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Barriers to ART adherence in minority groups in the U.S.A – A Systematic Review Of Intervention Research
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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.
Learning Areas:
Administer health education strategies, interventions and programsDiversity and culture
Implementation of health education strategies, interventions and programs
Social and behavioral sciences
Learning Objectives:
Identify interventions that have been implemented in populations of HIV positive minority groups to aid with their adherence to antiretroviral therapy.
Qualified on the content I am responsible for because: I am a graduate student in her second academic year at Nova Southeastern University. The program I am pursuing is a PhD in Social & Administrative Pharmacy with a goal of focusing on research in HIV/AIDS and minorities. I have practiced as a Pharmacist in rural and underdeveloped areas where I got a preview of the effects of minimal access to healthcare. Thus far I have concentrated all my scholarly activities on this research area.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.