Successful population-level antiretroviral therapy (ART) adherence will be required to end AIDS. Many still experience adherence challenges that may threaten virologic suppression. Supportive interventions have generally not been implemented at scale despite the importance of ART adherence. 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. The review 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. 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.
Tags: Amico, Bangsberg, Galárraga, Haberer, J Int AIDS Soc, Orrell, Resource-limited countries, Sabin, Tsai, meta-analysis
Full Citation: Haberer, J. E., Sabin, L., Amico, K. R., Orrell, C., Galárraga, O., Tsai, A. C., . . . Bangsberg, D. R. (2017). Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc, 20(1), 1-15. doi:10.7448/IAS.20.1.21371