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Meta-Analysis
. 2019 Aug;23(8):2059-2071.
doi: 10.1007/s10461-018-02390-8.

Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

James Wykowski  1 , Christopher G Kemp  2 , Jennifer Velloza  2   3 , Deepa Rao  2   4 , Paul K Drain  5   2   3
Affiliations
Meta-Analysis

Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

James Wykowski et al. AIDS Behav. 2019 Aug.

Abstract

Untreated mental health disorders among people living with HIV (PLHIV) may prevent low- and middle-income countries (LMICs) from achieving the UNAIDS 90-90-90 targets. Anxiety disorders may be associated with decreased adherence to antiretroviral therapy (ART). We sought to review and meta-analyze studies estimating associations between anxiety and ART adherence in LMICs. We searched PubMed, PsychINFO, CINAHL and EMBASE for relevant studies published before July 18, 2018. We defined anxiety as reported anxiety scores from screening questionnaires or having a clinical diagnosis of an anxiety disorder, and poor ART adherence as missed doses, poor visit attendance, or scores from structured adherence questionnaires. We used a random effects model to conduct a meta-analysis for calculating a pooled odds ratio, and conducted sensitivity analyses by time on ART, anxiety evaluation method, and study region. From 472 screened manuscripts, thirteen studies met our inclusion criteria. Eleven studies were included in the meta-analysis. PLHIV who reported anxiety had 59% higher odds of poor ART adherence compared with those who did not report anxiety disorder (pooled odds ratio [pOR]: 1.59, 95% confidence interval [CI] 1.29-1.96, p < 0.001). When excluding PLHIV who initiated ART within 6 months, reported anxiety remained strongly associated with poor ART adherence (pOR: 1.61, 95% CI 1.18-2.20, p = 0.003). Among PLHIV in LMICs, reported anxiety was associated with poor ART adherence. This association persisted after the ART initiation period. Increased resources for mental health may be important for achieving virologic suppression in LMICs.

Keywords: Adherence; Antiretroviral therapy; Anxiety; HIV; Low-income countries.

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Conflict of interest statement

Conflict of Interest: Authors Wykowski, Kemp, Velloza, Rao and Drain all declare they have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of study identification, screening, and inclusion
Figure 2.
Figure 2.
Forest plot of odds ratios between anxiety and poor adherence.
Figure 3A-D.
Figure 3A-D.
Forest plots of odds ratios between anxiety and poor adherence in four sensitivity analyses
See this image and copyright information in PMC

References

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