Background: Adherence to antiretroviral therapy (ART) is a necessary condition to the improvement of HIV patient health and public health through ART. This study sought to determine the comparative effectiveness of different interventions for improving ART adherence among HIV-infected persons living in Africa.
Methods: We searched for randomized trials that evaluated an intervention to promote antiretroviral adherence within Africa. We created a network of the differing interventions by pooling the published and individual patient data for comparable treatments and comparing them across the individual interventions using Bayesian network meta-analyses. Outcomes included self-reported adherence and viral suppression.
Findings: We obtained data on 14 randomized controlled trials, involving 7,110 patients. Interventions included daily and weekly short message service (SMS) messaging, calendars, peer supporters, alarms, counseling, and basic and enhanced standard of care (SOC). For self-reported adherence, we found distinguishable improvement in adherence compared to SOC with enhanced SOC (odds ratio [OR]: 1.46, 95% credibility interval [CrI]: 1.06-1.98), weekly SMS messages (OR:1.65; 95% CrI: 1.25-2.18), counseling and SMS combined (OR:2.07; 95% CrI: 1.22-3.53), and treatment supporters (OR:1.83; 95% CrI:1.36-2.45). We found no compelling evidence for the remaining interventions. Results were similar when using viral suppression as an outcome, although the network of evidence was sparser. Treatment supporters with enhanced SOC (OR:1.46; 95% CrI: 1.09-1.97) and weekly SMS messages (OR:1.55; 95% CrI: 1.00-2.39) were significantly superior to basic SOC.
Interpretation: Several recommendations for improving adherence are unsupported by the available evidence. These findings should influence guidance documents on improving ART adherence in poor settings.
Available at: http://works.bepress.com/sebastian_linnemayr/14/