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

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

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.

Keywords: ART; Adherence; Africa; HIV; Older adults; Systematic review.

Conflict of interest statement

Conflict of interest

All authors declare no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Prisma flow chart of study selection process. *Where articles only included children or did not include older adults
Fig. 2
Fig. 2
Forest plot indicating pooled effect of adherence among older adults compared with younger adults
Fig. 3
Fig. 3
Forest plot indicating sub-group analysis of studies using MPR or clinician contact as adherence measure

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