A systematic review comparing antiretroviral adherence descriptive and intervention studies conducted in the USA

Abstract

We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with US HIV-positive women and 47 were reports of intervention studies conducted with US HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity.

Keywords:

• systematic review
• antiretroviral adherence
• descriptive studies
• intervention studies

Acknowledgements

The method study referred to here, “Integrating qualitative & quantitative research findings,” is funded by the National Institute of Nursing Research, National Institutes of Health (5R01NR004907, 3 June 2005–31 March 2010). This material is the result of work supported, in part, with resources and facilities at the Veterans Affairs Medical Center in Durham, NC. Views expressed in this article are those of the authors and do not necessarily represent the Department of Veterans Affairs.