Mhaskar Rahul, Alandikar Vaibhav, Emmanuel Patricia, Djulbegovic Benjamin, Patel Sangita, Patel Atul, Naik Eknath, Mohapatra Shyam, Kumar Ambuj
Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Florida, USA ; Clinical and Translational Science Institute, University of South Florida, Florida, USA.
Indian J Community Med. 2013 Apr;38(2):74-82. doi: 10.4103/0970-0218.112435.
To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.
Systematic review and meta-analysis.
The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.
There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (P = 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59-81%, I(2) = 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor.
Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.
评估印度人类免疫缺陷病毒（HIV）感染人群对抗逆转录病毒疗法（ART）的依从性。
系统评价和荟萃分析。
检索了Medline和Cochrane图书馆数据库。纳入任何一项前瞻性或回顾性研究，这些研究至少招募10名受试者，其主要目的是评估印度HIV人群对ART的依从性。提取了关于依从性定义、依从性估计、研究设计、研究人群特征、回顾期和评估方法的数据。对于荟萃分析，使用随机效应模型，将合并比例计算为转换比例加权均值的逆变换（根据反正弦平方根的Freeman-Tukey变体计算）。
有7项横断面研究和1项回顾性研究，共纳入1666名参与者。发表偏倚显著（P = 0.003）。合并结果显示ART依从率为70%（95%置信区间：59 - 81%，I² = 96.3%）。基于研究设计、依从性评估方法和研究地区的敏感性分析未影响依从性估计。50%（4/8）的研究报告药物费用是ART依从性最常见的障碍。25%（2/8）报告无法获得药物是不依从的原因，12%（1/8）指出不良事件是最普遍的不依从原因。纳入研究的总体方法学质量较差。
合并结果表明，印度ART的总体依从性低于获得最佳治疗效果所需的水平。研究质量较差，无法用于指导改善ART依从性的政策。
