Nav: Home

Being HIV positive and staying on antiretroviral therapy in Africa: A systematic review

January 11, 2019

An international team of researchers have carried out a review of the evidence examining what influences people who are HIV positive to go to health services and then stay on antiretroviral drugs in Africa.

In a paper published in the Journal PLOS One the team, led by LSTM's Professor Paul Garner, used advanced methods of thematic synthesis to examine over 59 studies carried out in Africa, extracting key messages from the qualitative research. Professor Garner said: "We wanted to bring together the mass of research exploring what influences people taking and continuing to take antiretroviral drugs. Much has been achieved by governments, donors, NGOs and the World Health Organization in ensuring that people have access to these life-saving treatments but our review offers - for the first time - a more comprehensive understanding of the influences to treatment seeking and adherence to help health workers design approaches to keep people on their meds."

Looking at the evidence the team identified nine themes impacting on adherence and treatment seeking which they grouped under three main headings. The first of these was the acknowledgement that people who are HIV-Positive often must navigate the challenges presented by external issues such as poverty, unpredictable life events and stigma which can influence initiating and maintaining antiretroviral therapy (ART). Secondly, the health system is generally seen as punishing and uninviting, which can drive people out of care. Thirdly, long-term engagement requires adaptation and incorporation of ART into daily life, which is a process facilitated by factors including inherent self-efficacy, social responsibilities, previous HIV-related illness and emotional, practical or financial support.

Dr Ingrid Eshun-Wilson, lead author on the paper, who carried out the work whilst based at the Centre of Evidence-Based Healthcare, Stellenbosch University said: "The mix of all these factors happen over time, so there appears to be a tipping point when patients choose to either engage or disengage from care, with HIV-positive patients potentially cycling in and out of these care states in response to fluctuations in influences over time."

The team hope that their work can contribute to the design of service delivery approaches, and informed thinking and action on the part of policy makers, providers, and society to understand what it is to be HIV-positive in Africa and how attitudes and the health service need to shift to help those with HIV lead 'normal' lives.

"Our review goes beyond presenting barriers and facilitators such as cost and distance from care, which are well known." Continued Dr Eshun-Wilson: "We describe broadly how external influences and personal motivation interact and drive ART adherence and engagement decisions and presents a model for understanding why people do what they do."
-end-


Liverpool School of Tropical Medicine

Related Hiv Articles:

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).
Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.
Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.
The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.
The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.
NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
First ever living donor HIV-to-HIV kidney transplant
For the first time, a person living with HIV has donated a kidney to a transplant recipient also living with HIV.
The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.
Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.
More HIV News and HIV Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Making Amends
What makes a true apology? What does it mean to make amends for past mistakes? This hour, TED speakers explore how repairing the wrongs of the past is the first step toward healing for the future. Guests include historian and preservationist Brent Leggs, law professor Martha Minow, librarian Dawn Wacek, and playwright V (formerly Eve Ensler).
Now Playing: Science for the People

#566 Is Your Gut Leaking?
This week we're busting the human gut wide open with Dr. Alessio Fasano from the Center for Celiac Research and Treatment at Massachusetts General Hospital. Join host Anika Hazra for our discussion separating fact from fiction on the controversial topic of leaky gut syndrome. We cover everything from what causes a leaky gut to interpreting the results of a gut microbiome test! Related links: Center for Celiac Research and Treatment website and their YouTube channel
Now Playing: Radiolab

The Flag and the Fury
How do you actually make change in the world? For 126 years, Mississippi has had the Confederate battle flag on their state flag, and they were the last state in the nation where that emblem remained "officially" flying.  A few days ago, that flag came down. A few days before that, it coming down would have seemed impossible. We dive into the story behind this de-flagging: a journey involving a clash of histories, designs, families, and even cheerleading. This show is a collaboration with OSM Audio. Kiese Laymon's memoir Heavy is here. And the Hospitality Flag webpage is here.