scholarly journals Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review

2021 ◽  
Vol 18 (5) ◽  
pp. 2477
Author(s):  
Panmial Priscilla Damulak ◽  
Suriani Ismail ◽  
Rosliza Abdul Manaf ◽  
Salmiah Mohd Said ◽  
Oche Agbaji
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Behavioral Interventions ◽  
Controlled Trial ◽  
Self Report ◽  
Sub Saharan Africa ◽  
Art Adherence ◽  
Study Characteristics ◽  
Combination Study ◽  
Sub Saharan

Optimal adherence to antiretroviral therapy (ART) remains the bedrock of effective therapy and management of human immunodeficiency virus (HIV). This systematic review examines the effect of interventions in improving ART adherence in sub-Saharan Africa (SSA), which bears the largest global burden of HIV infection. In accordance with PRISMA guidelines, and based on our inclusion and exclusion criteria, PUBMED, MEDLINE, and Google Scholar databases were searched for published studies on ART adherence interventions from 2010 to 2019. Thirty-one eligible studies published between 2010 to 2019 were identified, the categories of interventions were structural, behavioral, biological, cognitive, and combination. Study characteristics varied across design, intervention type, intervention setting, country, and outcome measurements. Many of the studies were behavioral interventions conducted in hospitals with more studies being randomized controlled trial (RCT) interventions. Despite the study variations, twenty-four studies recorded improvements. Notwithstanding, more quality studies such as RCTs should be conducted, especially among key affected populations (KAPs) to control transmission of resistant strains of the virus. Reliable objective measures of adherence should replace the conventional subjective self-report. Furthermore, long-term interventions with longer duration should be considered when evaluating the effectiveness of interventions.

scholarly journals Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Christian Akem Dimala ◽  
Noah T. Fongwen ◽  
Adrian D. Smith
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Health System ◽  
Sample Size ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
System Level ◽  
Comprehensive Treatment ◽  
Barriers And Enablers ◽  
Sub Saharan

Abstract Introduction Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. Method A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. Results Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. Conclusions In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.

scholarly journals Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review

PLoS Medicine ◽  
2007 ◽  
Vol 4 (10) ◽  
pp. e298 ◽  
Author(s):  
Sydney Rosen ◽  
Matthew P Fox ◽  
Christopher J Gill
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Patient Retention

scholarly journals Feasibility and acceptability of financial incentives and peer-led life skills training for improving adherence to antiretroviral therapy among adolescents living with HIV in Rwanda: A pilot study

2020 ◽  
Author(s):  
Majdi Osman ◽  
Simon Pierre Niyonsenga ◽  
Manasi Sharma ◽  
Rebecca Hope ◽  
Shannon Milroy ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pilot Study ◽  
Financial Incentives ◽  
Life Skills ◽  
Skills Training ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Art Adherence ◽  
Life Skills Training ◽  
Sub Saharan

Abstract Background The Human Immunodeficiency Virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa. Despite the long-term benefits of antiretroviral therapy (ART), adherence remains low among adolescents due to challenges related to cost, acquisition, and treatment regimen. Sub-optimal adherence to ART is associated with the development of viral resistance, treatment failure, and increased morbidity and mortality. Financial incentives and life skills training interventions have shown early promise in motivating protective behaviors, however, gaps still remain around effective and innovative ways to motivate adolescents to stay in HIV care. In partnership with youth, we developed an intervention to address their social and financial pressures in order to promote adherence. Methods A human-centered design approach was utilized to engage adolescents in the initial design of the intervention. Through random sampling, 72 adolescents ages 12–19 were then recruited from two clinics in Rwanda for the pilot study. Adolescents participated in three monthly peer-led life skills trainings at clinics and received financial incentives via mobile money upon clinic attendance and demonstration of suppressed viral load. Semi-structured interviews were then conducted with adolescents, healthcare workers, and caregivers to understand their experiences with the intervention. Results Participants responded favorably to the intervention because of the psychosocial, financial, and health benefits it provided. Caregivers felt that adolescents’ moods, attitudes, and overall well-being improved over time. Adolescents used funds to purchase school supplies and save for investments, thus mitigating their financial burdens. Additionally, we learned that logistical challenges such as SIM card registration and mobile phone access must be considered for scale-up of the intervention. Conclusions To our knowledge, this is the first intervention designed in partnership with youth in sub-Saharan Africa aimed at removing financial barriers to ART adherence. The findings suggest that involving youth in the design of programs, providing them with financial incentives, and training them to use and invest their money wisely has a positive effect on them and their families. Thus, to improve adherence to ART and retention in care among HIV-positive youth, it is critical to address their socioeconomic and psychosocial needs.

scholarly journals Alcohol Use and Antiretroviral Therapy Non-Adherence Among Adults Living with HIV/AIDS in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 24 (6) ◽  
pp. 1727-1742 ◽  
Author(s):  
Jennifer Velloza ◽  
Christopher G. Kemp ◽  
Frances M. Aunon ◽  
Megan K. Ramaiya ◽  
Emma Creegan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Alcohol Use ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Aids

Post-Traumatic Stress Disorder Psychological Interventions in Sub-Saharan Africa: Protocol for a Systematic Review of Literature

2020 ◽  
Author(s):  
Vuyokazi Ntlantsana ◽  
Keneilwe Molebatsi ◽  
Sibongile Mashaphu ◽  
Bonginkosi Chiliza ◽  
Dickens H Akena
Keyword(s):  
Systematic Review ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Controlled Trial ◽  
Sub Saharan Africa ◽  
Post Traumatic Stress ◽  
Psychological Therapies ◽  
Post Traumatic ◽  
Sub Saharan

Abstract Background: While untreated post-traumatic stress disorder (PTSD) results in considerable morbidity and higher risk of mortality, little has been done to treat PTSD in low resourced sub-Saharan Africa settings where there is mass exposure of the population to traumatic events. This systematic review aims to summarise available evidence on the efficacy of psychological therapies for PTSD in sub-Saharan Africa (SSA).Methods: A systematic search of literature in the PubMed, PsychInfo, EMBASE and Cochrane Register of Controlled Trials electronic databases will be conducted using keywords related to “PTSD”, “psychological therapies” and “SSA”. Two independent researchers will screen for studies eligible for inclusion if set in SSA and randomised controlled trial study design. Data on intervention types, population, comorbidities, comparison group intervention and PTSD outcomes will be extracted from included studies. Risk of bias will be assessed, qualitative synthesis of data will be conducted, and pooled effect estimates calculated.Discussion: Trauma in SSA occurs within the context of unique conditions necessitating applicable interventions. The results of the systematic review will be important in providing a guide for clinicians and researchers in low resource settings in development of effective interventions. Systematic review registration: PROSPERO (CRD42020181638)

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