Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis
Identifieur interne : 002B21 ( Ncbi/Checkpoint ); précédent : 002B20; suivant : 002B22Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis
Auteurs : Nienke Langebeek ; Elizabeth H. Gisolf ; Peter Reiss ; Sigrid C. Vervoort ; Th Ra B. Hafsteinsd Ttir ; Clemens Richter ; Mirjam Ag Sprangers ; Pythia T. NieuwkerkSource :
- BMC Medicine [ 1741-7015 ] ; 2014.
Abstract
Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence.
We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression.
In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603,
These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12916-014-0142-1
PubMed: 25145556
PubMed Central: 4148019
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis</title><author><name sortKey="Langebeek, Nienke" sort="Langebeek, Nienke" uniqKey="Langebeek N" first="Nienke" last="Langebeek">Nienke Langebeek</name><affiliation><nlm:aff id="Aff1">Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands</nlm:aff><wicri:noCountry code="subfield">6815 AD Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff2">Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Gisolf, Elizabeth H" sort="Gisolf, Elizabeth H" uniqKey="Gisolf E" first="Elizabeth H" last="Gisolf">Elizabeth H. Gisolf</name><affiliation><nlm:aff id="Aff1">Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands</nlm:aff><wicri:noCountry code="subfield">6815 AD Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><affiliation><nlm:aff id="Aff3">Division of Infectious Diseases, and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff4">Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Vervoort, Sigrid C" sort="Vervoort, Sigrid C" uniqKey="Vervoort S" first="Sigrid C" last="Vervoort">Sigrid C. Vervoort</name><affiliation><nlm:aff id="Aff5">Department of Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands</nlm:aff><wicri:noCountry code="subfield">3584 CX Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Hafsteinsd Ttir, Th Ra B" sort="Hafsteinsd Ttir, Th Ra B" uniqKey="Hafsteinsd Ttir T" first="Th Ra B" last="Hafsteinsd Ttir">Th Ra B. Hafsteinsd Ttir</name><affiliation><nlm:aff id="Aff6">Department of Rehabilitation, Nursing Science and Sports medicine, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands</nlm:aff><wicri:noCountry code="subfield">3584 CX Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Richter, Clemens" sort="Richter, Clemens" uniqKey="Richter C" first="Clemens" last="Richter">Clemens Richter</name><affiliation><nlm:aff id="Aff1">Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands</nlm:aff><wicri:noCountry code="subfield">6815 AD Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Sprangers, Mirjam Ag" sort="Sprangers, Mirjam Ag" uniqKey="Sprangers M" first="Mirjam Ag" last="Sprangers">Mirjam Ag Sprangers</name><affiliation><nlm:aff id="Aff2">Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Nieuwkerk, Pythia T" sort="Nieuwkerk, Pythia T" uniqKey="Nieuwkerk P" first="Pythia T" last="Nieuwkerk">Pythia T. Nieuwkerk</name><affiliation><nlm:aff id="Aff2">Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff7">Department of Medical Psychology (J3-219-1), Academic Medical Center, Amsterdam, 1100 DE Netherlands</nlm:aff><wicri:noCountry code="subfield">1100 DE Netherlands</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25145556</idno><idno type="pmc">4148019</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148019</idno><idno type="RBID">PMC:4148019</idno><idno type="doi">10.1186/s12916-014-0142-1</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000646</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000646</idno><idno type="wicri:Area/Pmc/Curation">000645</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000645</idno><idno type="wicri:Area/Pmc/Checkpoint">001176</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001176</idno><idno type="wicri:Area/Ncbi/Merge">002B21</idno><idno type="wicri:Area/Ncbi/Curation">002B21</idno><idno type="wicri:Area/Ncbi/Checkpoint">002B21</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis</title><author><name sortKey="Langebeek, Nienke" sort="Langebeek, Nienke" uniqKey="Langebeek N" first="Nienke" last="Langebeek">Nienke Langebeek</name><affiliation><nlm:aff id="Aff1">Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands</nlm:aff><wicri:noCountry code="subfield">6815 AD Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff2">Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Gisolf, Elizabeth H" sort="Gisolf, Elizabeth H" uniqKey="Gisolf E" first="Elizabeth H" last="Gisolf">Elizabeth H. Gisolf</name><affiliation><nlm:aff id="Aff1">Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands</nlm:aff><wicri:noCountry code="subfield">6815 AD Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><affiliation><nlm:aff id="Aff3">Division of Infectious Diseases, and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff4">Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Vervoort, Sigrid C" sort="Vervoort, Sigrid C" uniqKey="Vervoort S" first="Sigrid C" last="Vervoort">Sigrid C. Vervoort</name><affiliation><nlm:aff id="Aff5">Department of Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands</nlm:aff><wicri:noCountry code="subfield">3584 CX Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Hafsteinsd Ttir, Th Ra B" sort="Hafsteinsd Ttir, Th Ra B" uniqKey="Hafsteinsd Ttir T" first="Th Ra B" last="Hafsteinsd Ttir">Th Ra B. Hafsteinsd Ttir</name><affiliation><nlm:aff id="Aff6">Department of Rehabilitation, Nursing Science and Sports medicine, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands</nlm:aff><wicri:noCountry code="subfield">3584 CX Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Richter, Clemens" sort="Richter, Clemens" uniqKey="Richter C" first="Clemens" last="Richter">Clemens Richter</name><affiliation><nlm:aff id="Aff1">Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands</nlm:aff><wicri:noCountry code="subfield">6815 AD Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Sprangers, Mirjam Ag" sort="Sprangers, Mirjam Ag" uniqKey="Sprangers M" first="Mirjam Ag" last="Sprangers">Mirjam Ag Sprangers</name><affiliation><nlm:aff id="Aff2">Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation></author><author><name sortKey="Nieuwkerk, Pythia T" sort="Nieuwkerk, Pythia T" uniqKey="Nieuwkerk P" first="Pythia T" last="Nieuwkerk">Pythia T. Nieuwkerk</name><affiliation><nlm:aff id="Aff2">Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands</nlm:aff><wicri:noCountry code="subfield">1105 AZ Netherlands</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff7">Department of Medical Psychology (J3-219-1), Academic Medical Center, Amsterdam, 1100 DE Netherlands</nlm:aff><wicri:noCountry code="subfield">1100 DE Netherlands</wicri:noCountry></affiliation></author></analytic><series><title level="j">BMC Medicine</title><idno type="eISSN">1741-7015</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence.</p></sec><sec><title>Methods</title><p>We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression.</p></sec><sec><title>Results</title><p>In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, <italic>P</italic> = 0.001), current substance use (SMD = -0.395, <italic>P</italic> = 0.001), concerns about ART (SMD = -0.388, <italic>P</italic> = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, <italic>P</italic> = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, <italic>P</italic> = 0.001), depressive symptoms (SMD = -0.305, <italic>P</italic> = 0.001), stigma about HIV (SMD = -0.282, <italic>P</italic> = 0.001), and social support (SMD = 0.237, <italic>P</italic> = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, <italic>P</italic> = 0.001), daily dosing frequency (SMD = -0.193, <italic>P</italic> = 0.001), financial constraints (SMD -0.187, <italic>P</italic> = 0.001) and pill burden (SMD = -0.124, <italic>P</italic> = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries.</p></sec><sec><title>Conclusions</title><p>These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mills, Ej" uniqKey="Mills E">EJ Mills</name></author><author><name sortKey="Nachega, Jb" uniqKey="Nachega J">JB Nachega</name></author><author><name sortKey="Bangsberg, Dr" uniqKey="Bangsberg D">DR Bangsberg</name></author><author><name sortKey="Singh, S" uniqKey="Singh S">S Singh</name></author><author><name sortKey="Rachlis, B" uniqKey="Rachlis B">B Rachlis</name></author><author><name sortKey="Wu, P" uniqKey="Wu P">P Wu</name></author><author><name sortKey="Wilson, K" uniqKey="Wilson K">K Wilson</name></author><author><name sortKey="Buchan, I" uniqKey="Buchan I">I 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Erlen</name></author><author><name sortKey="Liu, H" uniqKey="Liu H">H Liu</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list></list><tree><noCountry><name sortKey="Gisolf, Elizabeth H" sort="Gisolf, Elizabeth H" uniqKey="Gisolf E" first="Elizabeth H" last="Gisolf">Elizabeth H. Gisolf</name><name sortKey="Hafsteinsd Ttir, Th Ra B" sort="Hafsteinsd Ttir, Th Ra B" uniqKey="Hafsteinsd Ttir T" first="Th Ra B" last="Hafsteinsd Ttir">Th Ra B. Hafsteinsd Ttir</name><name sortKey="Langebeek, Nienke" sort="Langebeek, Nienke" uniqKey="Langebeek N" first="Nienke" last="Langebeek">Nienke Langebeek</name><name sortKey="Nieuwkerk, Pythia T" sort="Nieuwkerk, Pythia T" uniqKey="Nieuwkerk P" first="Pythia T" last="Nieuwkerk">Pythia T. Nieuwkerk</name><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name><name sortKey="Richter, Clemens" sort="Richter, Clemens" uniqKey="Richter C" first="Clemens" last="Richter">Clemens Richter</name><name sortKey="Sprangers, Mirjam Ag" sort="Sprangers, Mirjam Ag" uniqKey="Sprangers M" first="Mirjam Ag" last="Sprangers">Mirjam Ag Sprangers</name><name sortKey="Vervoort, Sigrid C" sort="Vervoort, Sigrid C" uniqKey="Vervoort S" first="Sigrid C" last="Vervoort">Sigrid C. 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