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Identification of Evidence-Based Interventions for Promoting HIV Medication Adherence: Findings from a Systematic Review of U.S.-Based Studies, 1996–2011

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Abstract

A systematic review was conducted to identify evidence-based interventions (EBIs) for increasing HIV medication adherence behavior or decreasing HIV viral load among persons living with HIV (PLWH). We conducted automated searches of electronic databases (i.e., MEDLINE, EMBASE, PsycINFO, CINAHL) and manual searches of journals, reference lists, and listservs. Interventions were eligible for the review if they were U.S.-based, published between 1996 and 2011, intended to improve HIV medication adherence behaviors of PLWH, evaluated the intervention using a comparison group, and reported outcome data on adherence behaviors or HIV viral load. Each intervention was evaluated on the quality of study design, implementation, analysis, and strength of findings. Of the 65 eligible interventions, 10 are EBIs. The remaining 55 interventions failed to meet the efficacy criteria primarily due to null findings, small sample sizes, or low retention rates. Research gaps and future directions for development of adherence EBIs are discussed.

Resumen

Se realizó una revisión sistemática para identificar intervenciones eficaces en aumentando comportamientos para tomar medicinas para VIH en manera prescrita (adherencia a medicamentos) o disminuyendo la carga viral de VIH detectada en la sangre (carga viral) entre personas viviendo con VIH. Realizamos búsquedas automatizadas de bases de datos electrónicas (es decir MEDLINE, EMBASE, PsycINFO, CINAHL) y búsquedas manuales de revistas, listas de referencia, y listservs. Las intervenciones fueron elegibles para la revisión, si fueron basadas en los EEUU, publicadas entre 1996 y 2011, intentaron mejorar los comportamientos de personas viviendo con VIH en tomar sus medicinas en manera prescrita, evaluaron la intervención usando un grupo de comparación, y reportaron los datos de resultados de los comportamientos de adherencia a medicamentos o carga viral del VIH. Se evaluó cada intervención sobre la calidad del diseño del estudio, implementación, análisis y validez de los resultados. De las 65 intervenciones elegibles, 10 fueron intervenciones identificadas como eficaz. Las 55 intervenciones que sobraron no cumplieron con los criterios de eficacia, principalmente debido a retención baja, tamaños de muestra pequeños o nulos resultados. Hoyos en los estudios y direcciones futuras para el desarrollo de intervenciones eficaces en aumentando adherencia a medicamentos se discuten.

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Acknowledgments

The authors would like to thank the following external consultants for providing invaluable insight and feedback on the medication adherence criteria development process: Rivet Amico, Deborah L. Jones, Robert H. Remien, Steven Safren, Jane Simoni, Ann Williams, and Ira Wilson. The authors would also like to thank all principal investigators of the original research who facilitated our review process by providing the necessary additional information or analyses as requested by PRS. Other members of the HIV/AIDS Prevention Research Synthesis Team who contributed to this review (listed alphabetically): Adebukola Adegbite (ICF International), Brittney Baack (CDC), Terrika Barham (ICF International), Mary M. Mullins (CDC), and Maria Luisa Tungol (CDC). This work was supported by the Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention and was not funded by any other organization.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

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  1. Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-37, Atlanta, GA, 30333, USA

    Mahnaz R. Charania, Khiya J. Marshall, Cynthia M. Lyles, Nicole Crepaz, Linda S. Kay, Linda J. Koenig, Paul J. Weidle & David W. Purcell

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  1. Mahnaz R. Charania
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  2. Khiya J. Marshall
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  3. Cynthia M. Lyles
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  4. Nicole Crepaz
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  5. Linda S. Kay
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  6. Linda J. Koenig
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  7. Paul J. Weidle
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  8. David W. Purcell
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HIV/AIDS Prevention Research Synthesis (PRS) Team

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Correspondence to Cynthia M. Lyles.

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Charania, M.R., Marshall, K.J., Lyles, C.M. et al. Identification of Evidence-Based Interventions for Promoting HIV Medication Adherence: Findings from a Systematic Review of U.S.-Based Studies, 1996–2011. AIDS Behav 18, 646–660 (2014). https://doi.org/10.1007/s10461-013-0594-x

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