Comparisons of Adherence to Antiretroviral Therapy in a High-Risk Population in China: A Systematic Review and Meta-Analysis

• Published in: PloS one 2016-01, Vol.11 (1), p.e0146659-e0146659
• Main Authors: Huan, Zhou, Fuzhi, Wang, Lu, Liu, Min, Zhang, Xingzhi, Chen, Shiyang, Jin
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; AIDS; Analysis; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; China; Confidence intervals; Disease transmission; Dosage and administration; Genetic transformation; Health aspects; Health risks; Heterogeneity; HIV; HIV Infections - drug therapy; HIV patients; Human immunodeficiency virus; Humans; Medication Adherence; Meta-analysis; Patient compliance; Patients; Populations; Pregnancy; Pregnant women; Publication Bias; Regression Analysis; Regression models; Risk; Risk Factors; Statistical analysis; Systematic review; Therapy; Transformation; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0146659

Reports on antiretroviral therapy (ART) adherence are scare in China; we performed this meta-analysis to estimate ART adherence rates in different populations at high risk for HIV transmission in China. We searched PubMed, Chinese Biomedical Literature Database (Chinese), China National Knowledge Infrastructure (Chinese), and Wanfang (Chinese) to identify studies published from January 1985 to May 2015. We used random-effects meta-analysis to calculate weighted mean estimates across studies and 95% CIs. Data were pooled with proportions transformed prior to pooling using the Freeman-Tukey double arcsine transformation and then back transformed to the original scale. We calculated the I2 (and its 95% confidence intervals) and tau2 to assess between-study heterogeneity. We identified 36 eligible articles, including 6885 HIV-positive individuals, reporting ART adherence. Pooled analysis produced an estimate of 77.61% (95% CI = 71.63-83.08) of patients with HIV with adequate adherence; however, high heterogeneity was observed between studies (I2 = 96.60%, 95%CI = 96.00%-97.20%; tau2 = 0.16). Three studies, which included 149 old HIV-infected patients, reported the highest ART adequate adherence rate (89.39%, 95% CI = 72.01-99.26) with high heterogeneity between the studies (I2 = 86.20%, 95%CI = 60.00-95.20%; tau2 = 0.13). While, only two studies, which included 143 heterosexual transmission group (HTG) patients, reported the lowest ART adequate adherence rate (51.55%, 95% CI = 41.33-61.71) with low heterogeneity between the studies (I2 = 31.3%, tau2 = 0.007). In the multivariable meta-regression model, high-risk populations was the main factor explaining heterogeneity (variance explained 28.14%). ART adherence in some high-risk populations (e.g., heterosexual transmission group) is below the recommended levels for maintaining virologic suppression. It is crucial to develop comprehensive intervention strategies to promote ART adherence in high-risk populations and effectively prevent the spread of HIV/AIDS in China.