https://orcid.org/0000-0003-1015-8402
Figures
Abstract
The HIV/AIDS pandemic continues to be a significant global public health crisis. The main HIV/AIDS treatment is the antiretroviral therapy (ART), which is highly effective but depends on the patient’s adherence to be successful. However, the adherence to antiretroviral therapy remains unsatisfactory across different populations, which raises considerable difficulties at both individual and collective levels. Suboptimal adherence to ART can be overcome through multidisciplinary management that includes evidence-based psychosocial interventions. Existing reviews on these interventions have focused mainly on studies with experimental designs, overlooking valuable interventions whose evidence comes from different study designs. Here, we aimed to carry out a comprehensive review of the current research on psychosocial interventions for ART adherence and their characteristics including studies with different designs. We conducted a systematic review following PRISMA guidelines. We searched five databases (Pubmed, EBSCO, LILACS, WoS and SCIELO) for articles reporting a psychosocial intervention to improve treatment adherence for people living with HIV (adults). The quality of each study was analyzed with standardized tools, and data were summarized using a narrative synthesis method. Twenty-three articles were identified for inclusion, and they demonstrated good to fair quality. Individual counseling was the most frequent intervention, followed by SMS reminders, education, and group support. Most interventions combined different strategies and self-efficacy was the most common underlying theoretical framework. This review provides insight into the main characteristics of current psychosocial interventions designed to improve ART treatment adherence.
PROSPERO number: CRD42021252449.
Citation: Costa-Cordella S, Rossi A, Grasso-Cladera A, Duarte J, Cortes CP (2022) Characteristics of psychosocial interventions to improve ART adherence in people living with HIV: A systematic review. PLOS Glob Public Health 2(10): e0000956. https://doi.org/10.1371/journal.pgph.0000956
Editor: Hannah Hogan Leslie, University of California San Francisco, UNITED STATES
Received: February 1, 2022; Accepted: September 20, 2022; Published: October 26, 2022
Copyright: © 2022 Costa-Cordella et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The database generated for this review can be found at 10.17605/OSF.IO/HCTRF.
Funding: This study was funded by the Chilean National Agency of Research and Development (Agencia Nacional de Investigación y Desarrollo de Chile) through FONDEF to CC (ID20I10174), and the Chilean National Agency of Research and Development (Agencia Nacional de Investigación y Desarrollo de Chile) through FONDECYT to AR (N° 1190610). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) continue to be a significant global public health crisis [1–3]. According to the World Health Organization (WHO) and the United Nations Joint Programme on HIV/AIDS (UNADIS), 37.7 million people were living with HIV/AIDS (PLWHA) worldwide in 2020; 1.5 million people were newly infected, and approximately 680.000 people were dying of HIV/AIDS [4].
The treatment cornerstone of PLWHA is Antiretroviral therapy (ART). The effectiveness of ART therapy has been translated into a significant decrease in morbidity and mortality [5–8]. For ART to be successful, adherence to its prescribed dose is critical [9–12]. Optimal adherence, which is often considered to correspond to 95% or more of the prescribed doses taken [13], increases the effectiveness of the treatment, allowing an undetectable viral load to be reached [14]. ART operates by inhibiting virus replication, measured by viral load (i.e., the quantity of virus in the blood). When viral load is undetectable (i.e., below the detection level of the technique), the treatment is considered successful. Reaching undetectability has two benefits: the individual, which allows the patient’s immune system to recover, and the collective, which prevents the virus transmission and new infections. In contrast, suboptimal adherence to treatment favors the appearance of mutations in the virus, generating subtypes resistant to ART, which become predominant, enabling the transmission of resistant viruses in subsequent infections.
However, many patients have suboptimal adherence. A meta-analysis of 84 studies found that only 62% of patients took their prescribed doses at least 90% of the time [15]. It has also been found that adherence percentages vary between 27% and 80% across various cultural settings [16, 17].
Suboptimal adherence to ART is a multi-factorial and dynamic process directly associated with more health complications, mortality, and a higher risk of HIV transmission [18].
Causes of suboptimal adherence to ART vary between and within individuals, over time, and according to how adherence is defined or measured [16]. Although aspects of regimen complexity (e.g., daily dosing frequency, pill burden, intake requirements or prohibitions associated with food, and side effects) influence adherence [19], adherence to ART is most strongly associated with psychosocial factors [19, 20].
Several systematic reviews and meta-analyses have shown that the strongest predictors of treatment adherence are self-efficacy (i.e., a person’s belief in their capacity to perform the behaviors needed to reach a given goal), concerns about ART effectivity, trust/satisfaction with the HIV care provider, depression symptoms, HIV stigma, and social support [19, 21–24].
For this reason, non-pharmacological interventions that focus on psychological/social factors (i.e., psychosocial interventions) have been widely promoted as one of the best options to improve treatment adherence in people with HIV [25, 26].
In recent years, several systematic reviews and meta-analyses have investigated the effectiveness of psychosocial interventions in improving ART adherence [20, 27–35].
However, previous reviews focused mainly on the intervention’s outcomes and, thus, they only included studies with an experimental design, such as Randomized Controlled Trials (RCT). Nevertheless, as far as psychosocial interventions are concerned, multiple types of evidence (e.g., clinical observation, qualitative research, systematic case studies) are considered valid to nourish evidence-based practice, according to the American Psychological Association (APA).
For this reason, it might be fruitful to review the literature on interventions to improve ART adherence exhaustively. Thus, the general objective of the present study was to carry out a comprehensive review, including various research designs (i.e., randomized controlled trials, controlled intervention studies, case-control studies, before-after studies with no control group and qualitative studies) of the current research on psychosocial interventions for ART adherence and their characteristics. Specifically, in each of the selected papers, we aimed to identify the intervention’s: a) type; b) frequency and duration; c) Target group; d) underlying theory; c) supporting evidence and d) setting of delivery.
Therefore, we conducted a systematic review of published literature to show the diversity of interventions that aim to improve adherence to ART in PLWHA and describe the main characteristics of these studies to enrich the current perspective on different designs.
Methods
We conducted a systematic review of the peer-reviewed academic literature. We registered the study protocol with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021252449). Additionally, the protocol and detailed methods are available in the Open Science Framework (osf.io/hctrf; 10.17605/OSF.IO/9MKRU). This review focused specifically on ART adherence. Other relevant concepts in HIV treatment were not included (e.g. retention in care, treatment adherence, self-efficacy, self-management) as this study is part of a larger project to improve ART adherence in Chile.
Eligibility criteria
We included studies published in peer-reviewed journals at any time. Searches were conducted on 1 October 2021; the review itself was completed from 1 October 2021 to 1 November 2021.We aimed to include studies that presented a psychosocial intervention aiming to improve ART adherence in people living with HIV or AIDS. We understood psychosocial interventions as interventions using a social, psychological or behavioral approach, or a combination of these two, as defined by Laurenzi et al. [36]. The primary outcome for the studies included in this review was improvement in ART adherence assessed with any type of measure of ART adherence. Studies eligible for inclusion could include male or female adults and young adults living with HIV/AIDS as participants. We also included studies whose participants’ age ranges were below 18 years old if the average age was above 18 years old. As shown in Table 1, studies eligible for inclusion could include evaluations conducted as RCT, case studies, qualitative studies, pilot studies, protocols for RCT, prospective studies, pre-post studies and comparison trials. Studies with any comparison intervention (e.g., care as usual, other intervention, untreated) were included. There was no exclusion based on the primary comparator. We included all languages and geographical regions. More detailed information of inclusion exclusion criteria in Table 1.
Search method for identification of studies
Following PRISMA guidelines [37], we identified relevant studies by using a set of predetermined search terms (S1 Text) to systematically search numerous academic databases, including Pubmed, EBSCO, LILACS (Latinamerican and Caribbean Literature for Health Sciences), WoS (Web of Science) and SCIELO (see S1 Text for search strategy). The searches were developed and conducted by the investigators (S.C.C. & A.G.C.) without the collaboration of a librarian due to limited resources. All identified studies were exported to EndNote [38] where all duplicates were removed. After removing duplicates, we uploaded the titles and abstracts of the remaining articles into the collaborative spreadsheet software Google Sheets for screening [39].
Two reviewers (S.C.C and A.G.C) independently screened each article for eligibility by title and abstract. Cases of disagreement were discussed in a meeting between three authors (S.C.C, A.G.C and J.D) until reaching consensus.
Data extraction
Three review authors (S.C.C, A.G.C and J.D) performed data extraction independently using the same online forms to codify: (i) Information about the studies (i.e., design, location, and results), and (ii) Information about the interventions (i.e., type of intervention, description, duration and frequency, target population, underlying theory, supporting evidence and setting). After independent review, data extraction was compared and disagreement resolved by consensus.
Study quality and risk of bias assessment
Two researchers (S.C.C and A.G.C) independently conducted a quality assessment for each study using the NHBLI quality and risk of bias assessment Tool [40]. Each study was assessed with the design-pertinent scale (i.e., controlled intervention studies, case-control studies, before-after studies with no control group). In the case of RCT protocols, and pilot/feasibility studies we used the same scale as for full RCT, but we considered only the first five items, which were applicable before the implementation of the intervention. For qualitative studies, we used the quality assessment for the systematic review of qualitative evidence [41]. Disagreements between reviewers were resolved through discussion and consensus. (S1 Table).
Synthesis method
We used a narrative synthesis method [42] to summarize the extracted data. A narrative synthesis method is a textual approach to the synthesis process and is widely used in systematic reviews, especially those focusing on broad questions beyond the interventions’ effectiveness [42]. Studies were grouped by intervention, population, outcomes and study design.
Results
Study selection
Our initial search yielded 382 potentially eligible articles. After removing duplicates, the article titles were screened for inclusion/exclusion, and 237 articles were removed. The abstracts were reviewed, and eight more were excluded. The full texts of the remaining 93 were reviewed, and a further 70 were removed. As illustrated in Fig 1, a total of 23 studies met all of the inclusion criteria and were thus included in this review.
Study characteristics
The studies reflected a variety of research designs. The most common design (n = 8) was protocols of Randomized Controlled Trial (RCT) followed by RCT (n = 6), pilot and feasibility studies (n = 5), qualitative studies (n = 2), and quasi-experimental (n = 2). The majority of the studies were conducted in North America (N = 11) or sub-Saharan Africa (N = 8). Only one study was conducted in Asia and two in Europe.
Regarding the findings, the majority of the RCT and quasi-experimental studies found a significantly bigger improvement in ART adherence in the intervention group [43–49]. Only in one RCT did both control and intervention groups improve their ART adherence levels, but with no significant differences [50]. Most pilot/feasibility studies were acceptable and feasible.
The main points of the reviewed studies are summarized in Table 2.
Quality assessment and risk of bias
Overall, the studies demonstrated good to fair quality. S1 Table provides details regarding the methodological quality assessment and overall risk of bias within and across studies for each outcome.
The majority of the reviewed studies (65%) were qualified as “good” (or “high quality” considering the terminology employed for qualitative studies) [43, 44, 47, 48, 50–62]. Five studies (21%) were qualified as “fair” [45, 46, 49, 63, 64], and only one (4.3%) was qualified as “poor” [65].
Among the good quality studies, five were RCT protocols [54, 56, 58, 62, 66], five were pilot and/or feasibility studies [51–53, 57, 61], four were RCT studies [43, 44, 47, 50] and one was a quasi-experimental study [48]. The “high quality” (qualitative) studies [59, 60].
Five studies qualified as “fair”. Of these, two were RCT [45, 46], two were RCT protocols [63, 64] and one was a quasi-experimental study [49].
The most common features within the fair-quality studies were the lack of validated measures to assess the study’s outcomes and the absence of blinding (although these criteria were not part of the assessment in the qualitative studies). The only research qualified as “poor quality” was an RCT protocol that did not report randomization techniques, blinding, and concealed treatment allocation. Fig 2 summarizes quality rating by research design.
Intervention characteristics
Intervention type.
Of the 23 interventions, 10 were counseling; three were educational interventions; six were SMS based interventions, and two were group support interventions. Two interventions were composed of a combination of interventions (both included counseling but not as the central intervention).
The main components of the interventions are described below (see also Table 3).
Intervention’s main components.
Counseling. Among the interventions using counseling, two integrated an educational component [44, 63], one included SMS as reminders of ART taking [43], and one directly addressed alcohol consumption and stigma [52]. One counseling was exclusively focused on the pre- ART treatment period [66]. Two counseling interventions concentrated on the participant’s partners; one was a couple’s counseling [65], and another offered counseling for women’s male partners [58]. Two counseling interventions were peer-delivered [58, 60], and two were part of a combination of other interventions [49, 58]. Two counseling interventions were delivered by phone [43, 52], and one was delivered by a virtual computer-based counselor [51].
SMS. Across SMS interventions, three consisted of health-related motivational messages and reminders [56, 59, 61]. Of these, one had bi-directional messages (i.e., the participant had the option to ask and receive an answer), and one had, in addition, bi-directional interactive voice calls. Two included psychoeducational messages [62, 64], and one included information regarding the participant’s adherence levels (as measured with pillbox technology) and their peers’ participants’ adherence levels [53].
Educational. There were three educational interventions; two of them used a platform with a virtual nurse guiding the users through client-centered information material [48, 50] and one used culturally adapted informational videos combined with counseling sessions [63].
Group support. Among group support interventions, there were two interventions delivered in a group format [46, 47]. One of them [47] consisted of an 8-sessions manualized group therapy led by two trained counselors, and they were focused on risk reduction in drugs using PLWHA. The other was a social media private group composed mainly of young PLWHA and led by an adult LWHA [46].
Intervention’s frequency.
Counseling interventions duration was commonly between 3 and 6 sessions. Group support interventions were either weekly [47] or daily [46]. The interventions based on educational components were usually weekly sessions [50]. And the SMS interventions varied being weekly [43, 61, 62, 64] and daily [64]. Some studies did not report the frequency of the interventions [49, 51, 56, 57, 59, 63].
Intervention’s target groups.
Ten of the reported interventions included patients with at least one month of ART treatment [43, 45, 46, 48–51, 56, 62, 67]. Some interventions were exclusively for women [58, 63, 64] and only one exclusively for men [65]. Two interventions had only HIV diagnosis as inclusion criteria [53, 57]. The remaining studies indicated more specific inclusion criteria such as being treatment-naive [55, 59], presenting low levels of treatment adherence [43, 54], substance abuse [47] and low health literacy [44].
Intervention’s underlying theory.
The most common theoretical framework was the self-efficacy/Behavior Change [43, 44, 52, 68] which was used in four counseling interventions [43, 44, 52, 54], in two educational [48, 50], and one SMS [59].
The Information-Motivation-Behavioral (IMB) skills model was also a common underlying theory, and it was used in two counseling interventions [63, 66] and one group support [47], which was also framed considering social support theories. Social support theory was also the theoretical base of a peer-delivered counseling intervention [47, 60].
The Social-Ecological Model was used in two interventions: one counseling [45, 58] and one facility-based intervention that included peer counseling sessions [45, 58]. The health belief model was the theoretical framework of two SMS based interventions [56, 64], while the other similar SMS interventions used the Nudge Theory [62]. Behavioral economics is the underlying theory in the intervention using SMS with information about the participant’s levels of adherence and that of their peers [53]. Principles of Cognitive behavioral Therapy were the basis of the couples counseling intervention [65]. The Technology Acceptance Model was used in the intervention employing a computer-based counselor [51].
Finally, four of the reviewed articles did not report the underlying theory of their interventions [46, 49, 57, 61].
Supporting evidence.
We assessed the presence or absence of previous evidence for the intervention described in the reviewed studies. Previous evidence included former RCTs evaluating the same intervention in other contexts and developing and testing previous cultural adaptations. Of the total number of interventions assessed (n = 23), 18 presented supporting evidence [44–52, 54, 57, 59, 62–66], only one had provided partial evidence [43], and five did not present any evidence [53, 56, 58, 60, 61].
Settings.
The most common setting in which the interventions were delivered were specialized HIV centers (N = 10) [43, 45, 49, 50, 54, 56, 57, 61, 64, 66], followed by public hospitals (N = 5) [48, 50, 51, 59, 60], and primary health centers (N = 3) [46, 58, 63]. Some interventions were delivered in community organizations (N = 4) [44, 46, 47, 63], social services agencies (N = 1) [44] or in a regional hospital (N = 1) [62]. Two studies did not report the context of intervention delivery [53, 65].
Discussion
According to the American Psychological Association (APA), evidence-based practice is composed of multiple types of research evidence. However, most systematic reviews of psychosocial interventions only include experimental designs in their analysis, as they are considered the highest quality evidence in medical practice. To address this gap, the present study carried out a comprehensive review of all current evidence on psychosocial interventions for ART adherence, regardless of study design. We analyzed the studies characteristics and assessed their quality to complement the information provided by systematic reviews that only include studies with experimental designs such as RCTs (e.g., [20, 29, 30, 32]). The latter is essential since all available tools and resources are important when improving adherence to ART in PLWHA.
The first finding that stands out from our review is that despite RCTs being considered the strongest type of evidence (type 1 evidence), our quality assessment shows that diverse study designs are of good quality. Our results reveal that studies with RCT, RCT protocols, pilot/feasibility, qualitative and quasi-experimental design scored high in quality. These findings show that a high-quality score is not something reserved for RCTs. For example, all qualitative studies scored for high-quality evidence. These studies provide relevant information for understanding in-depth adherence of ART for PLWHA. Qualitative methods applied to intervention’s development allow researchers to access and reveal participants’ experiences, providing essential information about what works well and how. This type of study needs to be developed to understand better what aspects of the interventions, the context, participants, and delivery are essential for adherence. Therefore, qualitative study designs should be included when analyzing the available evidence-based psychosocial interventions for a given problem. In this sense, reviewing intervention types and characteristics might be beneficial, especially in psychosocial interventions, to weigh potentially effective interventions.
Another interesting finding is that most interventions were centered on individual counseling and SMS reminders, while only two of the twenty-three studies focused on group intervention. Focusing on the individual rather than the group seems contradictory to evidence showing that support groups are the best way to help PLWHA deal with the stigma and discrimination [69]. Likewise, group treatment has been shown to provide good or excellent evidence for different mental health disorders such as depression and anxiety [70], which highly correlate with symptoms suffered by PLWHA. Similarly, although evidence shows that peer support is a substantial intervention with several advantages [71–73], only six studies included peer-related components (e.g., peer delivered counseling, peer group, among others). Peer support is crucial since it helps patients open up and feel understood by someone who has undergone similar experiences. In addition, implementing this kind of intervention is highly cost-effective [74–76].
Both group and peer-support components have been shown to boost the effectiveness of interventions [30, 45, 54, 59, 70, 77]. Hence, combining these types of intervention might be something to investigate further, since participants often report that having a sense of intimacy and being in a tailor-made intervention is what makes counseling appealing [78–80].
Another point to consider is that studies lack a more deep consideration of the training of the facilitators. Only half of the studies mentioned that the facilitators received training; however, developing clear protocols and formal guidance might help standardize the delivery of the interventions. Likewise, evidence shows that receiving formal training encourages commitment in the intervention’s facilitators [81–83]. Hence, this might be a feature to consider when designing interventions to improve adherence in PLWHA.
Our systematic review presents important limitations. First, we focused specifically on ART adherence. Future studies should consider adding other relevant aspects of HIV (e.g. retention in care, treatment adherence, self-efficacy, self-management). Second, we included only interventions customized for adults. Future reviews might include broader age ranges as interventions for populations such as young people living with HIV are extremely important. Third, our search strategy lacked the collaboration of a librarian, which would have helped develop a more precise and exhaustive inspection of scientific databases
Overall, our study provides evidence that supports the idea that there is a diversity of interventions that aim to improve adherence to ART in PLWHA whose quality is not necessarily linked to one type of study design. This is relevant when thinking about different ways to assess effectiveness in adherence to treatment and to design studies that better represent the target population.
Conclusions
This systematic review aimed to provide a comprehensive review of the evidence on psychosocial interventions for ART adherence and their characteristics. We included diverse types of study designs, assessing the quality of the studies, identifying different kinds of interventions, target populations, the health facility in which the intervention was delivered, and the intervention’s facilitator and their training.
This review emphasizes the diversity of research designs reporting and assessing interventions to improve ART adherence in PLWHA. This diversity of approaches may, in turn, enrich both clinical practice and future research programs.
This review highlighted several factors researchers should consider when planning further research into adherence to treatment in PLWHA. First, studies using qualitative methodologies should be considered since they have proven useful to deepen the understanding of participant behavior and, considering what this review shows, they scored highly in the quality assessment. Second, despite the evidence showing its effectiveness, the low number of group interventions indicates the need for additional work with this type of intervention. Third, further detail regarding the target population and the health facilities should be included when thinking about improving treatment adherence. Finally, training facilitators emerged as a common factor in these interventions; thus, training should be further investigated as a relevant factor.
While the body of work available in the literature emphasizes the problem of adherence to ART in PLWHA, it does not appear to have thoroughly examined the contribution of different types of research designs that report and assess interventions. Thus, a specific assessment of each type of study design is recommended.
Acknowledgments
We thank Bernardita Santibanez and Catalina Sanhueza for their contribution to the literature search process.
References
- 1. Chen X. Understanding the development and perception of global health for more effective student education. Yale J Biol Med. 2014;87: 231–240. pmid:25191139
- 2. Lancet The. The global HIV/AIDS epidemic-progress and challenges. The Lancet. pubmed.ncbi.nlm.nih.gov; 2017. p. 333. pmid:28745587
- 3. Govender RD, Hashim MJ, Khan MA, Mustafa H, Khan G. Global Epidemiology of HIV/AIDS: A Resurgence in North America and Europe. J Epidemiol Glob Health. 2021;11: 296–301. pmid:34270183
- 4.
United Nation Joint Programme on HIV/AIDS [UNADIS]. Global HIV & AIDS statistics—Fact sheet. In: United Nation Joint Programme on HIV/AIDS [UNADIS] [Internet]. 2021. https://www.who.int/data/gho/data/themes/hiv-aids#:~:text=Globally%2C%2037.7%20million%20%5B30.2%E2%80%93,considerably%20between%20countries%20and%20regions.
- 5. Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus Infection. N Engl J Med. 1998;338: 853–860.
- 6. Costa J de M, Torres TS, Coelho LE, Luz PM. Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta-analysis. J Int AIDS Soc. 2018;21: e25066.
- 7.
Looney D, Ma A, Johns S. HIV Therapy—The State of ART. In: Torbett BE, Goodsell DS, Richman DD, editors. The Future of HIV-1 Therapeutics: Resistance Is Futile? Cham: Springer International Publishing; 2015. pp. 1–29.
- 8. Ghosn J, Taiwo B, Seedat S, Autran B, Katlama C. HIV. Lancet. 2018;392: 685–697. pmid:30049419
- 9. Cao W, Hsieh E, Li T. Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges. Curr HIV/AIDS Rep. 2020;17: 26–34. pmid:31939111
- 10. Hoffmann CJ, Gallant JE. Rationale and evidence for human immunodeficiency virus treatment as prevention at the individual and population levels. Infect Dis Clin North Am. 2014;28: 549–561. pmid:25287588
- 11. Baral S, Rao A, Sullivan P, Phaswana-Mafuya N, Diouf D, Millett G, et al. The disconnect between individual-level and population-level HIV prevention benefits of antiretroviral treatment. Lancet HIV. 2019;6: e632–e638. pmid:31331822
- 12. Genberg BL, Wilson IB, Bangsberg DR, Arnsten J, Goggin K, Remien RH, et al. Patterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America. AIDS. 2012;26: 1415–1423. pmid:22767342
- 13. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133: 21–30. pmid:10877736
- 14. Raffa JD, Tossonian HK, Grebely J, Petkau AJ, DeVlaming S, Conway B. Intermediate highly active antiretroviral therapy adherence thresholds and empirical models for the development of drug resistance mutations. J Acquir Immune Defic Syndr. 2008;47: 397–399. pmid:18398974
- 15. Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodríguez E, et al. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011;15: 1381–1396. pmid:21468660
- 16. Iacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment—Clinical Points of View and Practical Considerations. Front Pharmacol. 2017;8: 831. pmid:29218008
- 17.
Cederfjäll C. Aspects of care among HIV infected patients: Needs, adherence to treatment and health related quality of life. Institutionen för immunologi, mikrobiologi, patologi och infektionssjukdomar / Department of Immunology, Microbiology, Pathology and Infectious Diseases. 2002. https://openarchive.ki.se/xmlui/handle/10616/42897
- 18. Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JSG. Is there a baseline CD4 cell count that precludes a survival response to modern antiretroviral therapy? AIDS. 2003;17: 711–720. pmid:12646794
- 19. Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12: 142. pmid:25145556
- 20. Spaan P, van Luenen S, Garnefski N, Kraaij V. Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis. J Health Psychol. 2020;25: 1326–1340. pmid:29417851
- 21. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58: 181–187. pmid:21857529
- 22. Malta M, Magnanini MMF, Strathdee SA, Bastos FI. Adherence to antiretroviral therapy among HIV-infected drug users: a meta-analysis. AIDS Behav. 2010;14: 731–747. pmid:19020970
- 23. Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24: 1101–1108. pmid:19653047
- 24. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16: 18640. pmid:24242258
- 25. Amico KR, Fisher WA, Cornman DH, Shuper PA, Redding CG, Konkle-Parker DJ, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42: 455–459. pmid:16810111
- 26. Sin NL, DiMatteo MR. Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis. Ann Behav Med. 2014;47: 259–269. pmid:24234601
- 27. Detsis M, Tsioutis C, Karageorgos SA, Sideroglou T, Hatzakis A, Mylonakis E. Factors Associated with HIV Testing and HIV Treatment Adherence: A Systematic Review. Curr Pharm Des. 2017;23: 2568–2578. pmid:28356038
- 28. Altice F, Evuarherhe O, Shina S, Carter G, Beaubrun AC. Adherence to HIV treatment regimens: systematic literature review and meta-analysis. Patient Prefer Adherence. 2019;13: 475–490. pmid:31040651
- 29. Casale M, Carlqvist A, Cluver L. Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review. AIDS Patient Care STDS. 2019;33: 237–252. pmid:31166783
- 30. Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A Review of Interventions to Enhance HIV Medication Adherence. Curr HIV/AIDS Rep. 2021. pmid:34152554
- 31. Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care. 2015;27: 805–816. pmid:25702789
- 32. Chaiyachati KH, Ogbuoji O, Price M, Suthar AB, Negussie EK, Bärnighausen T. Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. AIDS. 2014;28 Suppl 2: S187–204. pmid:24849479
- 33. Musayón-Oblitas Y, Cárcamo C, Gimbel S. Counseling for improving adherence to antiretroviral treatment: a systematic review. AIDS Care. 2019;31: 4–13. pmid:30309239
- 34. Zuge SS, de Paula CC, Padoin SM de M. Effectiveness of interventions for adherence to antiretroviral therapy in adults with HIV: a systematic review. Rev Esc Enferm USP. 2020;54: e03627.
- 35. Locher C, Messerli M, Gaab J, Gerger H. Long-Term Effects of Psychological Interventions to Improve Adherence to Antiretroviral Treatment in HIV-Infected Persons: A Systematic Review and Meta-Analysis. AIDS Patient Care STDS. 2019;33: 131–144. pmid:30844307
- 36. Laurenzi CA, du Toit S, Ameyan W, Melendez-Torres GJ, Kara T, Brand A, et al. Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta-analysis. J Int AIDS Soc. 2021;24: e25741. pmid:34338417
- 37. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and examples for reporting systematic reviews. BMJ. 2021;372: n160.
- 38.
The EndNote Team. EndNote. Philadelphia, PA; 2013.
- 39.
SAGE Books—Google Tools Meets Middle School. [cited 29 Sep 2021]. 10.4135/9781506360188.n6
- 40.
National Heart Lung, Institute B, Others. Study Quality Assessment Tools [https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools]. Accessed; 2019.
- 41.
Lorenc T, Petticrew M, Whitehead M, Neary D, Clayton S, Wright K, et al. Crime, fear of crime and mental health: synthesis of theory and systematic reviews of interventions and qualitative evidence. Southampton (UK): NIHR Journals Library; 2015.
- 42. Popay J, Roberts H, Sowden A. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the. 2006. Available: https://www.researchgate.net/profile/Mark_Rodgers4/publication/233866356_Guidance_on_the_conduct_of_narrative_synthesis_in_systematic_reviews_A_product_from_the_ESRC_Methods_Programme/links/02e7e5231e8f3a6183000000/Guidance-on-the-conduct-of-narrative-synthesis-in-systematic-reviews-A-product-from-the-ESRC-Methods-Programme.pdf
- 43. Kalichman SC, Kalichman MO, Cherry C, Eaton LA, Cruess D, Schinazi RF. Randomized factorial trial of phone-delivered support counseling and daily text message reminders for HIV treatment adherence. J Acquir Immune Defic Syndr. 2016;73: 47–54. pmid:27105048
- 44. Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, et al. Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr. 2013;63: 42–50. pmid:23337369
- 45. Bogart LM, Mutchler MG, McDavitt B, Klein DJ, Cunningham WE, Goggin KJ, et al. A Randomized Controlled Trial of Rise, a Community-Based Culturally Congruent Adherence Intervention for Black Americans Living with HIV. Ann Behav Med. 2017;51: 868–878. pmid:28432578
- 46. Dulli L, Ridgeway K, Packer C, Murray KR, Mumuni T, Plourde KF, et al. A Social Media–Based Support Group for Youth Living With HIV in Nigeria (SMART Connections): Randomized Controlled Trial. J Med Internet Res. 2020;22: e18343. pmid:32484444
- 47. Attonito J, Villalba K, Dévieux JG. Effectiveness of an Intervention for Improving Treatment Adherence, Service Utilization and Viral Load Among HIV-Positive Adult Alcohol Users. AIDS Behav. 2020;24: 1495–1504. pmid:31637608
- 48. Côté J, Rouleau G, Ramirez-Garcia P, Bourbonnais A. Virtual Nursing Intervention Adjunctive to Conventional Care: The Experience of Persons Living With HIV. JMIR Res Protoc. 2015;4: e124. pmid:26487327
- 49. Kunutsor S, Walley J, Muchuro S, Katabira E, Balidawa H, Namagala E, et al. Improving adherence to antiretroviral therapy in sub-Saharan African HIV-positive populations: an enhanced adherence package. AIDS Care. 2012;24: 1308–1315. pmid:22621288
- 50. Côté J, Rouleau G, Ramirez-Garcia MP, Auger P, Thomas R, Leblanc J. Effectiveness of a Web-Based Intervention to Support Medication Adherence Among People Living With HIV: Web-Based Randomized Controlled Trial. JMIR Public Health Surveill. 2020;6: e17733. pmid:32310145
- 51. Kurth AE, Chhun N, Cleland CM, Crespo-Fierro M, Parés-Avila JA, Lizcano JA, et al. Linguistic and cultural adaptation of a computer-based counseling program (CARE+ Spanish) to support HIV treatment adherence and risk reduction for people living with HIV/AIDS: a randomized controlled trial. J Med Internet Res. 2016;18: e5830. pmid:27417531
- 52. Kalichman SC, Mathews C, Banas E, Kalichman MO. Treatment adherence in HIV stigmatized environments in South Africa: stigma avoidance and medication management. Int J STD AIDS. 2019;30: 362–370. pmid:30501366
- 53. MacCarthy S, Wagner Z, Mendoza-Graf A, Gutierrez CI, Samba C, Birungi J, et al. A randomized controlled trial study of the acceptability, feasibility, and preliminary impact of SITA (SMS as an Incentive To Adhere): a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda. BMC Infect Dis. 2020;20: 173. pmid:32093630
- 54. Oberjé E, de Bruin M, Evers S, Viechtbauer W, Nobel H-E, Schaalma H, et al. Cost-effectiveness of a nurse-based intervention (AIMS) to improve adherence among HIV-infected patients: design of a multi-centre randomized controlled trial. BMC Health Serv Res. 2013;13: 274.
- 55. Wagner GJ, Linnemayr S, Ghosh-Dastidar B, Currier JS, Hoffman R, Schneider S. Supporting Treatment Adherence Readiness through Training (START) for patients with HIV on antiretroviral therapy: study protocol for a randomized controlled trial. Trials. 2016;17: 162. pmid:27009061
- 56. Tanue EA, Nsagha DS, Theophile NN, Assob JCN. Improving Retention in Care and Promoting Adherence to HIV Treatment: Protocol for a Multisite Randomized Controlled Trial of Mobile Phone Text Messaging. JMIR Res Protoc. 2020;9: e15680. pmid:32852282
- 57. Been SK, van de Vijver DAMC, Smit J, Bassant N, Pogány K, Stutterheim SE, et al. Feasibility of Four Interventions to Improve Treatment Adherence in Migrants Living with HIV in The Netherlands. Diagnostics (Basel). 2020;10. pmid:33233835
- 58. Orlando S, Palla I, Ciccacci F, Triulzi I, Thole D, Sangaré HM, et al. Improving Treatment Adherence and Retention of HIV-Positive Women Through Behavioral Change Interventions Aimed at Their Male Partners: Protocol for a Prospective, Controlled Before-and-After Study. JMIR Res Protoc. 2021;10: e19384. pmid:33492232
- 59. Rodrigues R, Poongulali S, Balaji K, Atkins S. “The phone reminder is important, but will others get to know about my illness?”Patient perceptions of an mHealth antiretroviral treatment support intervention in the …. BMJ Open. 2015. Available: https://bmjopen.bmj.com/content/5/11/e007574.short
- 60. Houston E, Osborn A, Lyons T, Masvawure T, Raja S. Exploring perceived social support from peer facilitators in an HIV treatment adherence intervention for African American patients: A content analysis of participant perspectives. J Community Appl Soc Psychol. 2015;25: 487–501.
- 61. Rana AI, van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS. 2016;30: 178–184. pmid:27028183
- 62. Nsagha DS, Siysi VV, Ekobo S, Egbe TO, Kibu OD. One-Way and Two-Way Mobile Phone Text Messages for Treatment Adherence Among Patients With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2020;9: e16127. pmid:32996886
- 63. Kim MH, Tembo TA, Mazenga A, Yu X, Myer L, Sabelli R, et al. The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi. Trials. 2020;21: 1–13.
- 64. Duthely LM, Sanchez-Covarrubias AP, Mohamed AB, Potter JE. A multilingual, culturally competent mobile health intervention to improve treatment adherence among women living with HIV: protocol for a randomized controlled trial. JMIR Res Protoc. 2020;9: e17656. pmid:32438338
- 65. Bazzi AR, Fergus KB, Stephenson R, Finneran CA, Coffey-Esquivel J, Hidalgo MA, et al. A dyadic behavioral intervention to optimize same sex male couples’ engagement across the HIV care continuum: Development of and protocol for an innovative couples-based approach (partner steps). JMIR Res Protoc. 2016;5: e168. pmid:27562905
- 66. Wagner G, Chan Osilla K, Garnett J, Ghosh-Dastidar B, Bhatti L, Goetz MB, et al. Patient Characteristics Associated with HCV Treatment Adherence, Treatment Completion, and Sustained Virologic Response in HIV Coinfected Patients. AIDS Res Treat. 2011;2011: 903480. pmid:22110904
- 67. Kalichman SC, Mathews C, Banas E, Kalichman MO. Stigma management intervention to improve antiretroviral therapy adherence: Phase-I test of concept trial, Cape Town South Africa. Glob Public Health. 2019;14: 1059–1074. pmid:30500309
- 68.
Bandura A. Self-Efficacy. happyheartfamilies.citymax.com; 1994 [cited 1 Jun 2022]. http://happyheartfamilies.citymax.com/f/Self_Efficacy.pdf
- 69. Paudel V, Baral KP. Women living with HIV/AIDS (WLHA), battling stigma, discrimination and denial and the role of support groups as a coping strategy: a review of literature. Reprod Health. 2015;12: 53. pmid:26032304
- 70. Burlingame GM, Strauss B, Joyce A. Change mechanisms and effectiveness of small group treatments. Bergin and Garfield’s handbook of psychotherapy and behavior change. 2013;6: 640–689.
- 71. Melling B, Houguet-Pincham T. Online peer support for individuals with depression: A summary of current research and future considerations. Psychiatric Rehabilitation Journal. 2011. pp. 252–254. pmid:21208865
- 72. Raine P. Promoting breast-feeding in a deprived area: the influence of a peer support initiative. Health Soc Care Community. 2003;11: 463–469. pmid:14629576
- 73. Lawton-Smith S. Peer support in mental health: where are we today? The Journal of Mental Health Training, Education and Practice. 2013. pp. 152–158.
- 74. Stant AD, Castelein S, Bruggeman R, van Busschbach JT, van der Gaag M, Knegtering H, et al. Economic aspects of peer support groups for psychosis. Community Ment Health J. 2011;47: 99–105. pmid:19308728
- 75. Leung P, Orrell M, Orgeta V. Social support group interventions in people with dementia and mild cognitive impairment: a systematic review of the literature. Int J Geriatr Psychiatry. 2015;30: 1–9. pmid:24990344
- 76. Landers G, Zhou M. The impact of Medicaid peer support utilization on cost. Medicare Medicaid Res Rev. 2014;4. pmid:24926416
- 77. Nance N, Pendo P, Masanja J, Ngilangwa DP, Webb K, Noronha R, et al. Short-term effectiveness of a community health worker intervention for HIV-infected pregnant women in Tanzania to improve treatment adherence and retention in care: A cluster-randomized trial. PLoS One. 2017;12: e0181919. pmid:28859083
- 78. Institute NC, National Cancer Institute. Intimacy Enhancement Intervention.. Definitions. 2020.
- 79.
Carlson J, Sperry L, Lewis JA. Family Therapy Techniques: Integrating and Tailoring Treatment. Routledge; 2013.
- 80. Aakhus E, Granlund I, Oxman AD, Flottorp SA. Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study. Int J Ment Health Syst. 2015;9: 36. pmid:26366193
- 81. Shipton H, Fay D, West M, Patterson M, Birdi K. Managing People to Promote Innovation. Creativity and Innovation Management. 2005. pp. 118–128.
- 82. Freeman S, Wright A, Lindqvist S. Facilitator training for educators involved in interprofessional learning. J Interprof Care. 2010;24: 375–385. pmid:20377399
- 83. Rew L, Banner M, Johnson K, Slesnick N. Intervention Fidelity and Facilitator Training. West J Nurs Res. 2018;40: 1843–1860. pmid:29298636