯作者：
Klipstein-Grobusch K
中科院分区：
文献类型：
--
作者：
Heestermans T;Browne JL;Aitken SC;Vervoort SC;Klipstein-Grobusch K
撒哈拉以南非洲(SSA)抗逆转录病毒治疗(ART)的迅速扩大导致人们更加关注患者的依从性。不坚持可能会导致抗药性艾滋病毒，原因是未能实现最大限度的病毒抑制。最佳治疗需要确定存在依从性不佳的高风险患者，并进行有针对性的干预。这篇综述的目的是确定和总结HIV阳性成年人坚持抗逆转录病毒治疗的决定因素。系统审查2002年1月至2014年10月SSA对抗逆转录病毒治疗的遵守情况。系统检索PubMed、Cochrane图书馆、EMBASE、Web of Science、Popline、Global Health Library等6个数据库中的定性和定量文献。评估了偏倚的风险。对依从性决定因素影响大小的综合估计进行了荟萃分析。在筛选的4,052篇文章中，有146篇纳入最终分析，报告了161名 922名艾滋病患者的决定因素，平均依从性得分为72.9%。不遵守的主要决定因素是饮酒、男性、使用传统/草药、对医疗机构和医护人员的不满、抑郁、歧视和污名，以及较差的社会支持。坚持的促进者包括咨询和教育干预、记忆辅助工具以及艾滋病毒携带者的积极披露。健康状况的决定因素对依从性有相互冲突的影响。社会人口、心理社会、健康状况、治疗相关和干预相关的决定因素是相互关联的，有助于实现最佳依从性。因此，在SSA中提供抗逆转录病毒治疗的诊所应该设计有针对性的干预措施，以解决这些决定因素，以优化健康结果。
The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of patients at high risk of suboptimal adherence and targeted interventions. The aim of this review was to identify and summarise determinants of adherence to ART among HIV-positive adults. Systematic review of adherence to ART in SSA from January 2002 to October 2014. A systematic search was performed in 6 databases (PubMed, Cochrane Library, EMBASE, Web of Science, Popline, Global Health Library) for qualitative and quantitative articles. Risk of bias was assessed. A meta-analysis was conducted for pooled estimates of effect size on adherence determinants. Of the 4052 articles screened, 146 were included for final analysis, reporting on determinants of 161 922 HIV patients with an average adherence score of 72.9%. Main determinants of non-adherence were use of alcohol, male gender, use of traditional/herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatisation, and poor social support. Promoters of adherence included counselling and education interventions, memory aids, and active disclosure among people living with HIV. Determinants of health status had conflicting influence on adherence. The sociodemographic, psychosocial, health status, treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence. Clinics providing ART in SSA should therefore design targeted interventions addressing these determinants to optimise health outcomes.