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Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence
Ma, QY1,2,3,4; Tso, LS1,3; Rich, ZC1; Hall, BJ5,6; Beanland, R7; Li, HC1,4,8; Lackey, M9; Hu, FY2; Cai, WP2; Doherty, M7; Tucker, JD1,4
2016-10-17
Source PublicationJOURNAL OF THE INTERNATIONAL AIDS SOCIETY
ISSN1758-2652
Volume19
Abstract

Introduction: Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitatorsand barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. 

Methods: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings. 

Results: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n = 1025), children living with HIV (two studies, n = 46), adolescents living with HIV (four studies, n = 70) and pregnant women living with HIV (one study, n = 79). Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay health workers and inadvertent disclosure of serostatus by participating in the intervention. 

Conclusions: Our study evaluated adherence interventions based on qualitative data from PLHIV and health providers. The study underlines the importance of incorporating social and cultural factors into the design and implementation of interventions. Further qualitative research is needed to evaluate ART adherence interventions.

KeywordArt Adherence Intervention Qualitative Research Systematic Review Health Policy
DOI10.7448/IAS.19.1.21166
Indexed BySSCI
Language英语
WOS Research AreaImmunology ; Infectious Diseases
WOS SubjectImmunology ; Infectious Diseases
WOS IDWOS:000397524100001
Fulltext Access
Citation statistics
Cited Times [WOS]:21   [WOS Record]     [Related Records in WOS]
Document TypeJournal article
CollectionFaculty of Social Sciences
DEPARTMENT OF PSYCHOLOGY
Affiliation1.Univ North Carolina Project China, Guangzhou, Guangdong, Peoples R China
2.Guangzhou Eighth Peoples Hosp, Guangzhou, Guangdong, Peoples R China
3.Sun Yat Sen Univ, Zhongshan Sch Med, Ctr Med Humanities, Guangzhou, Guangdong, Peoples R China
4.Univ N Carolina, Inst Global Hlth & Infect Dis, Chapel Hill, NC USA
5.Johns Hopkins Univ, Dept Hlth Behav & Soc, JohnsHopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA
6.Univ Macau, Dept Psychol, Global & Community Mental Hlth Res Grp, Macau, Peoples R China
7.World Hlth Org, Dept HIV AIDS, Geneva, Switzerland
8.Shandong Univ, Dept Epidemiol, Sch Publ Hlth, Jinan, Peoples R China
9.Univ Utah, Spencer S Eccles Hlth Sci Lib, Salt Lake City, UT USA
Recommended Citation
GB/T 7714
Ma, QY,Tso, LS,Rich, ZC,et al. Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence[J]. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY,2016,19.
APA Ma, QY.,Tso, LS.,Rich, ZC.,Hall, BJ.,Beanland, R.,...&Tucker, JD.(2016).Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence.JOURNAL OF THE INTERNATIONAL AIDS SOCIETY,19.
MLA Ma, QY,et al."Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence".JOURNAL OF THE INTERNATIONAL AIDS SOCIETY 19(2016).
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