Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
ICF International, Atlanta, Georgia.
AIDS Patient Care STDS. 2019 Dec;33(12):528-537. doi: 10.1089/apc.2019.0125. Epub 2019 Nov 21.
This overview of reviews summarizes the evidence from systematic reviews (SR) on the effectiveness of antiretroviral therapy (ART) adherence interventions for people with HIV (PWH) and descriptively compares adherence interventions among key populations. Relevant articles published during 1996-2017 were identified by comprehensive searches of CDC's HIV/acquired immunodeficiency syndrome (AIDS) Prevention Research Synthesis Database and manual searches. Included SRs examined primary interventions intended to improve ART adherence, focused on PWH, and assessed medication adherence or biologic outcomes (e.g., viral load). We synthesized the qualitative data and used the Assessment of Multiple Systematic Reviews (AMSTAR) for quality assessment. Forty-one SRs met inclusion criteria. Average quality was high. SRs that evaluated text-messaging interventions ( = 9) consistently reported statistically significant improvements in adherence and biologic outcomes. Other ART adherence strategies [e.g., behavioral, directly administered antiretroviral therapy (DAART)] reported improvements, but did not report significant effects for both outcomes, or intervention effects that did not persist postintervention. In the review focused on people who inject drugs ( = 1), DAART alone or in combination with medication-assisted therapy improved both outcomes. In SRs focused on children or adolescents aged <18 years ( = 5), regimen-related and hospital-based DAART improved biologic outcomes. ART adherence interventions (e.g., text-messaging) improved adherence and biologic outcomes; however, results differed for other intervention strategies, populations, and outcomes. Because few SRs reported evidence for populations at high risk (e.g., men who have sex with men), the results are not generalizable to all PWH. Future implementation studies are needed to examine medication adherence interventions in specific populations and address the identified gaps.
这篇综述总结了来自系统评价(SR)的关于抗逆转录病毒疗法(ART)依从性干预措施对 HIV 感染者(PWH)有效性的证据,并描述性地比较了关键人群中的依从性干预措施。通过对 CDC 的 HIV/获得性免疫缺陷综合征(AIDS)预防研究综合数据库进行全面搜索和手动搜索,确定了在 1996 年至 2017 年期间发表的相关文章。纳入的 SR 检查了旨在提高 ART 依从性的主要干预措施,重点关注 PWH,并评估了药物依从性或生物学结果(例如病毒载量)。我们综合了定性数据,并使用评估多个系统评价的工具(AMSTAR)进行质量评估。41 篇 SR 符合纳入标准。平均质量较高。评估短信干预的 SR( = 9)一致报告了在依从性和生物学结果方面的统计学显著改善。其他 ART 依从性策略[例如,行为,直接给予抗逆转录病毒治疗(DAART)]报告了改善,但没有报告两个结果都有显著效果,或干预效果在干预后没有持续。在专注于注射吸毒者的综述中( = 1),单独或与药物辅助治疗联合使用 DAART 可改善两个结果。在专注于 <18 岁的儿童或青少年的 SR 中( = 5),与方案相关和基于医院的 DAART 改善了生物学结果。ART 依从性干预措施(例如短信)改善了依从性和生物学结果;然而,其他干预策略、人群和结果的结果不同。由于很少有 SR 报告了高危人群(例如男男性行为者)的证据,因此结果不能推广到所有 PWH。需要未来的实施研究来研究特定人群中的药物依从性干预措施,并解决已确定的差距。
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