Mills Edward J, Nachega Jean B, Buchan Iain, Orbinski James, Attaran Amir, Singh Sonal, Rachlis Beth, Wu Ping, Cooper Curtis, Thabane Lehana, Wilson Kumanan, Guyatt Gordon H, Bangsberg David R
Centre for International Health and Human Rights Studies, Toronto, Ontario, Canada.
JAMA. 2006 Aug 9;296(6):679-90. doi: 10.1001/jama.296.6.679.
Adherence to antiretroviral therapy is a powerful predictor of survival for individuals living with human immunodeficiency virus (HIV) and AIDS. Concerns about incomplete adherence among patients living in poverty have been an important consideration in expanding the access to antiretroviral therapy in sub-Saharan Africa.
To evaluate estimates of antiretroviral therapy adherence in sub-Saharan Africa and North America.
Eleven electronic databases were searched along with major conference abstract databases (inclusion dates: inception of database up until April 18, 2006) for all English-language articles and abstracts; and researchers and treatment advocacy groups were contacted. Study Selection and Data Abstraction To best reflect the general population, studies of mixed populations in both North America and Africa were selected. Studies evaluating specific populations such as men only, homeless individuals, or drug users, were excluded. The data were abstracted in duplicate on study adherence outcomes, thresholds used to determine adherence, and characteristics of the populations. A random-effects meta-analysis was performed in which heterogeneity was examined using multivariable random-effects logistic regression. A sensitivity analysis was performed using Bayesian methods.
Thirty-one studies from North America (28 full-text articles and 3 abstracts) and 27 studies (9 full-text articles and 18 abstracts) from sub-Saharan Africa were included. African studies represented 12 sub-Saharan countries. Of the North American studies, 71% used patient self-report to assess adherence; this was true of 66% of the African assessments. Studies reported similar thresholds for adherence monitoring (eg, 100%, >95%, >90%, >80%). A pooled analysis of the North American studies (17,573 patients total) indicated a pooled estimate of 55% (95% confidence interval, 49%-62%; I2, 98.6%) of the populations achieving adequate levels of adherence. Our pooled analysis of African studies (12,116 patients total) indicated a pooled estimate of 77% (95% confidence interval, 68%-85%; I2, 98.4%). Study continent, adherence thresholds, and study quality were significant predictors of heterogeneity. Bayesian analysis was used as an alternative statistical method for combining adherence rates and provided similar findings.
Our findings indicate that favorable levels of adherence, much of which was assessed via patient self-report, can be achieved in sub-Saharan African settings and that adherence remains a concern in North America.
坚持抗逆转录病毒疗法是人类免疫缺陷病毒（HIV）感染者和艾滋病患者生存的有力预测指标。在撒哈拉以南非洲扩大抗逆转录病毒疗法的可及性时，贫困患者不完全坚持治疗的问题一直是一个重要考量因素。
评估撒哈拉以南非洲和北美的抗逆转录病毒疗法坚持率估计值。
检索了11个电子数据库以及主要会议摘要数据库（收录日期：数据库创建至2006年4月18日），查找所有英文文章和摘要；并联系了研究人员和治疗倡导团体。研究选择与数据提取 为了最好地反映总体人群，选择了北美和非洲混合人群的研究。排除评估特定人群（如仅男性、无家可归者或吸毒者）的研究。对研究的坚持结果、用于确定坚持的阈值以及人群特征的数据进行了双人提取。进行了随机效应荟萃分析，使用多变量随机效应逻辑回归检查异质性。使用贝叶斯方法进行了敏感性分析。
纳入了来自北美的31项研究（28篇全文文章和3篇摘要）以及来自撒哈拉以南非洲的27项研究（9篇全文文章和18篇摘要）。非洲的研究涵盖12个撒哈拉以南国家。在北美研究中，71%使用患者自我报告来评估坚持情况；非洲评估中有66%是这样。研究报告的坚持监测阈值相似（例如，100%、>95%、>90%、>80%）。对北美研究（共17,573名患者）的汇总分析表明，达到足够坚持水平的人群汇总估计值为55%（95%置信区间，49%-62%；I²，98.6%）。我们对非洲研究（共12,116名患者）的汇总分析表明，汇总估计值为77%（95%置信区间，68%-85%；I²，98.4%）。研究所在大洲、坚持阈值和研究质量是异质性的重要预测因素。贝叶斯分析用作合并坚持率的替代统计方法，得出了类似的结果。
我们的研究结果表明，在撒哈拉以南非洲地区可以实现良好的坚持水平，其中大部分是通过患者自我报告评估的，而在北美，坚持情况仍然是一个问题。
