EFFECTIVENESS OF PATIENT SUPPORT STRATEGIES FOR IMPROVING HAART ADHERENCE IN HIV-INFECTED INDIVIDUALS: A SYSTEMATIC REVIEW OF CONTROLLED TRIALS

Laura Park-Wyllie, Tony Antoniou, Ahmed Bayoumi, Richard Glazier
St Michael’s Hospital, Toronto, Ontario

Rationale: Near perfect medication adherence is required to derive maximal benefit from highly active antiretroviral treatment (HAART). Given the limited understanding of the impact of various patient support strategies on HAART adherence, as sytematic review addressing this question was performed.
Objectives: To determine whether patient support strategies improve medication adherence in HIV+ patients taking HAART when compared to usual care.
Methods: A search strategy reflecting the clinical question was developed incorporating the following inclusion criteria: (1) HIV patients, (2) HAART treatment approach, (3) Strategies to improve adherence, (4) Adherence Outcome, (5) Controlled studies. MEDLINE, CINAHL, HEALTHSTAR, EMBASE, PREMEDLINE, COCHRANE, International Pharmaceutical Abstracts and abstracts of conference proceedings were searched. A manual search of major HIV/AIDS journals was also performed. References from retrieved studies were reviewed to locate additional relevant studies. Studies published in abstract form were also considered for inclusion. Studies published in all languages were reviewed and translated if necessary. Experts were contacted to identify further studies. Study selection, quality assessments and data abstraction were performed independently by two reviewers.
Results: Seven studies were identified for data abstraction and quality assessment. In general, the studies were of poor quality and data abstraction was frequently limited by missing data. Two studies demonstrated improved adherence with the intervention. Two studies also showed a positive virologic effect at 16 and 48 weeks. A quantitative analysis (meta-analysis) was not possible as outcomes were reported differently from study to study. Therefore, the systematic review is presented descriptively.
Conclusions: The strength of the inferences that may be made from this systematic review are limited. Further study of the research question through controlled studies of sound methodologic design utilizing appropriate measures of adherence is needed. The authors of the primary studies are being contacted to obtain the necessary information to quantitatively combine the results.