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

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Abstract

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.

Resumen

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.

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Acknowledgements

The authors would like to thank Elizabeth Waisel for her assistance with this project and Alison Z. Weber for her translation of the abstract.

Funding

This study was funded by the National Institute of Mental Health (K01MH112443 and T32MH078788) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant R24HD077976). The funders did not have any role in the development, execution, or writing of this manuscript.

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Authors and Affiliations

  1. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Jennifer A. Pellowski, Abigail D. Harrison & Don Operario

  2. International Health Institute, Brown University School of Public Health, Providence, RI, USA

    Jennifer A. Pellowski, Abigail D. Harrison, Don Operario & Mark N. Lurie

  3. Hunter AIDS Research Team, Hunter College, New York, NY, USA

    Devon M. Price

  4. School of Nursing, University of California San Francisco, San Francisco, CA, USA

    Emily L. Tuthill

  5. Division of Epidemiology and Biostatistics, and Center for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Landon Myer

  6. Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA

    Don Operario & Mark N. Lurie

  7. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Mark N. Lurie

  8. Brown University, 121 South Main Street, Box G-S121 - 2nd Floor, Providence, RI, 02903, USA

    Jennifer A. Pellowski

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Pellowski, J.A., Price, D.M., Harrison, A.D. et al. A Systematic Review and Meta-analysis of Antiretroviral Therapy (ART) Adherence Interventions for Women Living with HIV. AIDS Behav 23, 1998–2013 (2019). https://doi.org/10.1007/s10461-018-2341-9

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