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Meta-Analysis
. 2019 Aug;23(8):1998-2013.
doi: 10.1007/s10461-018-2341-9.

A Systematic Review and Meta-analysis of Antiretroviral Therapy (ART) Adherence Interventions for Women Living with HIV

Jennifer A Pellowski  1   2   3 , Devon M Price  4 , Abigail D Harrison  5   6 , Emily L Tuthill  7 , Landon Myer  8 , Don Operario  5   6   9 , Mark N Lurie  6   9   10
Affiliations
Meta-Analysis

A Systematic Review and Meta-analysis of Antiretroviral Therapy (ART) Adherence Interventions for Women Living with HIV

Jennifer A Pellowski et al. AIDS Behav. 2019 Aug.

Abstract
in English, Spanish

A systematic review and meta-analysis was conducted to determine the efficacy of women-focused ART adherence interventions. Included studies (a) reported on a behavioral ART adherence intervention for cis-women living with HIV, (b) measured ART adherence as an outcome, and (c) employed a randomized controlled trial design. Thirteen studies were included in the meta-analysis. Overall, interventions significantly improved ART adherence compared to control conditions (random-effects d = 0.82, 95% CI [0.18, 1.45], p = 0.01), however, this was largely driven by two studies that had effect sizes greater than 3 standard errors above the mean effect size. Key moderators were location, recruitment method, group-based intervention, and alteration of the healthcare system. Innovative behavioral interventions that focus on young women and adolescents, target the critical periods of pregnancy and postpartum and test the integration of multiple levels of intervention to create lasting effects on ART adherence are needed.

Se llevó a cabo una revisión sistemática y un metaanálisis para determinar la eficacia de las intervenciones de adherencia al tratamiento antirretroviral (TAR) centradas en las mujeres. Los estudios incluidos (a) informaron sobre una intervención conductual de adherencia a TAR para mujeres cisgénero que viven con VIH, (b) midieron la adherencia a TAR como resultado y (c) emplearon un diseño de ensayo controlado aleatorio. Se incluyeron trece estudios en el metaanálisis. En general, las intervenciones mejoraron significativamente la adherencia al tratamiento de TAR en comparación con las condiciones de control (efectos aleatorios d = 0,84, IC del 95% [0,21, 1,47], p = 0,01), sin embargo, esto se debió principalmente a dos estudios que tuvieron tamaños de efectos superiores a 3 errores estándares por encima del tamaño medio del efecto. Los moderadores clave fueron la ubicación, el método de reclutamiento, la intervención grupal y la alteración del sistema de salud. Se necesitan intervenciones innovadoras de comportamiento que se enfoquen en mujeres jóvenes y adolescentes, que se centren en los períodos críticos del embarazo y el posparto y que prueben la integración de múltiples niveles de intervención para crear efectos duraderos en la adherencia al tratamiento antirretroviral.

Keywords: ART adherence; Meta-analysis; Randomized controlled trials; Women.

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Conflict of interest statement

Conflict of Interest: Jennifer Pellowski declares that she has no conflict of interest. Devon Price declares that she has no conflict of interest. Abigail Harrison declares that she has no conflict of interest. Emily Tuthill declares that she has no conflict of interest. Landon Myer declares that he has no conflict of interest. Don Operario declares that he has no conflict of interest. Mark Lurie declares that he has no conflict of interest.

Figures

Figure 1:
Figure 1:
PRISMA flow chart of literature search for randomized controlled trials testing ART behavioral adherence interventions tailored for women living with HIV
Figure 2:
Figure 2:
Effect size estimates for ART adherence at follow-up. Effect sizes are in alphabetical order. Positive effect sizes indicate increased ART adherence in the intervention condition at follow-up compared to control condition.
Figure 3:
Figure 3:
Effect size estimates for HIV viral load at follow-up. Effect sizes are in alphabetical order. Negative effect sizes indicate decreased HIV viral load in the intervention condition at follow-up compared to control condition.
Figure 4:
Figure 4:
Effect size estimates for CD4 T-cell count at follow-up. Effect sizes are in alphabetical order. Positive effect sizes indicate increased CD4 T-cell counts in the intervention condition at follow-up compared to control condition.
See this image and copyright information in PMC

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