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Abstract
Adherence to antiretroviral therapy in Africa versus North America: a meta-regression analysis
E. Mills1, J. Nachega2, I. Buchan3, J. Orbinski4, S. Singh5, B. Rachlis6, L. Thabane7, K. Wilson4, D. Bangsberg8, G. Guyatt7
Background:
Adherence to antiretroviral therapy is the most powerful predictor of survival for people living with HIV/AIDS. Authorities have assumed that adherence in Africa would be sub-optimal, which, in some circumstances, has led to restrictions in access to antiretroviral drugs.
We aimed to determine whether adherence in Africa really is suboptimal compared to North America.
Methods:
We searched 11 electronic databases, major conference abstract databases, contacted researchers, treatment and advocacy groups, and searched the Internet. We selected studies of mixed populations in both North America and Africa. We abstracted data in duplicate on study adherence outcomes, thresholds used to determine adherence and characteristics of the populations. We performed a random effects meta-analysis and examined heterogeneity using multivariate random-effects logistic regression. We performed sensitivity analyses using Bayesian methods.
Results:
We included 30 studies from North America (2 abstracts) and 22 studies (15 abstracts) from Africa. African studies represented 11 Sub-Saharan countries. All African studies were published after 2002. Of the North American studies, 70% used patient self-report to assess adherence; this was true of 82% of African. Studies used similar thresholds for measuring appropriate adherence (eg. 100%, >95%, >90%, >80%). Our pooled analysis including abstracts and full-text articles indicates that African patients have significantly greater levels of adherence: 77.1% (95% confidence interval [CI], 67.3% to 85.6%), I2=98.5%) than North American patients: 54.7% (95% CI, 48.0% to 61.3%, I2=98.6%), comparison odds ratio 2.5, 95% CI, 2.2 to 2.8, P£0.0001. We explained most heterogeneity across studies using predefined variables. The difference between continents was consistent across adherence thresholds and study quality. Bayesian analysis provided similar findings.
Conclusions:
Our findings indicate that African patients adhere more than North American patients to antiretroviral therapy. These findings should encourage provision of antiretroviral therapy in Africa and question why policymakers used assumptions to inform policy.
AIDS 2006 - XVI International AIDS Conference
Abstract no.
TUPDB03
Suggested Citation
"E.Mills, et al.
Adherence to antiretroviral therapy in Africa versus North America: a meta-regression analysis.
Poster discussion:
AIDS 2006 - XVI International AIDS Conference:
Abstract no.
TUPDB03"
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