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Interventions to improve medication adherence in adolescents with HIV: a systematic review and meta-analysis
  1. Sasha Alcon1,
  2. Billal Ahmed1,
  3. David Sloane1,
  4. Youn Seon Lim2,
  5. Joseph Steven Cervia3,4
  1. 1Medical School, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
  2. 2Quantitative and Mixed Methods Research Methodologies, Educational Studies, University of Cincinnati, Cincinnati, Ohio, USA
  3. 3Departments of Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
  4. 4Health Care Partners IPA & MSO, Garden City, New York, USA
  1. Correspondence to Sasha Alcon, Student, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA; salcon1{at}pride.hofstra.edu

Abstract

As of 2017, 1.8 million people living with HIV (PLWH) were adolescents between ages 10 and 19, accounting for 5% of all PLWH and 590,000 people between the ages 15 and 24 were newly infected with HIV. Between 2004 and 2011, AIDS-related deaths increased 50% among adolescents, and optimal adolescent adherence to antiretroviral treatment (ART) is estimated at only 62% of adolescents worldwide. While there have been great strides toward achieving the UNAIDS 90-90-90 goals, adolescents remain a group lacking appropriate resources and research to achieve these. This review analyzes current interventions aimed toward increasing adolescent ART adherence. Systematic searches of EMBASE, PubMed and PsycINFO were performed using the keywords ‘adolescent HIV medication adherence interventions’. The Gain Score effect size was calculated for studies reporting the Cohen’s d and variance to include both prestudy and poststudy values. A random-effects model analyzed intervention significance. Authors were contacted to obtain additional data values and study clarification. Twelve studies met inclusion criteria for meta-analysis. There were no significant differences seen between control and intervention groups in medication adherence (z=−1.4714, p<0.1412), viral load (z=−0.1946, p<0.8547) or CD4+ lymphocyte count (z=0.2650, p<0.7910). There was no significant difference between studies in increasing medication adherence. Results indicate that interventions did not improve medication adherence in adolescents with HIV. However, the paucity of quantitative research available speaks to a need for more quantitative intervention studies and standardization of measures of intervention efficacy.

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Footnotes

  • Contributors SA designed the study selection criteria and search keywords, performed the literature search, drafted the initial manuscript, performed data analysis and reviewed and revised the manuscript. BA and DS designed the study selection criteria and search keywords, performed the literature search and reviewed and revised the manuscript. YSL designed the data analysis and aided in carrying out the analysis, and reviewed and revised the manuscript. JSC conceptualized and designed the study, coordinated and supervised the process and reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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