Economic strengthening for retention in HIV care and adherence to antiretroviral therapy: a review of the evidence

ABSTRACT

To address the economic drivers of poor HIV care and treatment outcomes, household economic strengthening (HES) initiatives are increasingly being implemented with biomedical and behavioral approaches. The evidence linking HES with HIV outcomes is growing, and this evidence review aimed to comprehensively synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search.

Given the volume of evidence, the results are presented and discussed in three papers, each focused on a different HIV outcome area. This is the third paper in the series and focuses on the 38 studies on retention in HIV care, ART adherence, morbidity, and HIV-related mortality. Monthly food rations and conditional cash transfers are associated with improvements in care seeking and medication pick-up. Transportation assistance, income generation and microcredit show positive trends for care and treatment, but evidence quality is moderate and based heavily on integrated interventions. Clinical outcomes of CD4 count and viral suppression were not significantly affected in most studies where they were measured.

KEYWORDS:

• Evidence review
• economic strengthening
• HIV care
• antiretroviral therapy
• retention in care

Acknowledgments

We would like to acknowledge the excellent work of Cheryl Tam, formerly of FHI 360, in screening and assessing the quality of articles included in this review. We are grateful to several FHI 360 colleagues, including Whitney Moret for her contributions to this manuscript, Allison Burns and Tamara Fasnacht for their support in the literature search, and Jenae Tharaldson for her assistance preparing the manuscript. Finally, we would like to thank the researchers, donors and practitioners who participated in the half-day consultative meeting held on July 13, 2016 for their thoughtful input and expertise on this topic.

Disclosure statement

The author has no conflicts of interest to declare.

ORCID

Mandy Swann http://orcid.org/0000-0003-0348-8024

Notes

1. Green (positive) = positive findings on one or more primary outcome of interest and no negative findings; blue (null) = no effect/association was observed on primary outcome(s) or study was under-powered; yellow (mixed) = a mix of positive and negative results on primary outcomes of interest; and red (negative) = negative findings on one or more primary outcomes of interest and no positive findings.

Additional information

Funding

This study was produced under United States Agency for International Development (USAID) Cooperative Agreement No. AID-OAA-LA-13-00001 and was made possible by the generous support of the American people through USAID and the United States President's Emergency Plan for AIDS Relief. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.