The effectiveness of treatment supporter interventions in antiretroviral treatment adherence in sub-Saharan Africa: a systematic review and meta-Analysis

ABSTRACT

This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.

KEYWORDS:

• Treatment supporter interventions
• PLWH
• community-based
• ART adherence
• sub-Saharan Africa

Acknowledgments

The authors would like to acknowledge and thank Dr. Methodius Tuuli, Dr. Graham A Colditz, and Carolyn Stoll, our Systematic Review and Meta-Analysis course instructors in 2017, and Wendy Auslander, a course instructor for Issues and Directions in Intervention Research at Washington University in St. Louis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

ORCID

Thabani Nyoni http://orcid.org/0000-0002-0100-6258

Moses Okumu http://orcid.org/0000-0003-2555-3077