Barriers to ART adherence in minority groups in the U.S.A – A Systematic Review Of Intervention Research

Background: For benefit to be derived from antiretroviral therapy there must be strict adherence to the medication. HIV/AIDS patients belonging to minority groups generally have a greater issue of non adherence to ART than those of non-minority groups.  Efforts to evaluate relevant interventions are now increasing.

 Methods: Electronic databases were searched using combinations of the search terms   “HIV/AIDS, ART, HAART, adherence, minorities, ethnicity, intervention”. Inclusion criteria- English, human subjects, peer reviewed/scholarly articles published between 1/1/2000 and 11/30/2013 conducted in the United States.

Results: A total of 72 abstracts were reviewed after initial article extraction. Of these 45 articles were excluded because of inappropriate research question or no reporting of adherence results. In the remaining studies, interventions were either behavioral, clinical or peer based. Methods of reporting varied widely with many cases of incomplete data being presented. Means of measuring adherence were pill counts, visual scales, MEMS caps, refill rates, self-reporting. All interventions showed improved adherence rates during the study but there was an inability to sustain this.

Adherence self-efficacy had a direct effect on adherence to ART in minority patients. Recurring barriers to adherence in this population were low income and education literacy, depression, racial discrimination, lack of trust in the medical system or providers, lack of social support, complicated regimens and older age.

Conclusion: Minority HIV/AIDS patients are highly vulnerable to the mal-effects of non adherence. There is no best intervention to amend this problem, however, a combination of strategies tailored to the patient will give more reliable results.