Alemu Gebrie Getu, Yirsaw Bantie Getnet, Tesfie Tigabu Kidie, Yismaw Getaneh Awoke, Abuhay Habtamu Wagnew, Alemayehu Meron Asmamaw, Agimas Muluken Chanie, Derseh Nebiyu Mekonnen
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2025 Jan 6;20(1):e0312529. doi: 10.1371/journal.pone.0312529. eCollection 2025.
Children living with HIV in low-income settings, such as in Eastern and Southern Africa, are at a high risk for poor adherence to antiretroviral therapy. However, various primary studies presented inconsistent and inconclusive estimates of adherence and its associated factors among children living with HIV in Eastern and Southern Africa. Therefore, we were aimed to determine the pooled prevalence of adherence and its associated factors, and to guide interventions efforts to support adherence, this comprehensive systematic review and meta-analysis was conducted.
We have comprehensively searched PubMed, Google Scholar, EMBASE, Scopus, and Hinari databases for all primary studies. Unpublished studies were also searched manually and accessed from university repositories. Additional searches were conducted by examining the references in the included articles to further identify relevant studies. Data were extracted and analyzed using Microsoft Excel spreadsheet and STATA version 17 software, respectively. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of adherence to antiretroviral therapy among children living in Eastern and Southern Africa. We have used Cochran's Q test (χ2) and Higgins I2 statistics to identify heterogeneity. Subgroup and sensitivity analysis were conducted to investigate the potential sources of heterogeneity. Publication bias was assessed by the funnel plot and Egger's test. An association was expressed through the pooled adjusted odds ratio and statistical significance was considered at a p-value < 0.05.
This meta-analysis combined the effect estimates of 29 primary studies with 7414 study participants. The pooled prevalence of adherence to antiretroviral therapy among children living in Eastern and Southern Africa was 76.2% (95% CI: 71.4, 81.1) [I2 = 97.06%, P < 0.001 and Q test (χ2) = 953.83, p-value < 0.001]. Being a biological caregiver [AOR = 1.93 (95% CI: 1.34, 2.73)], receiving first-line antiretroviral treatment [AOR = 2.7 (95% CI: 1.39, 5.25)], and having social support [AOR = 1.88 (95% CI: 1.33, 2.66)] were significantly associated with adherence to antiretroviral therapy.
The pooled prevalence of adherence to antiretroviral therapy among children living with HIV is low. Biological caregiver, first-line antiretroviral treatment, and social support were factors associated with adherence to ART among children living with HIV. Therefore, healthcare providers, adherence counselors, supporters, as well as governmental and non-governmental organizations, should emphasize a multi-component intervention approach to address the multifaceted challenges associated with adherence to ART, thereby improving counseling efforts to enhance adherence. Moreover, clinicians should prioritize the selection and utilization of regimens for individuals in this age group on robust first-line options.
在东非和南非等低收入地区，感染艾滋病毒的儿童对抗逆转录病毒疗法的依从性较差，面临着较高风险。然而，多项初步研究对东非和南非感染艾滋病毒儿童的依从性及其相关因素的估计并不一致且尚无定论。因此，为了确定依从性及其相关因素的合并患病率，并指导支持依从性的干预措施，我们进行了这项全面的系统评价和荟萃分析。
我们全面检索了PubMed、谷歌学术、EMBASE、Scopus和Hinari数据库中的所有初步研究。未发表的研究也通过手动检索并从大学知识库中获取。通过检查纳入文章中的参考文献进行额外检索，以进一步识别相关研究。分别使用Microsoft Excel电子表格和STATA 17版软件提取和分析数据。采用随机效应DerSimonian-Laird模型计算东非和南非感染艾滋病毒儿童对抗逆转录病毒疗法的依从性合并患病率。我们使用Cochran's Q检验（χ2）和Higgins I2统计量来识别异质性。进行亚组分析和敏感性分析以调查异质性的潜在来源。通过漏斗图和Egger检验评估发表偏倚。通过合并调整后的比值比表示关联，p值<0.05时认为具有统计学意义。
这项荟萃分析综合了29项初步研究对7414名研究参与者的效应估计。东非和南非感染艾滋病毒儿童对抗逆转录病毒疗法的依从性合并患病率为76.2%（95%CI：71.4，81.1）[I2 = 97.06%，P < 0.001且Q检验（χ2）= 953.83，p值< 0.001]。作为亲生照料者[AOR = 1.93（95%CI：1.34，2.73）]、接受一线抗逆转录病毒治疗[AOR = 2.7（95%CI：1.39，5.25）]以及获得社会支持[AOR = 1.88（95%CI：1.33，2.66）]与对抗逆转录病毒疗法的依从性显著相关。
感染艾滋病毒儿童对抗逆转录病毒疗法的依从性合并患病率较低。亲生照料者、一线抗逆转录病毒治疗和社会支持是感染艾滋病毒儿童依从抗逆转录病毒疗法的相关因素。因此，医疗服务提供者、依从性咨询人员、支持者以及政府和非政府组织应强调采用多组分干预方法来应对与抗逆转录病毒疗法依从性相关的多方面挑战，从而加强咨询工作以提高依从性。此外，临床医生应优先为该年龄组个体选择和使用基于强有力一线方案的治疗方案。
