Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
Curr HIV/AIDS Rep. 2021 Oct;18(5):443-457. doi: 10.1007/s11904-021-00568-9. Epub 2021 Jun 21.
PURPOSE OF REVIEW: Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS: There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
目的综述:抗逆转录病毒治疗(ART)的依从性对于成功治疗 HIV 至关重要。不幸的是,据估计,45%的 HIV 感染者(PLWH)对 ART 的依从性较差。为了为医疗保健专业人员和 PLWH 提供支持依从性的有效工具,研究人员已经研究了心理社会干预措施增强 ART 依从性的有效性。本文综述了评估 PLWH 对 ART 依从性干预措施的干预研究、系统评价和荟萃分析。
最近的发现:干预措施在质量、样本、措施和结果特征方面存在很大差异。尽管 ART 依从性干预措施种类繁多,但也有一些一致的经验教训。关注个人和人际因素的干预措施已被证明可有效提高 ART 依从性;然而,依从性的改善往往是短暂的。此外,当针对那些依从性差风险较高的人群进行干预时,干预措施最成功。最后,基于理论的干预措施比非基于理论的干预措施更有可能有效。各种基于个体的心理干预措施已被证明可在短期内有效提高 ART 依从性。数字和移动干预有可能改善这些循证干预措施的传播和实施,并可用于延长干预效果。未来还应测试和优先考虑解决可及性、不平等、ART 依从性的结构性和制度性障碍等问题的干预措施。实施科学框架可用于评估和解决可及性和系统护理障碍问题。
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