Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies

Bärnighausen, Till; Chaiyachati, Krisda; Chimbindi, Natsayi; Peoples, Ashleigh; Haberer, Jessica; Newell, Marie-Louise

doi:10.1016/s1473-3099(11)70181-5

Cited by 246HIV/AIDS Research and InterventionsMedication Adherence and ComplianceMobile Health and mHealth Applications

Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies

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Bärnighausen, Till, Chaiyachati, Krisda, Chimbindi, Natsayi, Peoples, Ashleigh, Haberer, Jessica, Newell, Marie-Louise·2011·The Lancet Infectious Diseases

DOI 10.1016/s1473-3099(11)70181-5PMC PMC4250825

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Abstract

The success of potent antiretroviral treatment for HIV infection is primarily determined by adherence. We systematically review the evidence of effectiveness of interventions to increase adherence to antiretroviral treatment in sub-Saharan Africa. We identified 27 relevant reports from 26 studies of behavioural, cognitive, biological, structural, and combination interventions done between 2003 and 2010. Despite study diversity and limitations, evidence suggests that treatment supporters, directly observed therapy, mobile-phone text messages, diary cards, and food rations can effectively increase adherence in sub-Saharan Africa. However, some interventions are unlikely to have large or lasting effects, and others are effective only in specific settings. These findings emphasise the need for more research, particularly for randomised controlled trials, to examine the effect of context and specific features of intervention content on effectiveness. Future work should assess intervention targeting and selection of interventions based on behavioural theories relevant to sub-Saharan Africa.

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A systematic search for mHealth reviews in seven databases found several mHealth reviews that included aspects of monitoring such as adherence studies, behaviour change and attendance reminders.
“A systematic search for mHealth reviews in seven databases found several mHealth reviews that included aspects of monitoring such as adherence studies,17 behaviour change18 and attendance reminders.19 20”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [17]
Messages had more impact when they were linked with patient-health worker interaction.
“and messages had more impact when they were linked with patient–health worker interaction.17 27 49 51–53”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [17]
Weekly reminders worked better than daily reminders.
“For example, weekly reminders worked better than daily reminders”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [17]
Reviews have found variation in effect depending on how mechanisms were operationalised.
“Reviews have found variation in effect depending on how mechanisms were operationalised.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [17]

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Short- and Long-Term Efficacy of Modified Directly Observed Antiretroviral Treatment in Mombasa, Kenya: A Randomized Trial
Sarna, A., Luchters, S. M. F., Geibel, S., Chersich, M., Munyao, P., Kaai, S., Mandaliya, K. N., Shikely, K., Temmerman, M., & Rutenberg, N. (2008) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181806bf1 · Cited by 73 · see citing works
Association of Antiretroviral Therapy Adherence and Health Care Costs
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<i>Letter to the Editor:</i> Responding to the Human Resource Crisis: Peer Health Workers, Mobile Phones, and HIV Care in Rakai, Uganda.
Chang, L. W., Kagaayi, J., Nakigozi, G., Packer, A. H., Serwadda, D., Quinn, T. C., Gray, R. H., Bollinger, R. C., & Reynolds, S. J. (2008) · AIDS Patient Care and STDs · doi:10.1089/apc.2007.0234 · Cited by 68 · see citing works
Assessing the Viorologic and Adherence Benefits of Patient-Selected HIV Treatment Partners in a Resource-limited Setting
Taiwo, B., Idoko, J. A., Welty, L. J., Otoh, I., Job, G., Iyaji, P. G., Agbaji, O. O., Agaba, P. A., & Murphy, R. L. (2010) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/01.qai.0000371678.25873.1c · Cited by 67 · see citing works
Doubts about DOT: antiretroviral therapy for resource-poor countries
Liechty, C. A., & Bangsberg, D. R. (2003) · AIDS · doi:10.1097/00002030-200306130-00013 · Cited by 64 · see citing works
Association of aging and survival in a large HIV-infected cohort on antiretroviral therapy
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Modified Directly Observed Antiretroviral Therapy Compared With Self-administered Therapy in Treatment-Naïve HIV-1–Infected Patients
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Adherence without access to antiretroviral therapy in sub-Saharan Africa?
Bangsberg, D. R., Ware, N. C., & Simoni, J. M. (2005) · AIDS · doi:10.1097/01.aids.0000196168.50303.31 · Cited by 37 · see citing works
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Kouanfack, C., Laurent, C., Peytavin, G., Ciaffi, L., Ngolle, M., Mawamba, Y. N., Essomba, C. N., Calmy, A., Mpoudi‐Ngolé, E., Delaporte, É., et al. (2008) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181743955 · Cited by 31 · see citing works
Validating Five Questions of Antiretroviral Nonadherence in a Public-Sector Treatment Program in Rural South Africa
Chaiyachati, K. H., Hirschhorn, L. R., Tanser, F. C., Newell, M., & Bärnighausen, T. (2011) · AIDS Patient Care and STDs · doi:10.1089/apc.2010.0257 · Cited by 30 · see citing works
Self-citation
Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: the use of community treatment support can be effective
Idoko, J. A., Agbaji, O. O., Agaba, P. A., Akolo, C., Inuwa, B., Hassan, Z., Akintunde, L., Badung, B., Muazu, M., Danang, M., et al. (2007) · International Journal of STD & AIDS · doi:10.1258/095646207782212252 · Cited by 30 · see citing works
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Stubbs, B. A., Micek, M. A., Pfeiffer, J. T., Montoya, P., & Gloyd, S. S. (2009) · AIDS Care · doi:10.1080/09540120902814395 · Cited by 30 · see citing works
Results of an Antiretroviral Adherence Intervention: STAR (Staying Healthy: Taking Antiretrovirals Regularly)
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Involving Behavioral Scientists, Health Care Providers, and HIV-Infected Patients as Collaborators in Theory-Based HIV Prevention and Antiretroviral Adherence Interventions
Fisher, J. D., Cornman, D. H., Norton, W. E., & Fisher, W. A. (2006) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/01.qai.0000248335.90190.f9 · Cited by 23 · see citing works
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Thurman, T. R., Haas, L. J., Dushimimana, A., Lavin, B. C., & Mock, N. B. (2010) · AIDS Care · doi:10.1080/09540120903443376 · Cited by 18 · see citing works
Access to antiretroviral treatment in the developing world: a framework, review and health systems research agenda
Bärnighausen, T. (2007) · Cited by 17 · see citing works
Self-citation
Low ART adherence in Africa
Wakabi, W. (2008) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(08)70010-0 · Cited by 16 · see citing works
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HIV and tuberculosis in Durban, South Africa: adherence to two medication regimens
Corless, I. B., Wantland, D. J., Bhengu, B., McInerney, P. A., Ncama, B. P., Nicholas, P. K., McGibbon, C. A., Wong, E. B., & Davis, S. (2009) · AIDS Care · doi:10.1080/09540120902729932 · Cited by 14 · see citing works
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Adherence to HIV antiretroviral therapy Part II: which interventions are effective in improving adherence?
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Modified directly observed therapy to improve HIV treatment outcomes: Little impact with potent, once-daily therapy in unselected antiretroviral-naïve patients
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Impact of an Adherence Program on the Health and Outlook of HIV-Infected Patients Failing Antiretroviral Therapy
Parry, M. F., Wright, P. E., Stewart, J., McLeod, G. X., Tucker, J. B., & Weinberg, A. R. (2005) · Journal of the International Association of Physicians in AIDS Care · doi:10.1177/1545109705281897 · Cited by 6 · see citing works
Comparing Clinic Retention Between Residents and Nonresidents of Kibera, Kenya
Chung, M. H., Kohler, P. K., Attwa, M., Thiga, J. W., & John-Stewart, G. C. (2010) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181b32bd6 · Cited by 6 · see citing works
Adherence And Plasma Drug Concentrations Are Predictors of Confirmed Virologic Response after 24-Week Salvage Highly Active Antiretroviral Therapy
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La thérapie sous observation directe (DOT): de la tuberculose au VIH
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Diary cards: Preliminary evaluation of an intervention tool for improving adherence to antiretroviral therapy and TB preventive therapy in people living with HIV/AIDS
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Flagged first, then by citations

Research works printed but not linked: 10

[49]Conference on Retroviruses and Opportunistic Infections (CROI) 2010 Available from: http://retroconference.org/2010/display.asp?page=181 27 January 2010
[51]International Conference on HIV Treatment Adherence 2010 Available from: http://www.iapac.org/AdherenceConference/AdherenceConf2008-info.html 27 January 2010
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[78]Udo DU Itah A Udofia UA The Lutheran AIDS Research Unit. Promoting ART adherence and compliance through family and peer group support initiative. 2007 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention Sydney, Australia 22-25 July 2007
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[85]Nachega J Goliath R Efron A Chaudhary M Ram M Morroni C Randomized trial of trained patient-nominated treatment supporters providing partial directly observed ART in South African adults initiating HIV therapy. 2009 Conference on Retroviruses and Opportunistic Infections (CROI) Montréal, Canada February 8-11, 2009 2009
[88]Chung M Benki-Nugent S Richardson B Nguti R Simoni J Overbaugh J Randomized controlled trial comparing educational counseling and alarm device on adherence to antiretretroviral medications in Nairobi, Kenya: over 18 months follow-up. 2009 4th International Conference on HIV Treatment Adherence Miami, Florida 5-7 April 2009 2009
[96]van Loggerenberg F Murrman M Naidoo K Abdool Karim SS Grant A CAPRISA 058: Development of an Enhanced Adherence Support Programme (EASP) for Highly Active Antiretroviral Therapy (HAART) in Durban, South Africa. 2008 3rd Internationational Conference on HIV Treatment Adherence Jersey City, New Jersey March 17-18 2008
[113]Amico KR Harman JJ O'Grady M Johnson B Research synthesis of ART adherence interventions: A synthesis of published adherence intervention outcomes research from 1996 to September. 4th Annual HIV Treatment Adherence Conference of the International Association of Providers in AIDS Care Miami, FL 2009

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Self-citation
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“In addition to the historical bias towards enrolment of symptomatic patients, mentioned previously, our mortality estimates do not take into account potential future reductions in mortality that may occur as new drugs and salvage regimens [48] and innovations in patient management are introduced [49].”
Background
Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials
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“A number of reviews support the efficacy of behavioral interventions to promote ART adherence [14–16], yet these interventions have diverse approaches and variable financial costs.”
Background
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Sullivan, P. S., Carballo‐Diéguez, A., Coates, T. J., Goodreau, S. M., McGowan, I., Sanders, E. J., Smith, A. D., Goswami, P., & Sánchez, J. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60955-6 · Cited by 377 · see citing works
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“Many of our findings related to ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women are similar to those reported for people living with HIV (PLHIV) more broadly, including enablers such as social support [64,65] and barriers such as fear of disclosure and stigma, lack of knowledge…”
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Background
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“Interventions involving affective approaches Interventions classified as ‘‘affective’’ aim at improving ART adherence through emotional support [211,234] and include the use of psychotherapy or antidepressant medication.”
Background
A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS
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“For example, food supplementation programs in Zambia and Haiti demonstrated that food assistance improves a range of clinical outcomes, including adherence to ART [94–97].”
Background
Quasi-experimental study designs series—paper 4: uses and value
Bärnighausen, T., Tugwell, P., Røttingen, J., Shemilt, I., Rockers, P. C., Geldsetzer, P., Lavis, J. N., Grimshaw, J., Daniels, K., Brown, A. N., et al. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.03.012 · Cited by 243 · see citing works
“RCTs in health research commonly assess causal intervention effects over a time horizon of only a few years For instance, the vast majority of the more than 100 RCTs that have tested interventions to enhance adherence to HIV anti-retroviral treatment ran for five years or less and focused on clinical proxy indicators…”
BackgroundSelf-citation
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Background
How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts
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“Food rations and livelihood support may be combined with other support services shown to improve adherence, such as treatment supporters, directly observed therapy, mobilephone text messages, and diary cards [70], and such comprehensive treatment-support programs have been shown to increase ART adherence and retention…”
Background
Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa
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“observational and more randomised control trials (RCT) are required [184].”
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“As a result, improving food security may be an effective way to support HIV treatment adherence and retention in care [10,11], and international organizations have begun to integrate food, nutrition, and HIV/AIDS care initiatives [12–15].”
Background
Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature
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“Treatment strategies that include interventions designed to remove social and/or economic obstacles to care have been associated with improved ART adherence and HIVrelated health outcomes [13, 14].”
Background
Improving Adherence to Antiretroviral Therapy with Triggered Real Time Text Message Reminders: the China through Technology Study (CATS)
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Self-citation
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“[74] This study reviews 26 studies of ART adherence– enhancing interventions in sub-Saharan Africa, including mobile phone text messages for ART adherence Mobile phone text messages significantly improved ART adherence in two large, well conducted controlled trials”
BackgroundSelf-citation
Interventions to promote adherence to antiretroviral therapy in Africa: A network meta-analysis
Mills, E., Lester, R., Thorlund, K., Lorenzi, M., Muldoon, K., Kanters, S., Linnemayr, S., Gross, R., Calderone, Y., Amico, K. R., et al. (2014) · The Lancet HIV · doi:10.1016/s2352-3018(14)00003-4 · Cited by 122 · see citing works
Self-citation
M-health for health behaviour change in resource-limited settings: applications to HIV care and beyond
Thirumurthy, H., & Lester, R. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.11.099317 · Cited by 109 · see citing works
Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies
Mbuagbaw, L., Sivaramalingam, B., Navarro, T., Hobson, N., Keepanasseril, A., Wilczynski, N. J., & Haynes, R. B. (2015) · AIDS Patients Care and STDs · doi:10.1089/apc.2014.0308 · Cited by 116 · see citing works
mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones
Devi, B. R., Syed-Abdul, S., Kumar, A., Iqbal, U., Nguyen, P.-A., Li, Y.-C. (., & Jian, W.-S. (2015) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2015.08.003 · Cited by 110 · see citing works
“[13] T.”
Background
A Randomized Controlled Trial of Real-Time Electronic Adherence Monitoring With Text Message Dosing Reminders in People Starting First-Line Antiretroviral Therapy
Orrell, C., Cohen, K., Mauff, K., Bangsberg, D., Maartens, G., & Wood, R. (2015) · Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000770 · Cited by 96 · see citing works
A Side Door Into Care Cascade for HIV-Infected Patients?
Hallett, T. B., & Eaton, J. W. (2013) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e318298721b · Cited by 100 · see citing works
Patching a leaky pipe
Kilmarx, P. H., & Mutasa‐Apollo, T. (2012) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0b013e32835b806e · Cited by 97 · see citing works
Pharmacy refill adherence outperforms self-reported methods in predicting HIV therapy outcome in resource-limited settings
Sangeda, R. Z., Mosha, F. S., Prosperi, M., Aboud, S., Vercauteren, J., Camacho, R. J., Lyamuya, E., Wijngaerden, E. V., & Vandamme, A. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-1035 · Cited by 96 · see citing works
“Strategies to measure adherence to ART include the Medication Event Monitoring System (MEMS), pharmacy refill records, pill count, appointment keeping, adherence diaries, and interviewer-administered or self-report questionnaires [10-13].”
Method
Are Thai MSM Willing to Take PrEP for HIV Prevention? An Analysis of Attitudes, Preferences and Acceptance
Wheelock, A., Eisingerich, A. B., Ananworanich, J., Gomez, G. B., Hallett, T. B., Dybul, M. R., & Piot, P. K. (2013) · PLoS ONE · doi:10.1371/journal.pone.0054288 · Cited by 95 · see citing works
Mobility and its Effects on HIV Acquisition and Treatment Engagement: Recent Theoretical and Empirical Advances
Camlin, C. S., & Charlebois, E. D. (2019) · Current HIV/AIDS Reports · doi:10.1007/s11904-019-00457-2 · Cited by 94 · see citing works
Adherence to HIV postexposure prophylaxis
Ford, N. P., Irvine, C., Shubber, Z., Baggaley, R. C., Beanland, R. L., Vitória, M., Doherty, M. C., Mills, E. J., & Calmy, A. (2014) · AIDS · doi:10.1097/qad.0000000000000505 · Cited by 94 · see citing works
“Although further studies are needed to evaluate adherence support interventions specifically for PEP, promising interventions may be found in the HIV treatment adherence literature, including treatment supporters, mobile phone messaging, and the use of fixed-dose combinations [19,20].”
Background
Patient satisfaction with HIV and TB treatment in a public programme in rural KwaZulu-Natal: evidence from patient-exit interviews
Chimbindi, N., Bärnighausen, T., & Newell, M. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-32 · Cited by 94 · see citing works
“Patients’ ability to freely talk about missed doses or their problems with their healthcare provider is important for improving treatment outcomes and adherence which are essential for the full treatment benefits for both HIV and TB to be realized [52,53].”
BackgroundSelf-citation
Migration and risk of HIV acquisition in Rakai, Uganda: a population-based cohort study
Olawore, O., Tobian, A. A. R., Kagaayi, J., Bazaale, J. M., Nantume, B. S., Kigozi, G. N., Nankinga, J., Nalugoda, F. K., Nakigozi, G. F., Kigozi, G., et al. (2018) · The Lancet HIV · doi:10.1016/s2352-3018(18)30009-2 · Cited by 94 · see citing works
Combination Prevention: New Hope for Stopping the Epidemic
Vermund, S. H., & Hayes, R. (2013) · Current HIV/AIDS Reports · doi:10.1007/s11904-013-0155-y · Cited by 94 · see citing works
“In studies designed to enhance adherence to ART, for example, the impact of behavioral interventions has often be very contextual or transient [160].”
Background
Adherence to antiretroviral therapy for HIV in sub‐Saharan Africa and Asia: a comparative analysis of two regional cohorts
Bijker, R., Jiamsakul, A., Kityo, C. M., Kiertiburanakul, S., Siwale, M., Phanuphak, P., Akanmu, S. A., Chaiwarith, R., Wit, F. W. N. M., Sim, B. L. H., et al. (2017) · Journal of the International AIDS Society · doi:10.7448/ias.20.1.21218 · Cited by 93 · see citing works
Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda
Bermudez, L. G., Ssewamala, F. M., Neilands, T. B., Lu, L. Z. N., Mayo‐Wilson, L. J., Nakigozi, G. F., Mellins, C. A., McKay, M. M., & Mukasa, M. N. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2173-7 · Cited by 89 · see citing works
“The ten percent increase in participants with viral suppression falls at the lower-middle range of outcome effects for adherence interventions in Sub-Saharan Africa [40].”
Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia
Denison, J., Koole, O., Tsui, S., Menten, J., Torpey, K., van Praag, E., Mukadi, Y., Colebunders, R., Auld, A., Agolory, S., et al. (2015) · AIDS (London) · doi:10.1097/qad.0000000000000543 · Cited by 86 · see citing works
“Similar to previous studies, the adherence estimates varied greatly with the 3 and 30-day aggregate questions generating the lowest estimates of missed ART [42] and corresponding poorly with virologic failure.”
The future of HIV pre-exposure prophylaxis adherence: reducing barriers and increasing opportunities
Haberer, J. E., Mujugira, A., & Mayer, K. H. (2023) · The Lancet HIV · doi:10.1016/s2352-3018(23)00079-6 · Cited by 81 · see citing works
Self-citation
Systematic review and meta‐analysis: Patient and programme impact of fixed‐dose combination antiretroviral therapy
Ramjan, R., Calmy, A., Vitória, M., Mills, E. J., Hill, A. M., Cooke, G., & Ford, N. P. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12297 · Cited by 77 · see citing works
The Nucleoside Reverse Transcriptase Inhibitors, Nonnucleoside Reverse Transcriptase Inhibitors, and Protease Inhibitors in the Treatment of HIV Infections (AIDS)
Clercq, E. D. (2013) · Advances in pharmacology · doi:10.1016/b978-0-12-405880-4.00009-3 · Cited by 76 · see citing works
“The success of antiretroviral treatment (ART) for HIV infection is primarily determined by adherence (Bärnighausen et al., 2011).”
Background
Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa
Bor, J. H., Fox, M. P., Rosen, S. B., Venkataramani, A. S., Tanser, F. C., Pillay, D., & Bärnighausen, T. (2017) · PLoS Medicine · doi:10.1371/journal.pmed.1002463 · Cited by 72 · see citing works
Self-citation
Interactive Two-Way mHealth Interventions for Improving Medication Adherence: An Evaluation Using The Behaviour Change Wheel Framework
Chiang, N. Y. Z., Guo, M., Amico, K. R., Atkins, L., & Lester, R. T. (2018) · JMIR mhealth and uhealth · doi:10.2196/mhealth.9187 · Cited by 72 · see citing works
“Adherence to antiretroviral therapy (ART) for people living with HIV combats chronic infection through viral suppression, optimizes an individual’s immune recovery, mitigates drug resistance, and reduces odds of viral transmission [2-4].”
Facilitators and barriers to antiretroviral therapy adherence among HIV-positive adolescents living in Tanzania
Audi, C., Jahanpour, O. F., Antelman, G., Guay, L. A., Rutaihwa, M., van de Ven, R., Woelk, G. B., & Baird, S. (2021) · BMC Public Health · doi:10.1186/s12889-021-12323-1 · Cited by 70 · see citing works
Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda
Russell, S., Martin, F., Zalwango, F., Namukwaya, S., Nalugya, R., Muhumuza, R., Katongole, J., & Seeley, J. (2016) · PLoS ONE · doi:10.1371/journal.pone.0147896 · Cited by 65 · see citing works
Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy
Krumme, A. A., Kaigamba, F., Binagwaho, A., Murray, M. B., Rich, M., & Franke, M. F. (2014) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2014-204494 · Cited by 64 · see citing works
Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence
Ma, Q., Tso, L. S., Rich, Z. C., Hall, B. J., Beanland, R. L., Li, H., Lackey, M. J., Hu, F., Cai, W., Doherty, M. C., et al. (2016) · Journal of the International AIDS Society · doi:10.7448/ias.19.1.21166 · Cited by 64 · see citing works
“PLHIV empowerment could have significant implications for health equity and was not previously evaluated by quantitative adherence reviews [2,10,11], although other reviews noted the potential for empowerment as a result of interventions [13,61,62].”
Result
Predicting adherence to combination antiretroviral therapy for HIV in Tanzania: A test of an extended theory of planned behaviour model
Banas, K., Lyimo, R. A., Hospers, H. J., van der Ven, A. J. A. M., & de Bruin, M. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1283037 · Cited by 63 · see citing works
“A recent systematic review (Bärnighausen et al., 2011) identified 26 adherenceenhancing interventions in SSA evaluated between 2003 and 2010.”
Background
Tailored Nutrition Education and Food Assistance Improve Adherence to HIV Antiretroviral Therapy: Evidence from Honduras
Martı́nez, H., Palar, K., Linnemayr, S., Smith, A. C., Derose, K. P., Ramírez, B., Farías, H., & Wagner, G. J. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0786-z · Cited by 62 · see citing works
“Individual or household food aid is among the evidencebased strategies to improve adherence [9, 10].”
Background
High-Levels of Acquired Drug Resistance in Adult Patients Failing First-Line Antiretroviral Therapy in a Rural HIV Treatment Programme in KwaZulu-Natal, South Africa
Manasa, J., Lessells, R. J., Skingsley, A., Naidu, K., Newell, M., McGrath, N. M., de Oliveira, T., & the Southern African Treatment and Resistance Network (SATuRN) (2013) · PLoS ONE · doi:10.1371/journal.pone.0072152 · Cited by 60 · see citing works
“There are also few adherence interventions of proven efficacy and so health care workers can find it difficult not only to identify but also to address adherence problems [56].”
BackgroundSelf-citation
HIV Treatment as Prevention: Issues in Economic Evaluation
Bärnighausen, T., Salomon, J. A., & Sangrujee, N. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001263 · Cited by 59 · see citing works
“, community-based treatment supporters or mobile-phone short messages to ensure good ART retention and adherence [19].”
BackgroundSelf-citation
Psychosocial Predictors of Non-Adherence and Treatment Failure in a Large Scale Multi-National Trial of Antiretroviral Therapy for HIV: Data from the ACTG A5175/PEARLS Trial
Safren, S. A., Biello, K. B., Smeaton, L. M., Mimiaga, M. J., Walawander, A., Lama, J. R., Rana, A., Nyirenda, M., Kayoyo, V., Samaneka, W. P., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104178 · Cited by 53 · see citing works
Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention
Tucker, J. D., Tso, L. S., Hall, B. J., Ma, Q., Beanland, R. L., Best, J., Li, H., Lackey, M. J., Marley, G., Rich, Z. C., et al. (2017) · EBioMedicine · doi:10.1016/j.ebiom.2017.01.036 · Cited by 53 · see citing works
“This local social context is not captured in quantitative reviews of HIV interventions (Govindasamy et al., 2012; Govindasamy et al., 2014; Barnighausen et al., 2011; Mills et al., 2006; Ortego et al., 2011; Okeke et al., 2014).”
BackgroundResultInfluential
Systematic review of interventions aimed at improving HIV adherence to care in low- and middle-income countries in Sub-Saharan Africa
Pugh, L., Roberts, J. S., Viswasam, N., Hahn, E., Ryan, S., Turpin, G., Lyons, C. E., Baral, S., & Hansoti, B. (2022) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2022.08.012 · Cited by 52 · see citing works
Prevalence and Predictors of Immunological Failure among HIV Patients on HAART in Southern Ethiopia
Yirdaw, K. D., & Hattingh, S. (2015) · PLoS ONE · doi:10.1371/journal.pone.0125826 · Cited by 52 · see citing works
Sustaining the future of HIV counselling to reach 90‐90‐90: a regional country analysis
Bemelmans, M., Baert, S., Negussie, E. K., Bygrave, H., Biot, M., Jamet, C., Ellman, T., Banda, A., van den Akker, T., & Ford, N. P. (2016) · Journal of the International AIDS Society · doi:10.7448/ias.19.1.20751 · Cited by 52 · see citing works
HIV/AIDS Competent Households: Interaction between a Health-Enabling Environment and Community-Based Treatment Adherence Support for People Living with HIV/AIDS in South Africa
Masquillier, C., Wouters, E., Mortelmans, D., van Wyk, B. E., Hausler, H., & Damme, W. V. (2016) · PLoS ONE · doi:10.1371/journal.pone.0151379 · Cited by 50 · see citing works
Prospects for HIV control in South Africa: a model-based analysis
Johnson, L., Chiu, C., Myer, L., Davies, M., Dorrington, R., Bekker, L., Boulle, A., & Meyer-Rath, G. (2016) · Global Health Action · doi:10.3402/gha.v9.30314 · Cited by 51 · see citing works
High Loss to Followup and Early Mortality Create Substantial Reduction in Patient Retention at Antiretroviral Treatment Program in North-West Ethiopia
Wubshet, M., Berhane, Y., Worku, A., Kebede, Y., & Diro, E. (2012) · ISRN AIDS · doi:10.5402/2012/721720 · Cited by 49 · see citing works
“As a result, much attention has focused on patient day-to-day adherence to antiretroviral medications [10].”
Background
Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva
Bere, T. C., Nyamayaro, P. C., Magidson, J. F., Chibanda, D., Chingono, A., Munjoma, R., Macpherson, K., Ndhlovu, C. E., O’Cleirigh, C. M., Kidia, K. K., et al. (2016) · Journal of Health Psychology · doi:10.1177/1359105315626783 · Cited by 49 · see citing works
“In this phase, we reviewed systematic reviews of evidence-based interventions for adherence (Barnighausen et al., 2011; CDC, 2015; Rueda et al., 2006; Thompson et al., 2012).”
Method
Poor Diet Quality Is Associated With Low CD4 Count and Anemia and Predicts Mortality Among Antiretroviral Therapy–Naive HIV-Positive Adults in Uganda
Rawat, R., McCoy, S. I., & Kadiyala, S. (2012) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3182797363 · Cited by 48 · see citing works
Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis
Gesesew, H. A., Ward, P., Hajito, K. W., Feyissa, G. T., Mohammadi, L., & Mwanri, L. (2017) · PLoS ONE · doi:10.1371/journal.pone.0169651 · Cited by 48 · see citing works
Simplifying switch to second-line antiretroviral therapy in sub Saharan Africa
Shroufi, A., Cutsem, G. V., Cambiano, V., Bansi‐Matharu, L., Duncan, K., Murphy, R. A., Maman, D., & Phillips, A. N. (2019) · AIDS · doi:10.1097/qad.0000000000002234 · Cited by 47 · see citing works
“In terms of achieving sufficient adherence, while there is evidence to support counselling for adherence at the time of ART initiation [67], by the time a person previously suppressed on ART presents with a high viral load it is much less certain whether the intervention will be useful and whether any resuppression ac…”
Background
Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review
Damulak, P. P., Ismail, S., Manaf, R. A., Said, S. M., & Agbaji, O. O. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052477 · Cited by 50 · see citing works
“Interventions that are capital or resource-intensive may unlikely be conducted in SSA due to limited resources [18].”
BackgroundMethodInfluential
Virological Failure and Drug Resistance in Patients on Antiretroviral Therapy After Treatment Interruption in Lilongwe, Malawi
Luebbert, J., Tweya, H. M., Phiri, S., Chaweza, T., Mwafilaso, J., Hosseinipour, M. C., Ramroth, H., Schnitzler, P., & Neuhann, F. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis438 · Cited by 46 · see citing works
“Effective ART for patients living with human immunodeficiency virus (HIV) is primarily determined by drug adherence [3].”
Background
mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review
Anstey Watkins, J., Goudge, J., Gómez-Olivé, F. X., Huxley, C., Dodd, K., & Griffiths, F. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2017-000543 · Cited by 45 · see citing works
Feasibility and acceptability of mobile phone short message service as a support for patients receiving antiretroviral therapy in rural Uganda: a cross-sectional study
Kim, J., Zhang, W. W., Nyonyitono, M., Lourenço, L., Nanfuka, M., Okoboi, S., Birungi, J., Lester, R., Kaleebu, P., Munderi, P., et al. (2015) · Journal of the International AIDS Society · doi:10.7448/ias.18.1.20311 · Cited by 22 · see citing works
“Several methods have been proposed and implemented to support ART adherence in resource-limited settings by healthcare providers, including directly observed therapy, treatment supporters (providing different forms of support such as psychosocial support or HIV/ARTeducation), and availability of education and counsell…”
Method
Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: Results from a randomized trial
Peltzer, K., Ramlagan, S., Jones, D. L., Weiss, S. M., Fomundam, H., & Chanetsa, L. (2012) · SAHARA-J Journal of Social Aspects of HIV/AIDS · doi:10.1080/17290376.2012.745640 · Cited by 45 · see citing works
“Improved adherence might not persist over time, as found in some trials in Africa where a significant intervention effect in the first 6 months of the trial was not sustained in later phases (Bärnighausen et al. 2011).”
BackgroundResultInfluential
Retention in care prior to antiretroviral treatment eligibility in sub-Saharan Africa: a systematic review of the literature
Plazy, M., Orne‐Gliemann, J., Dabis, F., & Dray‐Spira, R. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-006927 · Cited by 45 · see citing works
“To date, several interventions have targeted the improvement of ART adherence, for example, reminder services (such as mobile phones, text messaging and diary cards)(29) 30 and treatment supporters.(30) These interventions should now be adapted for improving retention in pre-ART care, and especially before ART eligibi…”
Background
A peer adherence support intervention to improve the antiretroviral treatment outcomes of HIV patients in South Africa: The moderating role of family dynamics
Wouters, E., Masquillier, C., Ponnet, K. S., & Booysen, F. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.05.020 · Cited by 45 · see citing works
“Despite a general positive trend, reviews of the growing number of impact evaluations of community-based peer adherence support programmes highlight the considerable variability in the effectiveness of such support in improving ART outcomes, ranging from non-significant effects to improvements of 20% and more (Bärnigh…”
BackgroundResultInfluential
The Impact of Community Support Initiatives on the Stigma Experienced by People Living with HIV/AIDS in South Africa
Masquillier, C., Wouters, E., Mortelmans, D., & Booysen, F. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0865-1 · Cited by 41 · see citing works
“[31] and by Wouters et al.”
A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy
Phillips, T. K., Brittain, K., Mellins, C. A., Zerbe, A., Remien, R. H., Abrams, E. J., Myer, L., & Wilson, I. B. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1448-0 · Cited by 42 · see citing works
Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study
Bucciardini, R., Fragola, V., Abegaz, T., Lucattini, S., Halifom, A., Tadesse, E., Berhe, M., Pugliese, K., Binelli, A., Castro, P. D., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0136117 · Cited by 41 · see citing works
Adult antiretroviral therapy guidelines 2014
Meintjes, G. (2014) · Southern African Journal of HIV Medicine · doi:10.4102/sajhivmed.v15i4.330 · Cited by 41 · see citing works
HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment
Leon, C., Koosed, T., Philibert, B., Raposo, C., & Benzaken, A. S. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4062-9 · Cited by 41 · see citing works
“In regard to communication with health professionals, other studies have also found the quality of communication with health staff to affect patient satisfaction [18] and adherence to treatment [38, 39].”
Background
A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention
Tomori, C., Risher, K., Limaye, R. J., Lith, L. M. V., Gibbs, S., Smelyanskaya, M., & Celentano, D. D. (2014) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000239 · Cited by 40 · see citing works
“After an individual has initiated therapy, other formidable barriers arise, as many struggle with taking prescribed medications and must overcome the challenges of taking medications with potentially serious side effects each day for the rest of their lives, in the face of substantial barriers of supply disruptions, o…”
Background
Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteria
Pefura-Yone, E. W., Soh, E., Kengne, A. P., Balkissou, A. D., & Kuaban, C. (2013) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2013.02.003 · Cited by 40 · see citing works
Early access to antiretroviral therapy versus standard of care among HIV-positive participants in eswatini in the public health sector: the MaxART stepped-wedge randomized controlled trial
Khan, S., Spiegelman, D., Walsh, F., Mazibuko, S., Pasipamire, M., Chai, B., Reis, R., Mlambo, K., Delva, W., Khumalo, G., et al. (2020) · Journal of the International AIDS Society · doi:10.1002/jia2.25610 · Cited by 32 · see citing works
“As countries implement ART scale-up programmes, there is also a need for policies and interventions to sustain long-term retention and viral suppression rates, such as increased access to viral monitoring for all participants, mobile phone text messages for appointment reminders and VL result delivery, and others [32-…”
BackgroundSelf-citation
The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review
Grangeiro, A., Ferraz, D., Calazans, G. J., Zucchi, E. M., & Bermúdez, X. P. D. (2015) · Revista Brasileira de Epidemiologia · doi:10.1590/1809-4503201500050005 · Cited by 39 · see citing works
Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1
Mbuagbaw, L. C. E., Hajizadeh, A., Wang, A. R., Mertz, D., Lawson, D. O., Smieja, M., Benoit, A. C., Álvarez, E., Ritchie, L. M. P., Rachlis, B., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-034793 · Cited by 38 · see citing works
Effectiveness of mobile phone text message reminder interventions to improve adherence to antiretroviral therapy among adolescents living with HIV: A systematic review and meta-analysis
Mehra, N., Tunje, A., Hallström, I., & Jerene, D. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254890 · Cited by 38 · see citing works
Mobile Phone-Based Antiretroviral Adherence Support in Vietnam: Feasibility, Patient’s Preference, and Willingness-to-Pay
Tran, B. X., & Houston, S. C. (2012) · AIDS and Behavior · doi:10.1007/s10461-012-0271-5 · Cited by 37 · see citing works
“[2] showed that potential interventions on ART adherence in sub-Saharan Africa include treatment supporters, directly observed therapy, diary cards, food rations, and mobile phone text messages.”
Background
Are social support and HIV coping strategies associated with lower depression in adults on antiretroviral treatment? Evidence from rural KwaZulu-Natal, South Africa
Yeji, F., Klipstein‐Grobusch, K., Newell, M., Hirschhorn, L. R., Hosegood, V., & Bärnighausen, T. (2014) · AIDS Care · doi:10.1080/09540121.2014.931561 · Cited by 37 · see citing works
“Further research needs to establish whether social support and particular coping strategies do indeed decrease depression, e.g., in intervention studies enhancing behaviours that promote social support and effective coping (Bärnighausen et al., 2011).”
BackgroundSelf-citation
Leveraging the lessons learned from HIV/AIDS for coordinated chronic care delivery in resource-poor settings
Gupta, N., & Bukhman, G. (2015) · Healthcare · doi:10.1016/j.hjdsi.2015.09.006 · Cited by 37 · see citing works
“Strategies to maximize adherence to ART have been diverse, and outcomes have been mixed, with the use of treatment supporters, directly observed therapy, mobile phone text messages, diary cards, and food rations having demonstrated significant positive effect on treatment adherence in particular settings.(30) The use…”
Understanding Antiretroviral Treatment Adherence Among HIV-Positive Women at Four Postpartum Time Intervals: Qualitative Results from the Kabeho Study in Rwanda
Gill, M. M., Umutoni, A., Hoffman, H. J., Ndatimana, D., Ndayisaba, G., Kibitenga, S., Mugwaneza, P., Asiimwe, A., & Bobrow, E. (2017) · AIDS Patient Care and STDs · doi:10.1089/apc.2016.0234 · Cited by 37 · see citing works
“In a systematic review, treatment supporters (as friends, family, community health workers, or PLHIV) were found to significantly improve adherence in intervention versus comparison groups.(18) Another study from Rwanda found that being part of a support group for PLHIV led to increased HIV-free survival of their chil…”
Urine Tenofovir Concentrations Correlate With Plasma and Relate to Tenofovir Disoproxil Fumarate Adherence: A Randomized, Directly Observed Pharmacokinetic Trial (TARGET Study)
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“Systematic reviews of all interventions that target ART nonadherence suggested that SMS interventions have one of the strongest levels of supportive evidence.([6,8]) Independently conducted systematic reviews of RCTs on SMS-based adherence interventions concluded that weekly delivered reminders and SMS-based interacti…”
Background
Virtual Intervention to Support Self-Management of Antiretroviral Therapy Among People Living With HIV
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“Moreover, recent reviews [7,8] have suggested that ICT-assisted interventions, such as sending text messages via mobile phone, had the potential to increase treatment adherence in sub-Saharan Africa.”
Interventions to improve the performance of HIV health systems for treatment-as-prevention in sub-Saharan Africa: the experimental evidence
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Self-citation
Antiretroviral Therapy Adherence Support
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Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review
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Can Digital Health Interventions Improve Adherence to Antiretroviral (ART) for Patients Living with HIV/AIDS in Sub-Saharan Africa? Systematic Review
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Interventions to improve adherence to antiretroviral therapy
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Self-citation

Authors: Bärnighausen, T., Chaiyachati, K., Chimbindi, N., Peoples, A., Haberer, J., & Newell, M.-L.
Affiliations: Harvard University (US)
University of KwaZulu-Natal (ZA)
University of Michigan (US)
Massachusetts General Hospital (US)
University College London (GB)
Corresponding author: Bärnighausen, Till
ORCID: Bärnighausen, Till
Chaiyachati, Krisda
Chimbindi, Natsayi
Peoples, Ashleigh
Haberer, Jessica
Newell, Marie-Louise
Venue: The Lancet Infectious Diseases
Publisher: Elsevier BV
Published: 2011-12
Volume: 11
Issue: 12
Pages: 942-951
ISSN: 1473-3099 (ISSN-L)
DOI: 10.1016/s1473-3099(11)70181-5
PMC: PMC4250825
OpenAlex: W2098160568
Cited by: 246
References: 107
Citations by year: 2026: 4 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 14 · 2019: 15 · 2018: 19 · 2017: 17 · 2016: 24 · 2015: 29 · 2014: 33 · 2013: 26 · 2012: 29
FWCI: 3.62
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Wellcome Trust
U.S. Public Health Service (K-23 087228, 1R01MG083539-01)
National Institute of Child Health and Human Development
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD058482, 1R01-HD058482- 01)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords: antiretroviral therapy adherence, HIV, adherence interventions, treatment supporters, directly observed therapy, text messaging, rations, sub-Saharan Africa, behavioral interventions, intervention effectiveness
MeSH terms: Assessment of Medication Adherence, Humans, HIV Infections, Drug Monitoring, Outcome Assessment, Health Care, Africa South of the Sahara, Antiretroviral Therapy, Highly Active, Medication Adherence

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Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies

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