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Cited by 818HIV/AIDS Research and InterventionsMedication Adherence and ComplianceHIV/AIDS drug development and treatment

Adherence to HAART: A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators

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Mills, Edward J, Nachega, Jean B, Bangsberg, David R, Singh, Sonal, Rachlis, Beth, Wu, Ping, Wilson, Kumanan, Buchan, Iain +2 more·2006·PLoS Medicine
DOI 10.1371/journal.pmed.0030438PMC PMC1637123
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Abstract

BACKGROUND: Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. METHODS AND FINDINGS: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. CONCLUSIONS: We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations.

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Authors
Mills, E. J., Nachega, J. B., Bangsberg, D. R., Singh, S., Rachlis, B., Wu, P., Wilson, K., Buchan, I., Gill, C. J., & Cooper, C.
Affiliations
  • University of Toronto (CA)
  • Johns Hopkins University (US)
  • San Francisco General Hospital (US)
  • University of British Columbia (CA)
  • Canadian College of Naturopathic Medicine (CA)
  • University of Manchester (GB)
  • Boston University (US)
  • University of Ottawa (CA)
Corresponding author
Mills, Edward J
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2006-11-21
Volume
3
Issue
11
Pages
e438
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.0030438
PMC
PMC1637123
OpenAlex
W2035304784
Cited by
818
References
4
Citations by year
2026: 9 · 2025: 7 · 2024: 20 · 2023: 20 · 2022: 21 · 2021: 47 · 2020: 31 · 2019: 37 · 2018: 45 · 2017: 56 · 2016: 55 · 2015: 57 · 2014: 72 · 2013: 59 · 2012: 73
FWCI
3.75
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • OpenBU (Boston University) (submittedVersion)
Funders
  • Doris Duke Charitable Foundation
  • Ontario HIV Treatment Network
  • National Institutes of Health (5k24aa015287-03)
  • U.S. Public Health Service (K23A106858201)
  • National Institute on Alcohol Abuse and Alcoholism (K-24 AA015287, AA015287)
  • National Institute of Mental Health (MH 54907, R01MH054907)
  • National Institute of Allergy and Infectious Diseases (AI27763, AI005535901, P30AI027763)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords
HAART adherence, antiretroviral therapy, HIV, barriers to adherence, facilitators of adherence, patient-reported factors, developing countries, developed countries, fear of disclosure, substance abuse, medication regimen complexity, quality of life, access to medicines, patient engagement, HIV treatment outcomes, adverse drug reactions, social support, sleepiness, self-efficacy
MeSH terms
Developing Countries, Humans, Patient Compliance, Developed Countries, Antiretroviral Therapy, Highly Active

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