Adherence to Antiretroviral Medications among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

December 2014 - Combination Prevention

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Feelemyer, J., Jarlais, D. D., Arasteh, K., & Uusküla, A. AIDS and Behavior (October 2014), E-publication ahead of print.

The authors of this literature review examined adherence to antiretroviral therapy (ART) in transitional-, low-, and middle-income countries (TLMIC) among people who inject drugs (PWID) and persons with a history of injection drug use. The authors conducted a systematic review of articles and conference presentations presented between 1996 and 2012 that reported adherence to ART among these groups in TLMIC. They found 15 articles from seven countries that met the inclusion criteria (including documentation of ongoing ART therapy) in a sample of current or past opiate users, and measurement of ART adherence, and follow-up data. ART adherence was associated with different methods of measuring adherence in Eastern Europe and East Asia. The review found that adherence levels reported in the articles ranged from 33 percent to 97 percent; mean weighted adherence was 72 percent. The authors noted that adherence in TLMIC remains suboptimal, and is probably well below the levels needed to achieve positive treatment outcomes for individuals and a population-level effect on HIV transmission. The authors called for more research on ART adherence among PWID in TLMIC, and recommended using standardized methods for reporting adherence to ART in this group.

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