Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis
Identifieur interne : 001B18 ( Pmc/Checkpoint ); précédent : 001B17; suivant : 001B19Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis
Auteurs : Rahul Mhaskar [États-Unis] ; Vaibhav Alandikar [États-Unis] ; Patricia Emmanuel [États-Unis] ; Benjamin Djulbegovic [États-Unis] ; Sangita Patel [Inde] ; Atul Patel [Inde] ; Eknath Naik [États-Unis] ; Shyam Mohapatra [États-Unis] ; Ambuj Kumar [États-Unis]Source :
- Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine [ 0970-0218 ] ; 2013.
Abstract
To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.
Systematic review and meta-analysis.
The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.
There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (
Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.
Url:
DOI: 10.4103/0970-0218.112435
PubMed: 23878418
PubMed Central: 3714945
Affiliations:
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis</title>
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<author><name sortKey="Djulbegovic, Benjamin" sort="Djulbegovic, Benjamin" uniqKey="Djulbegovic B" first="Benjamin" last="Djulbegovic">Benjamin Djulbegovic</name>
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<placeName><region type="state">Floride</region>
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<author><name sortKey="Patel, Sangita" sort="Patel, Sangita" uniqKey="Patel S" first="Sangita" last="Patel">Sangita Patel</name>
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<author><name sortKey="Patel, Atul" sort="Patel, Atul" uniqKey="Patel A" first="Atul" last="Patel">Atul Patel</name>
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<author><name sortKey="Naik, Eknath" sort="Naik, Eknath" uniqKey="Naik E" first="Eknath" last="Naik">Eknath Naik</name>
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<author><name sortKey="Mohapatra, Shyam" sort="Mohapatra, Shyam" uniqKey="Mohapatra S" first="Shyam" last="Mohapatra">Shyam Mohapatra</name>
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<author><name sortKey="Kumar, Ambuj" sort="Kumar, Ambuj" uniqKey="Kumar A" first="Ambuj" last="Kumar">Ambuj Kumar</name>
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</placeName>
<orgName type="university">Université de Floride du Sud</orgName>
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<affiliation wicri:level="2"><nlm:aff id="aff4">Moffitt Cancer Center, Tampa, Florida, USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Moffitt Cancer Center, Tampa, Florida</wicri:regionArea>
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<idno type="ISSN">0970-0218</idno>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Objective:</title>
<p>To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.</p>
</sec>
<sec id="st2"><title>Design:</title>
<p>Systematic review and meta-analysis.</p>
</sec>
<sec id="st3"><title>Materials and Methods:</title>
<p>The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.</p>
</sec>
<sec id="st4"><title>Results:</title>
<p>There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (<italic>P</italic>
= 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59–81%, I<sup>2</sup>
= 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor.</p>
</sec>
<sec id="st5"><title>Conclusion:</title>
<p>Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.</p>
</sec>
</div>
</front>
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<pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Community Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Indian J Community Med</journal-id>
<journal-id journal-id-type="publisher-id">IJCM</journal-id>
<journal-title-group><journal-title>Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">0970-0218</issn>
<issn pub-type="epub">1998-3581</issn>
<publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23878418</article-id>
<article-id pub-id-type="pmc">3714945</article-id>
<article-id pub-id-type="publisher-id">IJCM-38-74</article-id>
<article-id pub-id-type="doi">10.4103/0970-0218.112435</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>CME</subject>
</subj-group>
</article-categories>
<title-group><article-title>Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Mhaskar</surname>
<given-names>Rahul</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Alandikar</surname>
<given-names>Vaibhav</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Emmanuel</surname>
<given-names>Patricia</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Djulbegovic</surname>
<given-names>Benjamin</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="aff" rid="aff2">2</xref>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Patel</surname>
<given-names>Sangita</given-names>
</name>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Patel</surname>
<given-names>Atul</given-names>
</name>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Naik</surname>
<given-names>Eknath</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mohapatra</surname>
<given-names>Shyam</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kumar</surname>
<given-names>Ambuj</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="aff" rid="aff2">2</xref>
<xref ref-type="aff" rid="aff4">4</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Florida, USA</aff>
<aff id="aff2"><label>2</label>
Clinical and Translational Science Institute, University of South Florida, Florida, USA</aff>
<aff id="aff3"><label>3</label>
Department of Pediatrcis, Morsani College of Medicine, University of South Florida, Florida, USA</aff>
<aff id="aff4"><label>4</label>
Moffitt Cancer Center, Tampa, Florida, USA</aff>
<aff id="aff5"><label>5</label>
Department of Preventive and Social Medicine, Government Medical College, Vadodara, Gujrat, India</aff>
<aff id="aff6"><label>6</label>
Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Florida, USA</aff>
<author-notes><corresp id="cor1"><bold>Address for correspondence:</bold>
Dr. Ambuj Kumar, Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Clinical and Translational Science Institute, 12901 Bruce B Downs Blvd, MDC 27, Tampa, FL, USA. E-mail: <email xlink:href="akumar1@health.usf.edu">akumar1@health.usf.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Apr-Jun</season>
<year>2013</year>
</pub-date>
<volume>38</volume>
<issue>2</issue>
<fpage>74</fpage>
<lpage>82</lpage>
<history><date date-type="received"><day>23</day>
<month>6</month>
<year>2011</year>
</date>
<date date-type="accepted"><day>12</day>
<month>4</month>
<year>2012</year>
</date>
</history>
<permissions><copyright-statement>Copyright: © Indian Journal of Community Medicine</copyright-statement>
<copyright-year>2013</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec id="st1"><title>Objective:</title>
<p>To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.</p>
</sec>
<sec id="st2"><title>Design:</title>
<p>Systematic review and meta-analysis.</p>
</sec>
<sec id="st3"><title>Materials and Methods:</title>
<p>The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.</p>
</sec>
<sec id="st4"><title>Results:</title>
<p>There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (<italic>P</italic>
= 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59–81%, I<sup>2</sup>
= 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor.</p>
</sec>
<sec id="st5"><title>Conclusion:</title>
<p>Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.</p>
</sec>
</abstract>
<kwd-group><kwd>Anti-retroviral therapy</kwd>
<kwd>India</kwd>
<kwd>systematic review</kwd>
<kwd>treatment compliance</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Inde</li>
<li>États-Unis</li>
</country>
<region><li>Floride</li>
</region>
<settlement><li>Tampa</li>
</settlement>
<orgName><li>Université de Floride du Sud</li>
</orgName>
</list>
<tree><country name="États-Unis"><region name="Floride"><name sortKey="Mhaskar, Rahul" sort="Mhaskar, Rahul" uniqKey="Mhaskar R" first="Rahul" last="Mhaskar">Rahul Mhaskar</name>
</region>
<name sortKey="Alandikar, Vaibhav" sort="Alandikar, Vaibhav" uniqKey="Alandikar V" first="Vaibhav" last="Alandikar">Vaibhav Alandikar</name>
<name sortKey="Djulbegovic, Benjamin" sort="Djulbegovic, Benjamin" uniqKey="Djulbegovic B" first="Benjamin" last="Djulbegovic">Benjamin Djulbegovic</name>
<name sortKey="Djulbegovic, Benjamin" sort="Djulbegovic, Benjamin" uniqKey="Djulbegovic B" first="Benjamin" last="Djulbegovic">Benjamin Djulbegovic</name>
<name sortKey="Djulbegovic, Benjamin" sort="Djulbegovic, Benjamin" uniqKey="Djulbegovic B" first="Benjamin" last="Djulbegovic">Benjamin Djulbegovic</name>
<name sortKey="Emmanuel, Patricia" sort="Emmanuel, Patricia" uniqKey="Emmanuel P" first="Patricia" last="Emmanuel">Patricia Emmanuel</name>
<name sortKey="Emmanuel, Patricia" sort="Emmanuel, Patricia" uniqKey="Emmanuel P" first="Patricia" last="Emmanuel">Patricia Emmanuel</name>
<name sortKey="Kumar, Ambuj" sort="Kumar, Ambuj" uniqKey="Kumar A" first="Ambuj" last="Kumar">Ambuj Kumar</name>
<name sortKey="Kumar, Ambuj" sort="Kumar, Ambuj" uniqKey="Kumar A" first="Ambuj" last="Kumar">Ambuj Kumar</name>
<name sortKey="Kumar, Ambuj" sort="Kumar, Ambuj" uniqKey="Kumar A" first="Ambuj" last="Kumar">Ambuj Kumar</name>
<name sortKey="Mhaskar, Rahul" sort="Mhaskar, Rahul" uniqKey="Mhaskar R" first="Rahul" last="Mhaskar">Rahul Mhaskar</name>
<name sortKey="Mohapatra, Shyam" sort="Mohapatra, Shyam" uniqKey="Mohapatra S" first="Shyam" last="Mohapatra">Shyam Mohapatra</name>
<name sortKey="Naik, Eknath" sort="Naik, Eknath" uniqKey="Naik E" first="Eknath" last="Naik">Eknath Naik</name>
</country>
<country name="Inde"><noRegion><name sortKey="Patel, Sangita" sort="Patel, Sangita" uniqKey="Patel S" first="Sangita" last="Patel">Sangita Patel</name>
</noRegion>
<name sortKey="Patel, Atul" sort="Patel, Atul" uniqKey="Patel A" first="Atul" last="Patel">Atul Patel</name>
</country>
</tree>
</affiliations>
</record>
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