Efficacy of Antiretroviral Therapy Adherence Interventions

Background: Nonadherence is one of the main barriers to achieve optimal treatment outcomes in HIV patients. This meta-analysis of antiretroviral therapy (ART) adherence intervention studies aims to better understand the efficacy of current ART adherence interventions. Methods: Medline and PsychINFO databases were searched for randomized controlled trials of ART adherence interventions between 2007 and 2010. A total of six studies were identified and included in this meta-analysis based on the inclusion criteria. Two coders independently coded each study. Both random-effects and fixed-effects analyses were used in this study. Results: Data from 957 participants were retrieved. ART adherence interventions were effective in supporting better adherence behavior in HIV patients (OR=2.27). Self-reported adherence was significantly higher than adherence measured by medication event monitoring systems (MEMS) and viral load records. Moderator analyses indicated intervention effectiveness increased with the number of intervention sessions, and decreased with the proportion of minority patients in the study sample. Previous exposure to ART did not make any difference in intervention effectiveness. Intervention intensity as measured by a behavior change technique taxonomy didn't explain intervention effectiveness. Conclusions: The findings suggest that adherence interventions do improve HIV patients' adherence to ART and their treatment outcome. Both the number of intervention sessions and proportion of minority patients in the study are important predictors for intervention effectiveness. Future studies should include adherence estimates other than self-reported data. Moreover, further investigations are needed to understand why ART interventions appear to be less effective for minority patients.