Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
PLoS One. 2011 May 12;6(5):e18948. doi: 10.1371/journal.pone.0018948.
We sought to examine the association between livelihood security and adherence to antiretroviral therapy (ARVs) in low- and middle-income countries (LIMC).
Performing a systematic review, we searched, independently and in duplicate, 7 electronic databases and 2 conference websites for quantitative surveys that examined the association between indicators of livelihood security and adherence to ARVs in LIMC between 2000-2010. Criteria for relevance were applied to complete papers (quantitative study with estimates of associations) and quality assessment was conducted on those deemed relevant. We performed three regressions to measure the association between each type of livelihood and adherence.
Twenty original studies and 6 conference abstracts were included, the majority from Africa (n = 16). Seventeen studies and 3 conference abstracts were cross-sectional and 3 studies and 3 abstracts were prospective clinical cohort studies, with considerable variation in quality for studies of each design type. Among the diverse populations represented, we observed considerable variation in associations between measurements of livelihood indicators and increasingly accepted adherence measures, irrespective of study design or quality. A financial capital indicator, financial constraints/payment for ARV medication, was more commonly associated with non-adherence (3/5 studies). A human capital indicator, educational level, was most commonly associated with adherence (11/20 studies).
Additional better quality research examining livelihood security is required to inform provision of optimal supports for adherence and mitigation of the impacts of HIV/AIDS.
我们旨在研究生计保障与中低收入国家（LMIC）抗逆转录病毒治疗（ART）依从性之间的关联。
通过系统综述，我们独立地重复搜索了 7 个电子数据库和 2 个会议网站，以寻找在 2000-2010 年间，调查生计保障指标与 LMIC 中抗逆转录病毒治疗依从性之间关联的定量调查。将相关标准应用于完整的论文（具有关联估计的定量研究），并对被认为相关的论文进行质量评估。我们进行了三次回归分析，以衡量每种生计类型与依从性之间的关联。
共纳入 20 项原始研究和 6 项会议摘要，其中大部分来自非洲（n=16）。17 项研究和 3 项会议摘要为横断面研究，3 项研究和 3 项摘要为前瞻性临床队列研究，每种设计类型的研究质量差异较大。在所代表的不同人群中，我们观察到生计指标测量值与日益被接受的依从性测量值之间的关联存在很大差异，无论研究设计或质量如何。金融资本指标，如财务约束/抗逆转录病毒药物支付，与不依从（3/5 项研究）更相关。人力资本指标，如教育水平，与依从性最相关（11/20 项研究）。
需要进行更多高质量的研究来研究生计保障，以为提供最佳的依从性支持和减轻 HIV/AIDS 的影响提供信息。
