The DOI matches its Crossref record; 113 of the 113 references it cites were found in a registry or an index.
Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies
Open accessAbstract
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,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]
In the citing paper
“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]
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“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]
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“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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Antiretroviral therapy requires life-long adherence
de Pee, S., Grede, N., Forsythe, M., & Bloem, M. W. (2012) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(12)70170-6 · Cited by 5
A decade of researching the social aspects of HIV and AIDS
Doyal, L. (2014) · The Lancet · doi:10.1016/s0140-6736(14)62362-x · Cited by 4
Managing Tuberculosis and Occupational Health in the Mining Sector in Southern Africa
Osewe, P. L., & Nkrumah, Y. K. (2018) · World Bank, Washington, DC eBooks · doi:10.1596/30161 · Cited by 4
Tymejczyk, O., Vo, Q., Kulkarni, S., Antelman, G., Boshe, J., Reidy, W. J., Parcesepe, A. M., Nash, D., & Elul, B. (2019) · AIDS Care · doi:10.1080/09540121.2019.1699642 · Cited by 4
“counseling, pick-up reminders, and peer support (Barnighausen et al., 2011; Chaiyachati et al., 2014).”
BackgroundPrice, J. T., Mabula‐Bwalya, C. M., Freeman, B. L., Carda-Auten, J., Phiri, W. M., Chibwe, K. F., Kantumoya, P., Vwalika, B., Stringer, J. S. A., & Golin, C. E. (2020) · PLoS ONE · doi:10.1371/journal.pone.0238748 · Cited by 4
Undernutrition, Food Insecurity, and Antiretroviral Outcomes
Musumari, P. M., Techasrivichien, T., Suguimoto, S. P., Ndarabu, A., Mboyo, A., Ngasia, B., El-saaidi, C., Lukhele, B. W., Ono‐Kihara, M., & Kihara, M. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-800767-9.00012-1 · Cited by 4
Keene, C., Jennings, L., Källström-Ståhlgren, C.-O., Katz, I. T., Sabin, L., Schreuder, C., Singh, Y., Orrell, C., & Amico, K. R. (2025) · AIDS and Behavior · doi:10.1007/s10461-025-04867-9 · Cited by 3
“However, this literature was dominated by self-reported adherence outcomes, which can be unreliable [ 11 – 13 ].”
Magidson, J. F., Regenauer, K. S., Andersen, L. S., & Safren, S. A. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814932-4.00012-4 · Cited by 3
Chang, A. Y., Haber, N., Bärnighausen, T., Herbst, K., Gareta, D., Pillay, D., & Salomon, J. A. (2018) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001852 · Cited by 3
“In light of the specific findings in our study, of potential for substantial bias, we su ggest that models should either reflect the leakages and delays in the treatment cascade, w hich will reduce the estimated incremental health benefits, or assign costs that a re associated with programs that have demonstrated effe…”
BackgroundSelf-citationBenefits and Costs of the HIV/AIDS Targets for the Post-2015 Development Agenda
Geldsetzer, P., Bloom, D. E., Humair, S., & Bärnighausen, T. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108233767.017 · Cited by 3
“…that mobile phone text message reminders and other types of reminders (e.g. diary cards), directly observed therapy, treatment supporters, food supplements, and education and counseling can significantly increase ART adherence (Bärnighausen et al., 2011; Finitsis, Pellowski, and Johnson, 2014).”
BackgroundSelf-citationPhippard, T. M. (2012) · Lirias · Cited by 3
Tarkang, E. E., Manu, E., Aku, F. Y., Komesuor, J., Charles-Unadike, V. O., Khuzwayo, N., & Anaman-Torgbor, J. A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0333695 · Cited by 2
“Discontinuation of donor funding leads to financial constraints and difficulties in accessing treatment [102–104].”
Ezelote, C. J., Nwoke, E. A., Ibe, S. N., Nworuh, B. O., Chukwuocha, U. M., Udujih, O. G., Iwuoha, G. N., Okereke, C. C. A., Osuoji, J. N., Asinobi, O. G., et al. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13541-8 · Cited by 2
Correlates of missed HIV appointments in low-resource settings: a study from Uganda
Vancampfort, D., Byansi, P. K., Ward, P. B., & Mugisha, J. (2021) · African Journal of AIDS Research · doi:10.2989/16085906.2021.1895235 · Cited by 2
“However, the evidence is inconsistent and only a few studies focused on adherence in low- and middle income countries in general and in SSA in particular (Bärnighausen et al., 2011).”
BackgroundBondarchuk, C. P., Lemon, T., Medina‐Marino, A., Rousseau, E., Sindelo, S., Sibanda, N., Butler, L., Bekker, L., Earnshaw, V. A., & Katz, I. T. (2024) · BMC Public Health · doi:10.1186/s12889-024-19966-w · Cited by 5
“Although the impact of undernutrition and poor HIV clinical outcomes has been well-established [79–81], our results as well as those of a growing body of literature suggest that the benefits of improved food security may also extend to key indicators of mental health [72, 82–84].”
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HIV/acquired immunodeficiency syndrome
Vermund, S. H., & Solomon, S. (2015) · doi:10.1093/med/9780199661756.003.0213 · Cited by 2
Using the travel cost method to value visits and stigma in connection with ARV adherence in Uganda
Brent, R. J. (2016) · Applied Economics · doi:10.1080/00036846.2016.1200185 · Cited by 2
“Bärnighausen et al. (2011) report that, in SSA, it is health workers specifically trained in care for patients with HIV who are usually responsible for monitoring and support of ARV clients, with little involvement from physicians.”
BackgroundGregson, S., & Nyamukapa, C. A. (2021) · Population Studies · doi:10.1080/00324728.2021.1874043 · Cited by 2
Ketchaji, A., Fokam, J., Assah, F. K., Ateba, F. N., Wandji, M. L., Pamen, J. B., Djoko, G. R. P., Nana, C. S., Kah, E., Atangana, A. F., et al. (2025) · AIDS Research and Therapy · doi:10.1186/s12981-025-00746-4 · Cited by 1
“Of note, studies have investigated interventions to enhance adherence and viral load suppression (VLS) among adults in Cameroon [4, 5], but none have focused on ALHIV.”
Graves, E., Schacht, C. D., Gong, W., Rompaey, S. V., Alvim, M. F. S., Claquin, G., Shepherd, B. E., Green, A. F., Tique, J. A., José, E., et al. (2025) · AIDS Research and Human Retroviruses · doi:10.1177/08892229251388415 · Cited by 1
Moon, Z., Kılıç, A., Amirova, A., Campbell, L. J., Cooper, V., Bondaronek, P., Chalder, T., Chisari, C., Glendinning, E., King, K., et al. (2025) · AIDS Care · doi:10.1080/09540121.2025.2598805 · Cited by 1
“In addition, access to healthcare and other contextual differences (e.g., resources) between low-middle-income countries (LMIC) and high-income countries (HIC) impact ART adherence and treatment efficacy (Bärnighausen et al., 2011; Fauci et al., 2014; Weiser et al., 2014).”
Masa, R. D. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/q9ba-dd89 · Cited by 1
IMPACT OF TECHNOLOGY ON IMPROVING HIV AND TUBERCULOSIS HEALTH OUTCOMES AMONG AFRICAN COUNTRIES
Ibeneme, S. (2018) · Digital Commons-TMC (Texas Medical Center) · Cited by 1
Clinical Features and Management of HIV/AIDS in Adults
Meintjes, G., Bekker, L., & Wood, R. (2023) · Elsevier eBooks · doi:10.1016/b978-0-7020-7959-7.00015-4 · Cited by 1
Kadium, N. L. (2020) · AL-Kindy College Medical Journal · doi:10.47723/kcmj.v15i2.171 · Cited by 1
Является ли Интернет сберегающим здоровье фактором в России?
Kalabikhina, I. E., & Kolotusha, A. V. (2020) · Демографическое обозрение · doi:10.17323/demreview.v7i3.11641 · Cited by 1
Fagundes, P. P., dos Santos, K. G., & Maggi, C. B. (2023) · Jornal Brasileiro de Doenças Sexualmente Transmissíveis · doi:10.5327/dst-2177-8264-2023351256 · Cited by 1
“and the preparation and supply of educational materials that allow greater knowledge about this strategy(35).”
BackgroundGeldsetzer, P., Bloom, D. E., Humair, S., & Bärnighausen, T. (2015) · SSRN Electronic Journal · doi:10.2139/ssrn.2655092 · Cited by 1
“diary cards), directly observed therapy, treatment supporters, food supplements, and education and counseling can significantly increase ART adherence (Bärnighausen et al., 2011; Finitsis, Pellowski, and Johnson, 2014).”
BackgroundSelf-citationGeldsetzer, P., Chebet, J. J., Chase, R. P., Tarumbiswa, T., Maponga, C., Mandara, E., Bärnighausen, T., & McMahon, S. A. (2022) · medRxiv · doi:10.1101/2022.12.05.22283125 · Cited by 1
Self-citationGass, T. E. (2014) · LSHTM Research Online (London School of Hygiene and Tropical Medicine) · doi:10.17037/pubs.02030899
Chu, H.-C., & Ko, N. (2013) · Canadian social science · doi:10.3968/j.css.1923669720130901.1993
“Horvath, Azman, Kennedy & Rutherford, 2012 PLWH, on HAART Meta-Analysis/ I Barnighausen et al., 2011 Patients initiating ART; IDU and MSM are at risk-population Systematic Reviews/ I Lester et al., 2010 Adult Patients initiating ART RCT/II Pop Eleches et al., 2010 Adult patient who had initiated…”
BackgroundInfluencing HIV treatment success in India : do mobile phones really work?
Shet, A. (2014) · Figshare
Antiretroviral therapy requires life-long adherence – Authors' reply
Bärnighausen, T., Chaiyachati, K. H., Chimbindi, N., Haberer, J. E., & Newell, M. (2012) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(12)70202-5
Self-citationJaffer, A. (2015) · ScholarWorks (Walden University)
Antiretroviral therapy requires life-long adherence
Osterholm, M. T., Kelley, N. S., Sommer, A. H., & Belongia, E. A. (2012)
Antiretroviral Treatment in Sub-Saharan Africa
Fetene, G. T., & Mesfin, R. (2013) · Cited by 8
Amlogu, A. M. (2019) · American Journal of Biomedical Science & Research · doi:10.34297/ajbsr.2019.05.000878
Université Laval, Q., & Gagnon, M.-P. (2017) · doi:10.30846/1701134
Jennings, L., West, R. L., Halim, N., Kaiser, J. L., Gwadz, M. V., MacLeod, W., Gifford, A. L., Haberer, J. E., Orrell, C., & Sabin, L. (2024) · Figshare · doi:10.6084/m9.figshare.26587533
Self-citationLujintanon, S., Eshun‐Wilson, I., Tourneau, N. L., Beres, L. K., Schwartz, S., Baral, S., Thompson, R. R., Underwood, A., Fox, B., Geng, E. H., et al. (2026) · Implementation Science Communications · doi:10.1186/s43058-026-00896-0
“This includes activities like voluntary counseling and testing, as well as adherence counseling [39–42].”
Fox, M. P., Kane, J. C., Mngadi-Ncube, S., Zheng, A., Metz, K. L., Manganye, P., Long, L. C., Greener, R., Sardana, S. M., Allen, T., et al. (2026) · Journal of the International AIDS Society · doi:10.1002/jia2.70172
“These results are in line with systematic reviews that found interventions such as CBT, adherence reminder devices and education programmes aimed at improving suppression and retention in care have had limited impact on HIV treatment outcomes [ 6, 43–47 ].”
Kanters, S., Lawrence, D. S., McLennan, V., Orrell, C., Pinto, C., Chou, R., Popoff, E., Harrigan, S. P., Yang, L., & Ford, N. (2026) · The Lancet HIV · doi:10.1016/s2352-3018(26)00119-0
Njue, J. K., Wekesa, L., Maiyo, A. K., Mwangi, Z. M., Kagendo, D. K., & Lwembe, R. (2026) · AIDS Research and Treatment · doi:10.1155/arat/5621772
“Similarly to a cohort reported in a sub-Saharan African study [36], forgetfulness, work, and travel were associated with a missed dose among 20.1% despite high adherence (79.9%).”
Influential
Metadata
- 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
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2011-12
- Volume
- 11
- Issue
- 12
- Pages
- 942-951
- ISSN
- 1473-3099 (ISSN-L)
- 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
- 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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