Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1

Lawrence Mbuagbaw; Anisa Hajizadeh; Annie Wang; Dominik Mertz; Daeria O Lawson; Marek Smieja; Anita C Benoit; Elizabeth Alvarez; Lisa Puchalski Ritchie; Beth Rachlis; Carmen Logie; Winston Husbands; Shari Margolese; Babalwa Zani; Lehana Thabane

doi:10.1136/bmjopen-2019-034793

Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1

BMJ Open. 2020 Sep 23;10(9):e034793. doi: 10.1136/bmjopen-2019-034793.

Authors

Lawrence Mbuagbaw^{1

2

3}, Anisa Hajizadeh⁴, Annie Wang⁴, Dominik Mertz^{4

5}, Daeria O Lawson^{4

6}, Marek Smieja^{4

5}, Anita C Benoit^{7

8}, Elizabeth Alvarez^{4

9}, Lisa Puchalski Ritchie^{10

11

12}, Beth Rachlis¹³, Carmen Logie^{7

14}, Winston Husbands¹⁵, Shari Margolese¹⁶, Babalwa Zani¹⁷, Lehana Thabane^{4

2

18

19

20}

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada mbuagblc@mcmaster.ca.
² Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada.
³ Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁶ Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada.
⁷ Women's College Research Institute, Toronto, Ontario, Canada.
⁸ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁹ Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada.
¹⁰ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹¹ Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada.
¹² Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
¹³ Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Ontario HIV Treatment Network, Toronto, Ontario, Canada.
¹⁶ Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada.
¹⁷ Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa.
¹⁸ Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada.
¹⁹ Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
²⁰ Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.

Abstract

Objectives: We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care.

Methods: We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis.

Results: We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care.

Conclusions: Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.

Keywords: HIV & AIDS; health policy; therapeutics.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Caribbean Region
HIV Infections* / drug therapy
Homosexuality, Male
Humans
Male
Medication Adherence
Retention in Care*
Sexual and Gender Minorities*
Systematic Reviews as Topic