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

Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART) significantly reduced huma...

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Autores principales:	Scanlon ML, Vreeman RC
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/22904f8a335a4bf692a865476dff5192
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spelling	oai:doaj.org-article:22904f8a335a4bf692a865476dff51922021-12-02T05:55:07ZCurrent strategies for improving access and adherence to antiretroviral therapies in resource-limited settings1179-1373https://doaj.org/article/22904f8a335a4bf692a865476dff51922013-01-01T00:00:00Zhttp://www.dovepress.com/current-strategies-for-improving-access-and-adherence-to-antiretrovira-a11884https://doaj.org/toc/1179-1373Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency 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&rsquo;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.Keywords: HIV, antiretroviral therapy, access, adherence, resource-limited settingsScanlon MLVreeman RCDove Medical PressarticleImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol 2013, Iss default, Pp 1-17 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607
spellingShingle	Immunologic diseases. Allergy RC581-607 Scanlon ML Vreeman RC Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
description	Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency 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&rsquo;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.Keywords: HIV, antiretroviral therapy, access, adherence, resource-limited settings
format	article
author	Scanlon ML Vreeman RC
author_facet	Scanlon ML Vreeman RC
author_sort	Scanlon ML
title	Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
title_short	Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
title_full	Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
title_fullStr	Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
title_full_unstemmed	Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
title_sort	current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/22904f8a335a4bf692a865476dff5192
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Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

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