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Meta-Analysis
. 2023 May 11;18(5):e0285571.
doi: 10.1371/journal.pone.0285571. eCollection 2023.

The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis

Melkamu Merid Mengesha  1 , Awugchew Teshome  1 , Dessalegn Ajema  1 , Abera Kenay Tura  2 , Inger Kristensson Hallström  3 , Degu Jerene  3   4
Affiliations
Meta-Analysis

The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis

Melkamu Merid Mengesha et al. PLoS One. .

Abstract

Introduction: Nine in ten of the world's 1.74 million adolescents living with human immunodeficiency virus (ALHIV) live in Sub-Saharan Africa. Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are important problems among adolescents. To guide intervention efforts in this regard, this review presented pooled estimates on the prevalence of adherence and how it is affected by disclosure of HIV status among ALHIV in Sub-Saharan Africa.

Methods: A comprehensive search in major databases (Excerpta Medica database (EMBASE), PubMed, Ovid/MEDLINE, HINARI, and Google Scholar) with additional hand searches for grey literature was conducted to locate observational epidemiologic studies published in English up to November 12, 2022 with the following inclusion criteria: primary studies that reported disclosure of HIV status as an exposure variable, had positive adherence to ART as an outcome, and conducted among adolescents and children. The COVIDENCE software was used for a title/abstract screening, full-text screening, the JBI quality assessment checklist, and data extraction. Random effects model was used to pool estimates. Furthermore, sensitivity analysis and subgroup analysis were also conducted by age groups and type of adherence measures used.

Results: This meta-analysis combines the effect estimates from 12 primary studies with 4422 participants. The prevalence of good adherence to ART was 73% (95% CI (confidence interval): 56 to 87; I2 = 98.63%, P = <0.001), and it was higher among adolescents who were aware of their HIV status, 77% (95% CI: 56 to 92; I2 = 98.34%, P = <0.001). Overall, knowledge of HIV status was associated with increased odds of adherence (odds ratio (OR) = 1.88, 95% CI: 1.21 to 2.94; I2 = 79.8%, P = <0.001). This was further supported in a subgroup analysis by age (seven studies, pooled OR = 1.89, 95% CI: 1.06 to 3.37; I2 = 81.3%, P = <0.0001) and whether primary studies controlled for confounding factors (six studies provided adjusted estimates, pooled OR = 2.61, 95% CI: 1.22 to 5.57; I2 = 88.1%, P = <0.001) confirmed this further.

Conclusions: Our meta-analysis and systematic review revealed that knowledge of one's HIV status was associated with adherence to ART, particularly among adolescents. The findings underscored the importance of encouraging disclosure in order to enhance adherence among adolescents.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram showing search results and study selection.
Fig 2
Fig 2. The influence graph for the meta-analysis of results from 13 independent samples on the association between disclosure of HIV status and adherence to ART.
Fig 3
Fig 3. Forest plot showing the pooled effect size of the association between HIV disclosure status and adherence to ART based on random effects model among HIV infected children and adolescents.
Fig 4
Fig 4. Subgroup analysis by age category (adolescent only subpopulation versus both children and adolescent subpopulation) showing the pooled effect size of the association between HIV disclosure status and adherence to ART based on random effects model among HIV infected children and adolescents.
Fig 5
Fig 5. A subgroup analysis of the association between awareness of HIV status and adherence to ART based on random effects model among HIV infected children and adolescents by whether effect sizes were adjusted.
Fig 6
Fig 6. Funnel plot for a visual assessment of publication bias.
See this image and copyright information in PMC

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