Determinants of non‐compliance with Antiretroviral Therapy among adults living with HIV/AIDS: A Systematic Review

Background Non‐compliance with Antiretroviral Therapy is a major public health concern and further challenged by interaction of various social and clinical obstacles. So; near perfect pill taking is desirable in order to maximise its benefits. Objectives To systematically search, appraise and synthesise the best available evidence on determinants of non‐compliance with Antiretroviral Therapy among adults living with HIV/AIDS and provide direction to future how to increase compliance with Antiretroviral Therapy. Inclusion criteria Types of participants The systematic review considered studies with 18 years and above year old adults living with HIV/AIDS. Focus of the review Determinants of non‐compliance with Antiretroviral Therapy among adults living with HIV/AIDS. Types of studies Quantitative study designs were considered for inclusion. Types of outcomes Socio‐economic, Health service, Psychosocial and behavioural and Clinical related outcomes. Search strategy English language articles published between January1997 and December 2011 were sought across major databases. Methodological quality Methodological quality was assessed using Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument critical appraisal tools. Data collection Data were extracted from papers included in the review by using a standardized data extraction tool. Data synthesis Meta‐ analysis was conducted using fixed and random effects model with mantel Haenszel method using Revman5 software. Heterogeneity between the studies was assessed using &khgr;2 test at a p‐value of <0.05. Summary statistics were expressed as adjusted odds ratio or adjusted risk ratio with 95% confidence intervals at a p‐value of <0.05. Results Nine studies (seven cross‐sectional, one cohort study and one case‐control study) were included in the review. Results from meta analysis showed that white race adults living with HIV/AIDS were 1.38 times more likely to non‐comply with Antiretroviral Therapy when compared with black adults living with HIV/ AIDS (Adjusted Relative Risk=1.38; 95%CI=1.21, 1.58, p value<0.00001). Non‐depressed adults living with HIV/AIDS were 1.77 times more likely to non‐comply with Antiretroviral Therapy when compared with depressed adults living with HIV/AIDS (Adjusted Odds ratio =1.77; 95%CI=1.17, 2.69, p value=0.007). Substance non‐user adults living with HIV/ AIDS were 2.04 times more likely to non‐comply with Antiretroviral Therapy when compared with substance user adults living with HIV/ AIDS (Adjusted Relative Risk =2.04; 95%CI=1.51, 2.74, p value=<0.00001). Adults living with HIV/ AIDS with baseline CD4 count ≥200cells/ml were 1.8 times more likely to non‐comply with Antiretroviral Therapy when compared with adults livings with HIV/ AIDS with baseline CD4 count ≥200cells/ml (Adjusted Odds ratio=1.84; 95%CI=1.08, 3.15, p value=0.03). Conclusion We found the base line CD4 count ≥200cells/ml, not being depressed; not using substances and being white in race were associated with non‐compliance with Antiretroviral Therapy. Implications for practice Behavioural change via counselling should be encouraged as a way to increase compliance. Reminders to take mediations regularly, on time, offering encouragement to keep going, helping to keep clinic appointments and providing emotional support for adults living with HIV/AIDS is important. Implications for research Further research utilizing more robust experimental methods would help to further explore the findings of this review.