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干预策略以提高撒哈拉以南非洲特定慢性病治疗的依从性:系统评价。

Intervention strategies to improve adherence to treatment for selected chronic conditions in sub-Saharan Africa: a systematic review.

机构信息

Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands.

出版信息

J Int AIDS Soc. 2024 Jun;27(6):e26266. doi: 10.1002/jia2.26266.


DOI:10.1002/jia2.26266
PMID:38924296
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11197966/
Abstract

INTRODUCTION: Evidence-based intervention strategies to improve adherence among individuals living with chronic conditions are critical in ensuring better outcomes. In this systematic review, we assessed the impact of interventions that aimed to promote adherence to treatment for chronic conditions. METHODS: We systematically searched PubMed, Web of Science, Scopus, Google Scholar and CINAHL databases to identify relevant studies published between the years 2000 and 2023 and used the QUIPS assessment tool to assess the quality and risk of bias of each study. We extracted data from eligible studies for study characteristics and description of interventions for the study populations of interest. RESULTS: Of the 32,698 total studies/records screened, 2814 were eligible for abstract screening and of those, 497 were eligible for full-text screening. A total of 82 studies were subsequently included, describing a total of 58,043 patients. Of the total included studies, 58 (70.7%) were related to antiretroviral therapy for HIV, 6 (7.3%) were anti-hypertensive medication-related, 12 (14.6%) were anti-diabetic medication-related and 6 (7.3%) focused on medication for more than one condition. A total of 54/82 (65.9%) reported improved adherence based on the described study outcomes, 13/82 (15.9%) did not have clear results or defined outcomes, while 15/82 (18.3%) reported no significant difference between studied groups. The 82 publications described 98 unique interventions (some studies described more than one intervention). Among these intervention strategies, 13 (13.3%) were multifaceted (4/13 [30.8%] multi-component health services- and community-based programmes, 6/13 [46.2%] included individual plus group counselling and 3/13 [23.1%] included SMS or alarm reminders plus individual counselling). DISCUSSION: The interventions described in this review ranged from adherence counselling to more complex interventions such as mobile health (mhealth) interventions. Combined interventions comprised of different components may be more effective than using a single component in isolation. However, the complexity involved in designing and implementing combined interventions often complicates the practicalities of such interventions. CONCLUSIONS: There is substantial evidence that community- and home-based interventions, digital health interventions and adherence counselling interventions can improve adherence to medication for chronic conditions. Future research should answer if existing interventions can be used to develop less complicated multifaceted adherence intervention strategies.

摘要

介绍:为确保更好的治疗效果,对于改善慢性病患者的治疗依从性,基于循证的干预策略至关重要。在本系统综述中,我们评估了旨在促进慢性病治疗依从性的干预措施的影响。

方法:我们系统地检索了 PubMed、Web of Science、Scopus、Google Scholar 和 CINAHL 数据库,以确定 2000 年至 2023 年间发表的相关研究,并使用 QUIPS 评估工具评估每项研究的质量和偏倚风险。我们从合格研究中提取了研究人群特征和干预措施描述的数据。

结果:在筛选出的 32698 项研究/记录中,有 2814 项符合摘要筛选标准,其中 497 项符合全文筛选标准。随后共有 82 项研究被纳入,共描述了 58043 名患者。在总共纳入的研究中,58 项(70.7%)与 HIV 的抗逆转录病毒治疗有关,6 项(7.3%)与降压药物治疗有关,12 项(14.6%)与抗糖尿病药物治疗有关,6 项(7.3%)与一种以上药物治疗有关。共有 54/82(65.9%)项研究根据描述的研究结果报告了治疗依从性的改善,13/82(15.9%)项研究没有明确的结果或定义的结果,而 15/82(18.3%)项研究报告研究组之间没有显著差异。82 篇出版物描述了 98 项独特的干预措施(一些研究描述了不止一项干预措施)。在这些干预策略中,有 13 项(13.3%)是多方面的(4/13 [30.8%] 多组分卫生服务和基于社区的方案、6/13 [46.2%] 包括个人加小组咨询、3/13 [23.1%] 包括短信或警报提醒加个人咨询)。

讨论:本综述中描述的干预措施范围从依从性咨询到更复杂的干预措施,如移动健康(mHealth)干预措施。由不同组成部分组成的综合干预措施可能比单独使用单一组成部分更有效。然而,设计和实施综合干预措施的复杂性常常使这些干预措施的实际应用变得复杂。

结论:有大量证据表明,基于社区和家庭的干预措施、数字健康干预措施和依从性咨询干预措施可以提高慢性病患者对药物的依从性。未来的研究应该回答现有的干预措施是否可以用于开发更简单的多方面的依从性干预策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a19/11197966/b4b9524a0270/JIA2-27-e26266-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a19/11197966/b4b9524a0270/JIA2-27-e26266-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a19/11197966/b4b9524a0270/JIA2-27-e26266-g001.jpg

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本文引用的文献

[1]
Integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-AFRICA): a pragmatic cluster-randomised, controlled trial.

Lancet. 2023-10-7

[2]
Effect of the Friendship Bench Intervention on Antiretroviral Therapy Outcomes and Mental Health Symptoms in Rural Zimbabwe: A Cluster Randomized Trial.

JAMA Netw Open. 2023-7-3

[3]
Supporting Adolescents With HIV in South Africa Through an Adherence-Supporting App: Mixed Methods Beta-Testing Study.

JMIR Form Res. 2023-6-1

[4]
A Structural Equation Model of the Impact of a Family-Based Economic Intervention on Antiretroviral Therapy Adherence Among Adolescents Living With HIV in Uganda.

J Adolesc Health. 2023-5

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HIV AIDS (Auckl). 2023-3-8

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Diabetes Metab Syndr Obes. 2022-3-1

[9]
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Front Reprod Health. 2021

[10]
One Pill, Once a Day: Simplified Treatment Regimens and Retention in HIV Care.

Am J Epidemiol. 2022-5-20

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