Marcus J L, Buisker T, Horvath T, Amico K R, Fuchs J D, Buchbinder S P, Grant R M, Liu A Y
Gladstone Institute of Virology and Immunology, San Francisco, CA, USA; Department of Epidemiology, University of California, Berkeley, CA, USA.
HIV Med. 2014 Aug;15(7):385-95. doi: 10.1111/hiv.12132. Epub 2014 Feb 24.
OBJECTIVES: Adherence is critical for maximizing the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection. Strategies for promoting adherence to HIV treatment, and their potential application to PrEP adherence, have received considerable attention. However, adherence promotion strategies for prevention medications have not been well characterized and may be more applicable to PrEP. We aimed to identify adherence support interventions that have been effective in other prevention fields and could be applied in the HIV prevention context to support pill taking among PrEP users. METHODS: To identify adherence support interventions that could be evaluated and applied in the PrEP context, we conducted a systematic review across the following prevention fields: hypertension, latent tuberculosis infection, hyperlipidaemia, oral contraceptives, osteoporosis, malaria prophylaxis, and post-exposure prophylaxis for HIV infection. We included randomized controlled trials that evaluated the efficacy of interventions to improve adherence to daily oral medications prescribed for primary prevention in healthy individuals or for secondary prevention in asymptomatic individuals. RESULTS: Our searches identified 585 studies, of which 48 studies met the eligibility criteria and were included in the review; nine evaluated multiple strategies, yielding 64 separately tested interventions. Interventions with the strongest evidence for improving adherence included complex, resource-intensive interventions, which combined multiple adherence support approaches, and low-cost, low-intensity interventions that provided education or telephone calls for adherence support. CONCLUSIONS: Our review identified adherence interventions with strong evidence of efficacy across prevention fields and provides recommendations for evaluating these interventions in upcoming PrEP studies.
目的:坚持服药对于使暴露前预防(PrEP)预防HIV感染的效果最大化至关重要。促进HIV治疗依从性的策略及其在PrEP依从性方面的潜在应用已受到广泛关注。然而,预防用药的依从性促进策略尚未得到充分描述,可能更适用于PrEP。我们旨在确定在其他预防领域有效的依从性支持干预措施,并将其应用于HIV预防背景下,以支持PrEP使用者服药。 方法:为了确定可在PrEP背景下进行评估和应用的依从性支持干预措施,我们对以下预防领域进行了系统综述:高血压、潜伏性结核感染、高脂血症、口服避孕药、骨质疏松症、疟疾预防以及HIV感染的暴露后预防。我们纳入了评估干预措施疗效的随机对照试验,这些干预措施旨在提高健康个体初级预防或无症状个体二级预防中每日口服药物的依从性。 结果:我们的检索共识别出585项研究,其中48项研究符合纳入标准并被纳入综述;9项研究评估了多种策略,产生了64种分别测试的干预措施。有最有力证据表明能提高依从性的干预措施包括复杂、资源密集型干预措施,这些措施结合了多种依从性支持方法,以及低成本、低强度的干预措施,即提供教育或通过电话提供依从性支持。 结论:我们的综述确定了在预防领域有强有力疗效证据的依从性干预措施,并为在即将开展的PrEP研究中评估这些干预措施提供了建议。
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