Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 30;1(4):e000125.
doi: 10.1136/bmjgh-2016-000125. eCollection 2016.

Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review

Tessa Heestermans  1 , Joyce L Browne  1 , Susan C Aitken  2   3 , Sigrid C Vervoort  4 , Kerstin Klipstein-Grobusch  1   5
Affiliations

Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review

Tessa Heestermans et al. BMJ Glob Health. .

Abstract

Objective: The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of patients at high risk of suboptimal adherence and targeted interventions. The aim of this review was to identify and summarise determinants of adherence to ART among HIV-positive adults.

Design: Systematic review of adherence to ART in SSA from January 2002 to October 2014.

Methods: A systematic search was performed in 6 databases (PubMed, Cochrane Library, EMBASE, Web of Science, Popline, Global Health Library) for qualitative and quantitative articles. Risk of bias was assessed. A meta-analysis was conducted for pooled estimates of effect size on adherence determinants.

Results: Of the 4052 articles screened, 146 were included for final analysis, reporting on determinants of 161 922 HIV patients with an average adherence score of 72.9%. Main determinants of non-adherence were use of alcohol, male gender, use of traditional/herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatisation, and poor social support. Promoters of adherence included counselling and education interventions, memory aids, and active disclosure among people living with HIV. Determinants of health status had conflicting influence on adherence.

Conclusions: The sociodemographic, psychosocial, health status, treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence. Clinics providing ART in SSA should therefore design targeted interventions addressing these determinants to optimise health outcomes.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the study selection for inclusion in the systematic review on determinants of adherence to ART in SSA. ART, antiretroviral treatment; SSA, sub-Saharan Africa.
Figure 2
Figure 2
Summary risk of bias assessment for qualitative (items 1–6) and qualitative studies on adherence to ART. ART, antiretroviral treatment.
Figure 3
Figure 3
Forrest plot meta-analysis for determinants of non-adherence to ART. ART, antiretroviral treatment.
See this image and copyright information in PMC

References

    1. 2016. Global Aids Update 2016. http://www.unaids.org/en/resources/documents/2016/Global-AIDS-update-2016.
    1. Dorfman D, Saag MS. Decline in locomotor functions over time in HIV-infected patients. AIDS 2014;28:1531–2. 10.1097/QAD.0000000000000302 - DOI - PubMed
    1. Vyankandondera J, Mitchell K, Asiimwe-Kateera B et al. Antiretroviral therapy drug adherence in Rwanda: perspectives from patients and healthcare workers using a mixed-methods approach. AIDS Care 2013;25:1504–12. 10.1080/09540121.2013.779626 - DOI - PubMed
    1. Dahab M, Charalambous S, Karstaedt AS et al. Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study. BMC Public Health 2010;10:1–14. 10.1186/1471-2458-10-430 - DOI - PMC - PubMed
    1. Bangsberg DR. Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. J Infect Dis 2008;197(Suppl 3):S272–8. 10.1086/533415 - DOI - PubMed

LinkOut - more resources