20
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations

      research-article
      a , b , * , c , d , e , f , g , h , i , f , j , k , l , m , n , o , o , p , q , r , s , t , u , v , w , x , y , z , aa , ab , ac , ad , ae
      Journal of the International AIDS Society
      Taylor & Francis
      HIV, antiretroviral therapy adherence, interventions, resource-limited settings

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings.

          Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described.

          Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement.

          Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.

          Related collections

          Most cited references152

          • Record: found
          • Abstract: found
          • Article: not found

          Poverty impedes cognitive function.

          The poor often behave in less capable ways, which can further perpetuate poverty. We hypothesize that poverty directly impedes cognitive function and present two studies that test this hypothesis. First, we experimentally induced thoughts about finances and found that this reduces cognitive performance among poor but not in well-off participants. Second, we examined the cognitive function of farmers over the planting cycle. We found that the same farmer shows diminished cognitive performance before harvest, when poor, as compared with after harvest, when rich. This cannot be explained by differences in time available, nutrition, or work effort. Nor can it be explained with stress: Although farmers do show more stress before harvest, that does not account for diminished cognitive performance. Instead, it appears that poverty itself reduces cognitive capacity. We suggest that this is because poverty-related concerns consume mental resources, leaving less for other tasks. These data provide a previously unexamined perspective and help explain a spectrum of behaviors among the poor. We discuss some implications for poverty policy.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Organizing care for patients with chronic illness.

            Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study

              Background The Framework Convention on Tobacco Control (FCTC), a World Health Organization treaty, has now been ratified by over 165 countries. However there are concerns that implementing the Articles of the treaty may prove difficult, particularly in the developing world. In this study we have used qualitative methods to explore the extent to which the FCTC has been implemented in Ghana, a developing country that was 39th to ratify the FCTC, and identify barriers to effective FCTC implementation in low income countries. Methods Semi-structured interviews with 20 members of the national steering committee for tobacco control in Ghana, the official multi-disciplinary team with responsibility for tobacco control advocacy and policy formulation, were conducted. The Framework method for analysis and NVivo software were used to identify key issues relating to the awareness of the FCTC and the key challenges and achievements in Ghana to date. Results Interviewees had good knowledge of the content of the FCTC, and reported that although Ghana had no explicitly written policy on tobacco control, the Ministry of Health had issued several tobacco control directives before and since ratification. A national tobacco control bill has been drafted but has not been implemented. Challenges identified included the absence of a legal framework for implementing the FCTC, and a lack of adequate resources and prioritisation of tobacco control efforts, leading to slow implementation of the treaty. Conclusion Whilst Ghana has ratified the FCTC, there is an urgent need for action to pass a national tobacco control bill into law to enable it to implement the treaty, sustain tobacco control efforts and prevent Ghana's further involvement in the global tobacco epidemic.
                Bookmark

                Author and article information

                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                ZIAS
                zias20
                Journal of the International AIDS Society
                Taylor & Francis
                1758-2652
                2017
                22 March 2017
                : 20
                : 1
                : 21371
                Affiliations
                [ a ]Massachusetts General Hospital Global Health , Boston, MA, USA
                [ b ]Department of Medicine, Harvard Medical School , Boston, MA, USA
                [ c ]Department of Global Health, Center for Global Health and Department, Boston University School of Public Health , Boston, MA, USA
                [ d ]Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, MI, USA
                [ e ]Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town , Cape Town, South Africa
                [ f ]Department of Health Services, Policy and Practice, Brown University School of Public Health , Providence, RI, USA
                [ g ]Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital , Boston, MA, USA
                [ h ]Department of Pediatrics, Indiana University School of Medicine , Indianapolis, IN, USA
                [ i ]Academic Model Providing Access to Healthcare (AMPATH) , Eldoret, Kenya
                [ j ]Clinical Department, Institute of Human Virology Nigeria , Abuja, Nigeria
                [ k ]Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine , Baltimore, MD, USA
                [ l ]Department of Medicine and Clinical Pharmacology, Stanford University School of Medicine , Stanford, CA, USA
                [ m ]Department of Biostatistics, University of Liège , Liège, Wallonia, Belgium
                [ n ]WestRock Healthcare , Sion, Switzerland
                [ o ]HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University , New York, NY, USA
                [ p ]Division of HIV, ID and Global Medicine, Department of Medicine, University of California , San Francisco, CA, USA
                [ q ]Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine , Philadelphia, PA, USA
                [ r ]Division of AIDS Research, National Institute of Mental Health , Bethesda, MD, USA
                [ s ]Bill and Melinda Gates Foundation , Seattle, WA, USA
                [ t ]Department of Infectious diseases, University of Dakar , Dakar, Sénégal
                [ u ]The Arcady Group, LLC , Richmond, VA, USA
                [ v ]Department of HIV/AIDS, World Health Organization , Geneva, Switzerland
                [ w ]Faculty of Health Sciences, University of Ottawa , Ottawa, Ontario, Canada
                [ x ]Division of Infectious Diseases, Department of Medicine, University of British Columbia
                [ y ]Department of Epidemiology, University of Pittsburgh Graduate School of Public Health , Pittsburgh, PA, USA
                [ z ]Department of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda
                [ aa ]Columbia University School of Social Work & School of International and Public Affairs , New York, NY, USA
                [ ab ]Department of Health Research Methods, Evidence and Impact, McMaster University , Hamilton, Ontario, Canada
                [ ac ]HIV Care Research Program, Medical Research Council, Uganda Virus Research Institute , Entebbe, Uganda
                [ ad ]Division of HIV, Infectious Disease and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California , San Francisco, CA, USA
                [ ae ]Oregon Health & Sciences University-Portland State University School of Public Health , Portland, OR, USA
                Author notes
                [ § ] Corresponding author: Jessica E. Haberer, Global Health, Massachusetts General Hospital and Department of Medicine, Harvard Medication School , 125 Nashua Street, Suite 722, Boston, MA 02114, USA. Tel: +1-617-724-0351. jhaberer@ 123456mgh.harvard.edu
                Article
                1302678
                10.7448/IAS.20.1/21371
                5467606
                266f942d-dd50-46c9-b2f2-d99ae21adbd1
                © 2017 Haberer JE et al; licensee International AIDS Society.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 July 2016
                : 24 February 2017
                Page count
                Figures: 1, Tables: 2, References: 197, Pages: 16
                Categories
                Article
                Review Article

                Infectious disease & Microbiology
                hiv,antiretroviral therapy adherence,interventions,resource-limited settings

                Comments

                Comment on this article