The assessment of complementary and alternative medicine use among individuals with HIV: a systematic review and recommendations for future research

Abstract

Objectives: The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use.

Design: A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria.

Results: Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed.

Conclusions: CAM assessment--regardless of the specific study population--is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner.

FIG. 1.

Search strategy. HIV, human immune deficiency virus; CAM, complementary and alternative medicine. ¹Databases used: MEDLINE,^® EMBASE, CINAHL, Alternative Health Watch, Global Health, EBM Reviews, PsychInfo, Sociological Abstracts, and Health and Sociological Abstracts. ²In four cases, there were two articles published from the same dataset (identified by having the same study sponsor, location and time period of data collection, methodology, and number of study participants). In these cases, the first article published chronologically was selected for inclusion.