While on the subject of evidence, here is a review of high quality studies to see what works to increase ART adherence. Email hiv.information.for.myanmar@gmail.com if you want me to email you the paper.
If CD4 thresholds for treatment initiation disappear then more people who have never felt sick are going to start treatment. Adherence is going to be a challenge.
Jamie
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Interventions for Enhancing Adherence
to Antiretroviral Therapy (ART):
A Systematic Review of High Quality Studies
Lawrence Mbuagbaw, MD,1–3 Bhairavi Sivaramalingam, MD,4 Tamara Navarro,1
Nicholas Hobson,1 Arun Keepanasseril, MD,5 Nancy J Wilczynski,1
R Brian Haynes, MD,5 and the Patient Adherence Review (PAR) Team
Abstract
We sought to review the effectiveness of interventions designed to improve adherence to antiretroviral therapy
(ART) from studies included in a recent Cochrane review that reported a clinical and an adherence outcome,
with at least 80% follow-up for 6 months or more. Data were extracted independently and in duplicate, with an
adjudicator for disagreements. Risk of bias was assessed using the Cochrane Risk of Bias tool. Of 182 relevant
studies in the Cochrane review, 49 were related to ART. Statistical pooling was not warranted due to heterogeneity
in interventions, participants, treatments, adherence measures and outcomes. Many studies had high
risk of bias in elements of design and outcome ascertainment. Only 10 studies improved both adherence and
clinical outcomes. These used the following interventions: adherence counselling (two studies); a once-daily
regimen (compared to twice daily); text messaging; web-based cognitive behavioral intervention; face-to-face
multi-session intensive behavioral interventions (two studies); contingency management; modified directly
observed therapy; and nurse-delivered home visits combined with telephone calls. Patient-related adherence
interventions were the most frequently tested. Uniform adherence measures and higher quality studies of
younger populations are encouraged.
