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AIDS and Behavior
Published in: AIDS and Behavior 2/2019

Open Access 01-02-2019 | Original Paper

Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis

Authors: Najeebullah Soomro, Grace Fitzgerald, Janet Seeley, Enid Schatz, Jean B. Nachega, Joel Negin

Published in: AIDS and Behavior | Issue 2/2019

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Abstract

As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94–1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02–1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life.
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Literature
1.
UNAIDS. Global HIV statistics, fact sheet. Geneva: UNAIDS; 2017.
2.
UNAIDS. Get on the fast-track. The life-cycle approach to HIV. Finding solutions for everyone at every stage of life. Geneva: UNAIDS; 2016.
3.
Mahy M, Autenrieth CS, Stanecki K, Wynd S. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS. 2014;28(4):S453.PubMedCrossRef
4.
UNAIDS. HIV and aging: a special supplement to the UNAIDS report on the global AIDS epidemic 2013. Geneva: UNAIDS; 2013. p. 2013.
5.
6.
Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Org. 2010;88(11):847–53.PubMedCrossRefPubMedCentral
7.
Ghidei L, Simone MJ, Salow MJ, Zimmerman KM, Paquin AM, Skarf LM, et al. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging. 2013;30(10):809–19.PubMedCrossRef
8.
9.
Negin J, Gregson S, Eaton JW, Schur N, Takaruza A, Mason P, et al. Rising levels of HIV infection in older adults in Eastern Zimbabwe. PLoS ONE. 2016;11(11):e0162967.PubMedPubMedCentralCrossRef
10.
Cornell M, Johnson LF, Schomaker M, Tanser F, Maskew M, Wood R, et al. Age in antiretroviral therapy programmes in South Africa: a retrospective, multicentre, observational cohort study. Lancet HIV. 2015;2(9):e368–75.PubMedPubMedCentralCrossRef
11.
Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ (Clinical Research Ed). 2009;338:a3172.CrossRef
12.
Colleen H, Meigs JB, Colleen C, Petra R, Sarah P, Nesli B, et al. Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis. 2001;32(1):130–9.CrossRef
13.
Friis-Møller N, Weber R, Reiss P, Thiébaut R, Kirk O, Monforte AdA, et al. Cardiovascular disease risk factors in HIV patients–association with antiretroviral therapy. Results from the DAD study. AIDS. 2003;17(8):1179–93.PubMedCrossRef
14.
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.PubMedCrossRef
15.
Krumme AA, Kaigamba F, Binagwaho A, Murray MB, Rich ML, Franke MF. Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy. J Epidemiol Commun Health. 2015;69(3):284–9.CrossRef
16.
Denison JA, Packer C, Stalter RM, Banda H, Mercer S, Nyambe N, et al. Factors related to incomplete adherence to antiretroviral therapy among adolescents attending three HIV clinics in the copperbelt, Zambia. AIDS Behav. 2018;22(3):996–1005.PubMedCrossRef
17.
Denison JA, Koole O, Tsui S, Menten J, Torpey K, van Praag E, et al. Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia. AIDS. 2015;29(3):361–71.PubMedCrossRef
18.
UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
19.
Negin J, Barnighausen T, Lundgren JD, Mills EJ. Aging with HIV in Africa: the challenges of living longer. AIDS. 2012;26(Suppl 1):S1–5.PubMedCrossRef
20.
Abara WE, Adekeye OA, Xu J, Heiman HJ, Rust G. Correlates of combination antiretroviral adherence among recently diagnosed older HIV-infected adults between 50 and 64 years. AIDS Behav. 2016;20(11):2674–81.PubMedPubMedCentralCrossRef
21.
Johnson CJ, Heckman TG, Hansen NB, Kochman A, Sikkema KJ. Adherence to antiretroviral medication in older adults living with HIV/AIDS: a comparison of alternative models. AIDS Care. 2009;21(5):541–51.PubMedPubMedCentralCrossRef
22.
Poggenpoel M. Perceived basic needs and resources for the elderly in the peri-urban and rural communities in the Hhohho region in Swaziland. Curationis. 2010.
23.
Schatz E, Seeley S, Negin J, Mugisha J, editors. They “don’t cure old age”: older Ugandans’ delays to health care access. American Sociological Association Annual Meeting; 2016; Seattle, WA.
24.
High KP, Brennan-Ing M, Clifford DB, Cohen MH, Currier J, Deeks SG, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr. 2012;60(Suppl 1):S1–18.PubMedCrossRef
25.
Kuteesa MO, Seeley J, Cumming RG, Negin J. Older people living with HIV in Uganda: understanding their experience and needs. Afr J AIDS Res. 2012;11(4):295–305.PubMedCrossRef
26.
Ettenhofer ML, Hinkin CH, Castellon SA, Durvasula R, Ullman J, Lam M, et al. Aging, neurocognition, and medication adherence in HIV infection. Am J Geriatr Psychiatry. 2009;17(4):281–90.PubMedPubMedCentralCrossRef
27.
28.
Mugisha JO, Schatz E, Seeley J, Kowal P. Gender perspectives in care provision and care receipt among older people infected and affected by HIV in Uganda. Afr J AIDS Res. 2015;14(2):159–67.PubMedCrossRef
29.
Wright S, Zalwango F, Seeley J, Mugisha J, Scholten F. Despondency among HIV-positive older men and women in Uganda. J Cross Cult Gerontol. 2012;27(4):319–33.PubMedPubMedCentralCrossRef
30.
Ware NC, Idoko J, Kaaya S, Biraro IA, Wyatt MA, Agbaji O, et al. Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS Med. 2009;6(1):e1000011.PubMedCentralCrossRef
31.
Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health. 2016;1(4):e000125.PubMedPubMedCentralCrossRef
32.
Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
33.
Lassane K, Paul M, Eric C, Anne Z, Greer B, Michael JM. Self-report measures in the assessment of antiretroviral medication adherence: comparison with medication possession ratio and HIV viral load. J Int Assoc Provid AIDS Care. 2014;14(2):156–62.
34.
Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.PubMedCrossRef
35.
Raebel MA, Schmittdiel J, Karter AJ, Konieczny JL, Steiner JF. Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases. Med Care. 2013;51(803):S11–21.PubMedPubMedCentralCrossRef
36.
Brannick MT, Yang L-Q, Cafri G. Comparison of weights for meta-analysis of r and d under realistic conditions. Org Res Methods. 2011;14(4):587–607.CrossRef
37.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health. 1998;52(6):377–84.CrossRef
38.
Muya AN, Geldsetzer P, Hertzmark E, Ezeamama AE, Kawawa H, Hawkins C, et al. Predictors of nonadherence to antiretroviral therapy among HIV-infected adults in Dar es Salaam, Tanzania. J Int Assoc Provid AIDS Care. 2015;14(2):163–71.PubMedCrossRef
39.
Vinikoor MJ, Joseph J, Mwale J, Marx MA, Goma FM, Mulenga LB, et al. Age at antiretroviral therapy initiation predicts immune recovery, death, and loss to follow-up among HIV-infected adults in urban Zambia. AIDS Res Human Retrovir. 2014;30(10):949–55.CrossRef
40.
Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21(6):1074–90.PubMedCrossRef
41.
Godin G, Gagne C, Naccache H. Validation of a self-reported questionnaire assessing adherence to antiretroviral medication. 2003 Jul. Report No.: 1087-2914 (Print) 1087-2914 Contract No.: 7.
42.
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50:105–16.PubMedCrossRef
43.
Fairley CK, Permana A, Read TRH. Long-term utility of measuring adherence by self-report compared with pharmacy record in a routine clinic setting. HIV Med. 2005;6:366–9.PubMedCrossRef
44.
Chalker JC, Andualem T, Gitau LN, Ntaganira J, Obua C, Tadeg H, et al. Measuring adherence to antiretroviral treatment in resource-poor settings: the feasibility of collecting routine data for key indicators. BMC Health Serv Res. 2010;10:43.PubMedPubMedCentralCrossRef
45.
Mekuria LA, Prins JM, Yalew AW, Sprangers MAG, Nieuwkerk PT. Which adherence measure—self-report, clinician recorded or pharmacy refill—is best able to predict detectable viral load in a public ART programme without routine plasma viral load monitoring? Trop Med Int Health. 2016;21(7):856–69.PubMedCrossRef
46.
McMahon JH, Manoharan A, Wanke CA, Mammen S, Jose H, Malini T, et al. Pharmacy and self-report adherence measures to predict virological outcomes for patients on free antiretroviral therapy in Tamil Nadu, India. AIDS Behav. 2013;17(6):2253–9.PubMedPubMedCentralCrossRef
47.
Chesney MA. The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S149–55.PubMedCrossRef
48.
Shubber Z, Mills EJ, Nachega JB, Vreeman R, Freitas M, Bock P, et al. Patient-reported barriers to adherence to antiretroviral therapy: a systematic review and meta-analysis. PLoS Med. 2016;13(11):e1002183.PubMedPubMedCentralCrossRef
49.
50.
Horne M, Tierney S. What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies. Prev Med. 2012;55(4):276–84.PubMedCrossRef
51.
Al-Rashed S, Wright D, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;54(6):657–64.PubMedPubMedCentralCrossRef
52.
George J, Elliott RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging. 2008;25(4):307–24.PubMedCrossRef
53.
Darr A, Astin F, Atkin K. Causal attributions, lifestyle change, and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the United Kingdom. Heart Lung: J Acute Crit Care. 2008;37(2):91–104.CrossRef
54.
Nachega JB, Hsu AJ, Uthman OA, Spinewine A, Pham PA. Antiretroviral therapy adherence and drug–drug interactions in the aging HIV population. AIDS. 2012;26:S39–53.PubMedCrossRef
55.
Eduardo E, Lamb MR, Kandula S, Howard A, Mugisha V, Kimanga D, et al. Characteristics and Outcomes among older HIV-positive adults enrolled in HIV programs in four Sub-Saharan African Countries. PLoS ONE. 2014;9(7):e103864.PubMedPubMedCentralCrossRef
56.
Mutevedzi PC, Lessells RJ, Rodger AJ, Newell M-L. Association of age with mortality and virological and immunological response to antiretroviral therapy in rural South African adults. PLoS ONE. 2011;6(7):e21795.PubMedPubMedCentralCrossRef
57.
Fatti G, Mothibi E, Meintjes G, Grimwood A. Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa. PLoS ONE. 2014;9(6):e100273.PubMedPubMedCentralCrossRef
58.
Negin J, van Lettow M, Semba M, Martiniuk A, Chan A, Cumming RG. Anti-retroviral treatment outcomes among older adults in Zomba district, Malawi. PLoS ONE. 2011;6(10):e26546.PubMedPubMedCentralCrossRef
59.
Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16(8):2101–18.PubMedCrossRef
60.
Haberer JE, Sabin L, Amico KR, Orrell C, Galarraga O, Tsai AC, et al. Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc. 2017;20(1):1–15.
61.
Nachega JB, Adetokunboh O, Uthman OA, Knowlton AW, Altice FL, Schechter M, et al. Community-based interventions to improve and sustain antiretroviral therapy adherence, retention in HIV care and clinical outcomes in low- and middle-income countries for achieving the UNAIDS 90-90-90 targets. Curr HIV/AIDS Rep. 2016;13(5):241–55.PubMedPubMedCentralCrossRef
62.
Mills EJ, Lester R, Thorlund K, Lorenzi M, Muldoon K, Kanters S, et al. Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis. Lancet HIV. 2014;1(3):e104–11.PubMedPubMedCentralCrossRef
63.
Mathes T, Antoine S-L, Pieper D. Adherence-enhancing interventions for active antiretroviral therapy in sub-Saharan Africa: a systematic review and meta-analysis. Sex Health. 2014;11(3):230–9.PubMedCrossRef
64.
Wouters E, Masquillier C, Ponnet K, le Roux Booysen F. A peer adherence support intervention to improve the antiretroviral treatment outcomes of HIV patients in South Africa: the moderating role of family dynamics. Soc Sci Med. 2014;113:145–53.PubMedCrossRef
65.
Negin J, Rozea A, Martiniuk AL. HIV behavioural interventions targeted towards older adults: a systematic review. BMC Public Health. 2014;14(1):1.CrossRef
66.
67.
Diabate S, Alary M, Koffi CK. Determinants of adherence to highly active antiretroviral therapy among HIV-1-infected patients in Cote d’Ivoire. AIDS. 2007;21(13):1799–803.PubMedCrossRef
68.
Carlucci JG, Kamanga A, Sheneberger R, Shepherd BE, Jenkins CA, Spurrier J, et al. Predictors of adherence to antiretroviral therapy in rural Zambia. J Acquir Immune Defic Syndr. 2008;47(5):615–22.PubMedPubMedCentralCrossRef
69.
Fielding KL, Charalambous S, Stenson AL, Pemba LF, Martin DJ, Wood R, et al. Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: a cohort study. BMC Infect Dis. 2008;8:93.PubMedPubMedCentralCrossRef
70.
Birbeck GL, Chomba E, Kvalsund M, Bradbury R, Mang’ombe C, Malama K, et al. Antiretroviral adherence in rural Zambia: the first year of treatment availability. Am J Trop Med Hyg. 2009;80(4):669–74.PubMedCrossRef
71.
Pirkle CM, Boileau C, Nguyen VK, Machouf N, Ag-Aboubacrine S, Niamba PA, et al. Impact of a modified directly administered antiretroviral treatment intervention on virological outcome in HIV-infected patients treated in Burkina Faso and Mali. HIV Med. 2009;10(3):152–6.PubMedCrossRef
72.
Stubbs BA, Micek MA, Pfeiffer JT, Montoya P, Gloyd S. Treatment partners and adherence to HAART in Central Mozambique. AIDS Care. 2009;21(11):1412–9.PubMedCrossRef
73.
Jaquet A, Ekouevi DK, Bashi J, Aboubakrine M, Messou E, Maiga M, et al. Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West Africa. Addiction. 2010;105(8):1416–21.PubMedCrossRef
74.
Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838–45.PubMedCrossRef
75.
Watt MH, Maman S, Golin CE, Earp JA, Eng E, Bangdiwala SI, et al. Factors associated with self-reported adherence to antiretroviral therapy in a Tanzanian setting. AIDS Care. 2010;22(3):381–9.PubMedPubMedCentralCrossRef
76.
Chung MH, Richardson BA, Tapia K, Benki-Nugent S, Kiarie JN, Simoni JM, et al. A randomized controlled trial comparing the effects of counseling and alarm device on HAART adherence and virologic outcomes. PLoS Med. 2011;8(3):e1000422.PubMedPubMedCentralCrossRef
77.
Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Improving clinic attendance and adherence to antiretroviral therapy through a treatment supporter intervention in Uganda: a randomized controlled trial. AIDS Behav. 2011;15(8):1795–802.PubMedCrossRef
78.
Messou E, Chaix ML, Gabillard D, Minga A, Losina E, Yapo V, et al. Association between medication possession ratio, virologic failure and drug resistance in HIV-1-infected adults on antiretroviral therapy in Cote d’Ivoire. J Acquir Immune Defic Syndr. 2011;56(4):356–64.PubMedPubMedCentralCrossRef
79.
Ncaca LN, Kranzer K, Orrell C. Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa. PLoS ONE. 2011;6(8):e23088.PubMedPubMedCentralCrossRef
80.
Mbuagbaw L, Thabane L, Ongolo-Zogo P, Lester RT, Mills EJ, Smieja M, et al. The Cameroon Mobile Phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy. PLoS ONE. 2012;7(12):e46909.PubMedPubMedCentralCrossRef
81.
Annison L, Dompreh A, Adu-Sarkodie Y. The immunological response of HIV-positive patients initiating HAART at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Ghana Med J. 2013;47(4):164–70.PubMedPubMedCentral
82.
Kiwuwa-Muyingo S, Oja H, Walker A, Ilmonen P, Levin J, Mambule, et al. Dynamic logistic regression model and population attributable fraction to investigate the association between adherence, missed visits and mortality: a study of HIV-infected adults surviving the first year of ART. BMC Infect Dis. 2013;13:395.PubMedPubMedCentralCrossRef
83.
Negash T, Ehlers V. Personal factors influencing patients’ adherence to ART in Addis Ababa, Ethiopia. J Assoc Nurses in AIDS Care. 2013;24(6):530–8.CrossRef
84.
Jones D, Cook R, Spence A, Weiss SM, Chitalu N. Antiretroviral therapy in Zambia: do partners on ART enhance adherence? J Int Assoc Provid AIDS Care. 2014;13(6):497–500.PubMedCrossRef
Metadata
Title
Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis
Authors
Najeebullah Soomro
Grace Fitzgerald
Janet Seeley
Enid Schatz
Jean B. Nachega
Joel Negin
Publication date
01-02-2019
Publisher
Springer US
Published in
AIDS and Behavior / Issue 2/2019
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-018-2196-0

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