Adherence to HAART

A systematic review of developed and developing nation patient-reported barriers and facilitators

Edward J. Mills, Jean B. Nachega, David Bangsberg, Sonal Singh, Beth Rachlis, Ping Wu, Kumanan Wilson, Iain Buchan, Christopher J. Gill, Curtis Cooper

Research output: Contribution to journalReview article

512 Citations (Scopus)

Abstract

Background: Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. Methods and Findings: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. Conclusions: We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations. Copyright:

Original languageEnglish (US)
Pages (from-to)2039-2064
Number of pages26
JournalPLoS Medicine
Volume3
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

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Highly Active Antiretroviral Therapy
Developed Countries
Developing Countries
Disclosure
Libraries
Fear
Substance-Related Disorders
Meta-Analysis
Therapeutics
Economics
Quality of Life
Databases
Mortality
Research
Pharmaceutical Preparations
Population
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adherence to HAART : A systematic review of developed and developing nation patient-reported barriers and facilitators. / Mills, Edward J.; Nachega, Jean B.; Bangsberg, David; Singh, Sonal; Rachlis, Beth; Wu, Ping; Wilson, Kumanan; Buchan, Iain; Gill, Christopher J.; Cooper, Curtis.

In: PLoS Medicine, Vol. 3, No. 11, 11.2006, p. 2039-2064.

Research output: Contribution to journalReview article

Mills, EJ, Nachega, JB, Bangsberg, D, Singh, S, Rachlis, B, Wu, P, Wilson, K, Buchan, I, Gill, CJ & Cooper, C 2006, 'Adherence to HAART: A systematic review of developed and developing nation patient-reported barriers and facilitators', PLoS Medicine, vol. 3, no. 11, pp. 2039-2064. https://doi.org/10.1371/journal.pmed.0030438
Mills, Edward J. ; Nachega, Jean B. ; Bangsberg, David ; Singh, Sonal ; Rachlis, Beth ; Wu, Ping ; Wilson, Kumanan ; Buchan, Iain ; Gill, Christopher J. ; Cooper, Curtis. / Adherence to HAART : A systematic review of developed and developing nation patient-reported barriers and facilitators. In: PLoS Medicine. 2006 ; Vol. 3, No. 11. pp. 2039-2064.
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abstract = "Background: Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. Methods and Findings: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. Conclusions: We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations. Copyright:",
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AU - Singh, Sonal

AU - Rachlis, Beth

AU - Wu, Ping

AU - Wilson, Kumanan

AU - Buchan, Iain

AU - Gill, Christopher J.

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N2 - Background: Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. Methods and Findings: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. Conclusions: We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations. Copyright:

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