Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1
Objectives We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care.Methods We conducted an overview of systematic reviews...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e034793.full |
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| author | Lehana Thabane Shari Margolese Lawrence Mbuagbaw Beth Rachlis Winston Husbands Carmen Logie Marek Smieja Elizabeth Alvarez Daeria O Lawson Anisa Hajizadeh Annie Wang Dominik Mertz Anita C Benoit Lisa Puchalski Ritchie Babalwa Zani |
| author_facet | Lehana Thabane Shari Margolese Lawrence Mbuagbaw Beth Rachlis Winston Husbands Carmen Logie Marek Smieja Elizabeth Alvarez Daeria O Lawson Anisa Hajizadeh Annie Wang Dominik Mertz Anita C Benoit Lisa Puchalski Ritchie Babalwa Zani |
| author_sort | Lehana Thabane |
| collection | DOAJ |
| description | Objectives We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care.Methods We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis.Results We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care.Conclusions Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations. |
| format | Article |
| id | doaj-art-3b8efbb416bc48329a84a0d64e40bfee |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-3b8efbb416bc48329a84a0d64e40bfee2025-01-08T23:50:08ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-034793Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1Lehana Thabane0Shari Margolese1Lawrence Mbuagbaw2Beth Rachlis3Winston Husbands4Carmen Logie5Marek Smieja6Elizabeth Alvarez7Daeria O Lawson8Anisa Hajizadeh9Annie Wang10Dominik Mertz11Anita C Benoit12Lisa Puchalski Ritchie13Babalwa Zani14Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, CanadaCommunity Advisory Committee, CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canadaassociate professorDivision of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, CanadaOntario HIV Treatment Network, Toronto, Ontario, CanadaFactor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, CanadaDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, CanadaCentre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, CanadaDivision of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canadadoctoral studentDepartment of Life Sciences, McMaster University, Hamilton, Ontario, Canadaassistant professorWomen`s College Research Institute, Toronto, Ontario, CanadaDepartment of Medicine, University of Toronto, Toronto, Ontario, CanadaBurden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South AfricaObjectives We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care.Methods We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis.Results We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care.Conclusions Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.https://bmjopen.bmj.com/content/10/9/e034793.full |
| spellingShingle | Lehana Thabane Shari Margolese Lawrence Mbuagbaw Beth Rachlis Winston Husbands Carmen Logie Marek Smieja Elizabeth Alvarez Daeria O Lawson Anisa Hajizadeh Annie Wang Dominik Mertz Anita C Benoit Lisa Puchalski Ritchie Babalwa Zani Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1 BMJ Open |
| title | Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1 |
| title_full | Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1 |
| title_fullStr | Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1 |
| title_full_unstemmed | Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1 |
| title_short | Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1 |
| title_sort | overview of systematic reviews on strategies to improve treatment initiation adherence to antiretroviral therapy and retention in care for people living with hiv part 1 |
| url | https://bmjopen.bmj.com/content/10/9/e034793.full |
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