Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review

• Published in: PloS one 2018-12, Vol.13 (12), p.e0208814-e0208814
• Main Authors: Penn, Amy W, Azman, Hana, Horvath, Hacsi, Taylor, Kelly D, Hickey, Matthew D, Rajan, Jay, Negussie, Eyerusalem K, Doherty, Margaret, Rutherford, George W
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; AIDS; Analysis; Anti-Retroviral Agents - economics; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; CD4 antigen; Clinical trials; Communities; Comparators; Control methods; Delivery of Health Care; Developing Countries; Dosage and administration; Drug resistance; Drug therapy; Female; Health sciences; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - economics; HIV Infections - mortality; HIV patients; HIV-1; Human immunodeficiency virus; Humans; Income; Infections; Infectious diseases; Intervention; Low income groups; Male; Management; Medicine and Health Sciences; Mortality; Nursing; Nursing care; Nursing research; Observational studies; Observational Studies as Topic; Outcome and process assessment (Medical care); Patient care; Patients; People and Places; Pharmacists; Randomized Controlled Trials as Topic; Research and Analysis Methods; Retention; Risk Factors; Risk groups; Society; Studies; Systematic review; Therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0208814

To determine whether supportive interventions can increase retention in care for patients on antiretroviral therapy (ART) in low- and middle-income countries (LMIC). Systematic review and meta-analysis. We used Cochrane Collaboration methods. We included randomised controlled trials (RCT) and observational studies with comparators conducted in LMIC. Our principal outcomes were retention, mortality and the combined outcome of lost-to-follow-up (LTFU) or death. We identified seven studies (published in nine articles); six of the studies were from Sub-Saharan Africa. We found four types of interventions: 1) directly observed therapy plus extra support ("DOT-plus"), 2) community-based adherence support, 3) adherence clubs and 4) extra care for patients with low CD4 count. One RCT of a community-based intervention showed significantly improved retention at 12 months (RR 1.14, 95% CI 1.02 to 1.27), and three observational studies found significantly improved retention for paediatric patients followed for 12 to 36 months (RR 1.07, 95 CI 1.03 to 1.11), and for adult patients at 12 (RR 1.38, 95% CI 1.13 to 1.70) and 60 months (RR 1.07, 95% CI 1.07 to 1.08). One observational study of adherence clubs showed significantly reduced LTFU or mortality (RR 0.20, 95% CI 0.12 to 0.33). A cluster RCT of an extra-care intervention for high-risk patients also showed a significant increase in retention (RR 1.06, 95% CI 1.01 to 1.10), and an observational study of extra nursing care found a significant decrease in LTFU or mortality (RR 0.76, 95% CI 0.66 to 0.87). Supportive interventions are associated with increased ART programme retention, but evidence quality is generally low to moderate. The data from this review suggest that programmes addressing psychosocial needs can significantly help retain patients in care.