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https://www.arca.fiocruz.br/handle/icict/1377
ADHERENCE TO ANTIRETROVIRAL THERAPY FOR HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME AMONG DRUG USERS: A SYSTEMATIC REVIEW
antiretroviral therapy
Aids
drug use
HAART
HIV
methadone maintenance therapy
psychosocial support
systematic review
Author
Affilliation
Oswaldo Cruz Foundation. Center for Scientific and Technological Information. Health Information Department. Rio de Janeiro, RJ, Brazil
Oswaldo Cruz Foundation. Sergio Arouca School of Public Health. Social Science Department. Rio de Janeiro, RJ, Brazil
University of Califórnia. School of Medicine. Department of Family and Preventive Medicine. Division of International Health and Cross Cultural Medicine. San Diego, CA, USA
Institute of Public Health Studies, Federal University of Rio de Janeiro (IESC/UFRJ), Rio de Janeiro, Brazil
Oswaldo Cruz Foundation. Sergio Arouca School of Public Health. Social Science Department. Rio de Janeiro, RJ, Brazil
University of Califórnia. School of Medicine. Department of Family and Preventive Medicine. Division of International Health and Cross Cultural Medicine. San Diego, CA, USA
Institute of Public Health Studies, Federal University of Rio de Janeiro (IESC/UFRJ), Rio de Janeiro, Brazil
Abstract
Aims Adherence to highly active antiretroviral therapy (HAART) is a key predictor of survival for human immunodeficiency
virus (HIV)-infected people. Suboptimal adherence among marginalized populations such as HIV-positive
drug users could be associated with clinical failure and the emergence of viral resistance. Objective To conduct a
systematic review of studies assessing adherence to HAART among HIV-positive drug users (DU) and identify factors
associated with non-adherence to HIV treatment. Data sources Seven electronic databases were searched for peerreviewed
papers published in English, French, Spanish or Portuguese, from 1996 to 2007. Study selection and data
abstraction Studies were excluded if they presented only qualitative data, were reviews themselves or assessed other
populations without disaggregating data on DU. Findings on adherence were extracted and summarized. Data
synthesis Forty-one studies were considered, which studied a total of 15 194 patients, the majority of whom were
HIV-positive DU (n = 11 628, 76.5%). Twenty-two studies assessed adherence using patient self-reports, eight used
pharmacy records, three used electronic monitoring [i.e. Medication Event Monitoring Systems (MEMS) caps], six
studies used a combination of patient self-report, clinical data and MEMS-caps, and two analyzed secondary data.
Overall, active substance use was associated with poor adherence, as well as depression and low social support. Higher
adherence was found in patents receiving care in structured settings (e.g. directly observed therapy) and/or drug
addiction treatment (especially substitution therapy). Conclusion While lower than other populations—especially
among users of stimulants, incarcerated DU and patients with psychiatric comorbidities—adherence to HAART
among HIV-positive DU can be achieved. Better adherence was identified among those engaged in comprehensive
services providing HIV and addiction treatment with psychosocial support.
Keywords
Adherenceantiretroviral therapy
Aids
drug use
HAART
HIV
methadone maintenance therapy
psychosocial support
systematic review
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