Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention

Joseph D Tucker¹, Lai Sze Tso², Brian Hall³, Qingyan Ma⁴, Rachel Beanland⁵, John Best⁶, Haochu Li⁷, Mellanye Lackey⁸, Gifty Marley⁹, Zachary C Rich¹⁰, Ka-Lon Sou¹¹, Meg Doherty¹²

Affiliations

¹ University of North Carolina Project-China, Guangzhou, China; Institute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, USA. Electronic address: jdtucker@med.unc.edu.
² University of North Carolina Project-China, Guangzhou, China. Electronic address: ltso@umich.edu.
³ Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA. Electronic address: brianhall@umac.mo.
⁴ University of North Carolina Project-China, Guangzhou, China. Electronic address: qingyan_ma@med.unc.edu.
⁵ HIV Department, World Health Organization, Geneva, Switzerland. Electronic address: beanlandr@who.int.
⁶ School of Medicine, University of California, San Francisco, San Francisco, USA. Electronic address: John.Best@ucsf.edu.
⁷ University of North Carolina Project-China, Guangzhou, China.
⁸ Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA. Electronic address: mellanye.lackey@utah.edu.
⁹ University of North Carolina Project-China, Guangzhou, China. Electronic address: giftatluck@yahoo.com.
¹⁰ University of North Carolina Project-China, Guangzhou, China. Electronic address: zackrich@gmail.com.
¹¹ University of North Carolina Project-China, Guangzhou, China. Electronic address: soukalon19920126@gmail.com.
¹² HIV Department, World Health Organization, Geneva, Switzerland. Electronic address: dohertym@who.int.

PMID: 28161401
PMCID: PMC5360566
DOI: 10.1016/j.ebiom.2017.01.036

Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention

Joseph D Tucker et al. EBioMedicine. 2017 Mar.

. 2017 Mar:17:163-171.

doi: 10.1016/j.ebiom.2017.01.036. Epub 2017 Jan 31.

Authors

Affiliations

¹ University of North Carolina Project-China, Guangzhou, China; Institute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, USA. Electronic address: jdtucker@med.unc.edu.
² University of North Carolina Project-China, Guangzhou, China. Electronic address: ltso@umich.edu.
³ Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA. Electronic address: brianhall@umac.mo.
⁴ University of North Carolina Project-China, Guangzhou, China. Electronic address: qingyan_ma@med.unc.edu.
⁵ HIV Department, World Health Organization, Geneva, Switzerland. Electronic address: beanlandr@who.int.
⁶ School of Medicine, University of California, San Francisco, San Francisco, USA. Electronic address: John.Best@ucsf.edu.
⁷ University of North Carolina Project-China, Guangzhou, China.
⁸ Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA. Electronic address: mellanye.lackey@utah.edu.
⁹ University of North Carolina Project-China, Guangzhou, China. Electronic address: giftatluck@yahoo.com.
¹⁰ University of North Carolina Project-China, Guangzhou, China. Electronic address: zackrich@gmail.com.
¹¹ University of North Carolina Project-China, Guangzhou, China. Electronic address: soukalon19920126@gmail.com.
¹² HIV Department, World Health Organization, Geneva, Switzerland. Electronic address: dohertym@who.int.

PMID: 28161401
PMCID: PMC5360566
DOI: 10.1016/j.ebiom.2017.01.036

Abstract

Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.

Keywords: HIV; Intervention; Public health; Qualitative; Systematic review.

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Figures

**Fig. 1**
PRISMA flow chart of included studies. Cross-cutting themes.

See this image and copyright information in PMC

Comment in

The HIV Care Continuum-Is the Whole Greater Than the Sum of Its Parts? Implications for Interventions in a Test and Treat World.
Fonner VA. Fonner VA. EBioMedicine. 2017 Mar;17:18-19. doi: 10.1016/j.ebiom.2017.02.005. Epub 2017 Feb 8. EBioMedicine. 2017. PMID: 28196655 Free PMC article. No abstract available.

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Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention

Affiliations

Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention

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