Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

Michael L. Scanlon, Rachel C. Vreeman

Research output: Contribution to journalReview articlepeer-review

81 Scopus citations

Abstract

The rollout of antiretroviral therapy (ART) significantly reduced human immune Deficiency virus (HIV)-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world's HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a compelling case for more data to guide strategies to improve access and adherence to treatment in resource-limited settings.

Original languageEnglish (US)
Pages (from-to)1-17
Number of pages17
JournalHIV/AIDS - Research and Palliative Care
Volume5
DOIs
StatePublished - 2013

Keywords

  • Access
  • Adherence
  • Antiretroviral therapy
  • HIV
  • Resource-limited settings

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Dermatology
  • Infectious Diseases
  • Virology

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