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Review
. 2020 Oct;17(5):529-546.
doi: 10.1007/s11904-020-00511-4.

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

Rebecca Jopling  1 , Primrose Nyamayaro  2 , Lena S Andersen  3 , Ashraf Kagee  4 , Jessica E Haberer  5 , Melanie Amna Abas  6
Affiliations
Review

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

Rebecca Jopling et al. Curr HIV/AIDS Rep. 2020 Oct.

Abstract

Purpose of review: We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era.

Recent findings: ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

Keywords: ART initiation; Adherence; Antiretroviral therapy (ART); HIV; Interventions; Retention in care; Review.

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Conflict of interest statement

Ms. Jopling declares no conflict of interest.

Ms. Nyamayaro declares no conflict of interest.

Dr. Kagee declares no conflict of interest.

Dr. Andersen declares no conflict of interest.

Dr. Haberer reports personal fees from Merck, outside the submitted work.

Dr. Abas reports grants and personal fees from the National Institute of Mental Health, grants and personal fees from the UK Medical Research Council and grants and personal fees from the Wellcome Trust, outside the submitted work.

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